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tv   Book Discussion on The Next Pandemic  CSPAN  June 19, 2016 9:00am-9:54am EDT

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we have to talk on a daily basis. i vehemently objected to the way he ran the senate and my goal in this current majority is to be as different in every way from harry and the way he ran the previous majority. in other words, i'm trying to do everything totally different so i do object to the way he ran the senate and i do object to this inflammatory rhetoric like calling anton greenspan a political hack, alan greenspan may be many things
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.. in the fight to contain the world's deadliest diseases. he's not the first to have done so. throughout history, humans have been fighting diseases, waging never-ending wars against violent contagions. in fact, there has never been a time when humans were not affected with microbes. during this time of the south described as the detective, our speaker aside his own brushes with infectious diseases and contagion. he worked in my workers in zaire for the first ebola crisis.
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after 9/11 he -- after 2003 he was called to quarantine big guns. these are some of the stories he crafted in the next pandemic. as an epidemic intelligence officer, a disease center at the welcome his mission for over two decades was to lead the efforts to prepare the public for the outbreaks and health emergencies. while docked there khan told with microbes will be problem, he writes that not all epidemics and pandemics are inevitable. in fact, most outbreaks can be mitigated if not prevented. the question is how end do we have enough resources to separate what diseases pose the greatest risk and what we need to do to prevent the next pandemic. please join me in a public health journey to the four
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corners of the earth by welcoming dr. khan to the carnegie council this morning. thank you so much for coming. [applause] >> thank you very much. good morning, everybody. let's put this over here. there we go. so as you heard, i expect the career of the preparedness business and usually you're ready we peered over time it became started getting ready just in time. at this point in my career we are in the real-time speaking process which is a pretty much pretty much make it up as they go along. now one of the things i've been told when to speak for an audience is put a 90s conservative joke. but as you can tell, nothing about my career starts with levity.
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but i do promise sex. lots of sex. it will be mosquito sex. so i am really delighted to have this opportunity to share a whole bunch of stories with a broader audience of what it means to be a disease detective. you hear about patience who read the papers, and the press, the movie, it better. what is the perspective of someone who's been doing it with lots of other amazing public health practitioners. also tonight if you read the paper this morning, if you read about zika or ebola. it's easy to start a discussion not about emerging infections. let's just start there. the idea of why we're always hearing abth diseases. our classical diseases, think about smallpox, you know, those
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all started hurting much around the agricultural revolution when people sort of came together because he didn't have enough people to spread disease from person to person. that is when i start my story up in texas diseases. everyone has their own story when the world starts. when the rodents that were carrying some smallpox moved into somebody's home and the virus made this jump started to cut smallpox and people. well, let me fast forward to the industrial revolution. we realize infectious diseases weren't due to my asthma's but actually due to infectious agent spread from person to person and a lot of enthusiasm that occurred around the beginning of the 20th century with the sanitation revolution, vaccines, antibiotics and people thought we are done with this whole infectious disease problem. all we have to do is put a shot in somebody's son, give him a
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couple pills and they will be all better. if that was true, we wouldn't be having this conversation right now. what is happening is even i was taken care a lot of these classical birches, we have continued the merging of facts. there's a lot of factors that drive this emerges of those diseases. some of the key factors are around microbes. collect lee i'm somebody who thinks they are smart collect ugly and they have all three of their multiple generations with a single day. humans if we are lucky and 35 years before we can swap our genetic materials. microbes, no problem at all. they sought genetic material all the time, get murder all the time. it's why you read about drug-resistant microbes because that's what they do assertive move around, find a good set of genes and say this will protect me from a set of antibiotics. the microbes evolve your humans change their behaviors.
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100 years ago i can tell you nobody had a kidney transplant. and 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 my behalf emerging infectious diseases. you should not be surprising when i talk about zika, when i talk about ebola, very quick with the animal connection comes into play. zika is that mosquitoes. with ebola, it is not, the original cause somewhere in lives and not can spread out the change of transmission. 75% of the diseases you hear about, the new emerging diseases are sore and not it. that means an animal connection. if you move people out into the environment, into the jungle, they can infect dead and not deceive has a potential done to cause person-to-person transmission as we see with
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ebola or with murders, which is battling camels. somehow contact with camels is how you see the disease. it is not a surprise when we think about emerging infections can attend a come from africa or south america or parts of southeast asia we have a lot of connections with animals. her flu is another good example, or you have people in china and other parts of southeast asia. they are very close to their birds, chicken and this great opportunity for viruses to swap their genes and eventually a team and then become global pandemics. those are the environmental condition that each of these infections and why we keep hearing about them. a special callout to climate change as one of those environmental factors that lead to emerging infections. first i want to set off an climate change is framed as either an economic issue for us
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in energy, somehow energy issues. over the last year or two we been doing a better time reframing this actually as a public-health issue of what is happening with climate currently. april was the hottest record all year, hottest year on record since 1880. people ask me, how do you know what is going on in 1880? believe it or not, if you are a farmer, it's really important to you but the temperature is. so there are excellent records about what temperature look like at least for the last 10150 years. same thing with varying temperatures. out as a captain, one of the things you'd be lobbying us what is water temperature look like. we have excellent records. if you pass through the historical document of record and also to gather information and looks at temperatures, to millions of years ago.
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april was the hottest record -- hottest year on record in the 12th hottest year in a row. this isn't a coincidence what is happening with climate. if you look at carbon dioxide, we should be about 200 parts per million, 230 parts per million preindustrial. not 400 parts per million. the thought that 2100 are going to only cap increases to 1.5 degrees is highly late. but let me tell the story from a different way. i got into the business 20 years ago almost in a have to do with where folly theater. a mosquito borne disease in africa. if you're in africa, you don't have a 401(k). you have your past. you have your goat. that is your 401(k). if a virus -- of a mosquito or virus comes around and your
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animals die, that is bad news. so it is a biblical disease. while we've recognized over the last couple of decades of studying this, besides the fact is moving out of sub-saharan africa into northern africa and the middle east is that it is actually dependent on climate on wednesday's viruses -- when this mosquito emerges any sort of have to have these great heavy dry periods followed by wet. to cause this to happen. to protect your animals in this virus also causes bad disease in humans. it causes abortions in humans. hemorrhagic fever and brain hemorrhage and politeness in humans. the farmers don't have the money to vaccinate every year. if you have some sort of tool every five to 10 years to say they vaccinated. that would benefit them.
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people have spent a lot of time trying to understand said they can help protect these farmers and protect their animals. climate change issues of understanding and what we talk about climate change, what will happen in 2100. it's really what happens today. the biggest disease caused by an arc deposits, which are ticks and mosquitoes is one disease. if you live in the northeast, if you look at where it is these factors are spreading. they have continued to spread across the united states further almost about half of the u.s. county. we see that already today. as a tropical fungus up in vancouver causing infections of human and animals, it doesn't
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belong in vancouver. it belongs in the tropics. we are getting infect good oysters from the northwest. so we all know -- and the oyster eaters here like me? you don't pay attention to all the good public-health messages about oysters. i'm an oyster. do you eat oysters and cold months? one of the reasons you eat oysters and months with our best to protect yourself from infected oysters come especially golf oysters. that shouldn't be a problem if you get your oysters from the northwestern united states, the last area because they should be nice cold waters. outbreaks are reported from oysters and cold waters. the letters are nice cold anymore. contemporary examples of today where we are already seeing climate change. the shift over from the u.s. to europe.
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sweden has this disease called very simply encephalitis. we doctors would rename stuff, we take whatever we tell us, give it back to you as a medical term and you think we are all smart. because my head hurts. oh my gosh, you're so it's hard. yeah, exactly. we know what it says in my. what we've seen in sweden is this disease has been spreading over the last couple decades and there's a lot of fact there's in addition to where we are living. climate is one of those. respiratory virus free to view up kids or grandchildren come up little kids could infect did with rac, which causes a severe little respiratory illness. usually they are paid, but not always. we see this virus seasons in europe are becoming shorter and shorter because there's less cold months. the seasons are becoming
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shorter. contemporary examples right now will make a person will make up for a summit in he plays. 128 degrees or something like that he plays an get is people will die from cold, but proportionately more will die from heat. when we think about heart and lung disease from all the air pollution and obvious we are the infectious disease. anything that has to do with mosquitoes and ticks and where things are. climate plays a big role in the foodborne illnesses, waterborne illnesses that are an issue as we get flooding. obviously severe storms the mental health. a quick shout out to climate change is one of the factors to keep in mind is about emerging infections. the biggest factor about all of these what is happening to the microbes ms of the environment is more political social environment. if you look at outbreaks, these
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diseases will continue to emerge as i hope i've convinced you over the last five to 10 minutes. i think we play a role in keeping them from becoming academic. a good example would be the recent outbreak of ebola in west africa. we've known about the science of ebola since 1976. i had the opportunity in the mid-1990s when i didn't ebola outbreak. so what happens? usually at that. if you are out in the bush, you die. 85% to 95% of people die. unfortunately family member or two will die with you. you are out in the middle of the bush, you're done. the sea change the dynamic and decide to go seek health care in hospital. unfortunately in the hospital
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that doesn't have infection control. when you are infected with ebola, you essentially become a virus factory. if your immune system doesn't kick in, you are increasing the amount of virus to produce every minute until you die. when you have the most possible by reason your body? when you die. as you go to the hospital because you are sick. you don't have more than when you die. i can give you a ton of thoughts of the numbers mean hundreds of millions or billions that happened to be in the middle of your blood. so here you are sick, dying in a hospital in somebody doesn't wash their hands as they go from patient to patient. what is going to happen? spreading the ball and appeared hospitals have always served and we've known for many years as a reservoir for how to use as a spread within their community. somebody sick at home with a family member taking care of them, you are risk.
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they die, unfortunately and then you decide to wash the body, kiss the body, hugs the body, that the loved ones. one of the practices as they would watch the body needs the water to love kids and other people to wash their hands to take on the attributes of the sainted person who has just died. this is not a good idea. let's admit that. but that's the science. we know the science. but the sciences and the issue. when this outbreak occurred 24th, 25th we've seen since 1976. many people thought this was like what we've seen happening in south africa. he shut them within a couple days with a system in place. they don't even need international teams anymore. the locals know exactly what to do.
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the russian can attest everybody, followed everybody has potentially sick. the outbreak occurred in west africa where it never occurred before. it very quickly spread to urban areas. large metropolitan in urban areas with slums and the thinking was. take care of everything and this will go away. what happened? that's not what happened. 11,000 deaths, it each and every one was for me the path i would say. an inadequate response. the biggest role in sounds about -- what we had was an academic across west africa. including on this that we know
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what happened here in the united states. one of the reasons we had the case in the united states is another actor, social political fact is that plays into infectious diseases that we didn't have in the 1800s. how many people -- en masse because it will be yes, have read around the world in 80 days. how quaint, 80 days to get around the world. for 22 years i worked public health uniform and i'm a public health uniform was an anchor. the public uniform looks very much like a navy uniform and the reason that looks like it may be uniform as he started 200 years ago providing care to marines. one of the chores of the health service, which we have right now was essentially a quarantine flags on a ship came into port. if it's going to take you 80 days to go from point a to point b., by the time he showed up in
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the port of new york city, we knew if you had pol pot's beard we knew if you have yellow fever because incubation period, the time it takes to get infect it, to manifest your system was always shorter the time ago from point a to point b. we turned that upside down. you could now go to your mother's funeral in liberia. you fly to liberia, coach your mother's funeral, engage in the usual acts that you would around a funeral. kissing her, hugging her. the next day you get on a plane of pure amsterdam to new york city. we've got 18, 24 hours, maybe 48 hours incubation period of five to seven days. three days after show back in new york before other side new staff got a headache and a fever and i'm not feeling well. a good hospital number one diagnosis will be malaria.
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one, two and three. if not malaria and the no-space, it's easy to say how you get hospitalized for something a spread disease within the community. we saw this happen in texas did exact same scenario. infected to local nurses. i spent a lot of time and place is across the world to let you know that our health care system is not better than what you see in toronto, what you saw in singapore when they had their sars outbreak or hong kong. i just spent some time in seoul. solheim outbreak due to a sars relative. excellent health care system like ours, but they are not ready for these patients coming in with high hazard viruses. travel has played a big role in how these diseases emerge currently. so i think it started giving you
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a sense of why you always hear about this, but what we can do to make things better on the social, political aspects of protecting people. i did want to spend a couple minutes to talk about the carnegie council ethics matters. this observation, which i guess i've recognized my whole life. if you think about hiv in who gets infected with hiv, it often marginalized operations. as i started to write the book, a sort of dawned on me how almost every chapter you could pull out the marginalized population that would freeze the risk for emerging effects. this is a disease that is due to rodents, often occurs in the southwestern united states and the most likely people to get infected with the original outbreak was against native americans. some of you will remember when the outbreak occurred in the early 90s, there was this group of young navajo code who came to d.c. and they were
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denied because you happen to come from the southwest. there is nothing in anything we needed to assess these kids wordpress and they were. often these diseases affect marginalized populations and helps increase some of the prejudice against those marginalized populations. i've heard he talked about hiv. i've talked a little bit about ebola and the marginalized populations in west africa. today's day and age we are talking about zika. therefore pregnant women in brazil. brazil has 1.1 million cases i think is what they are calculating now and over 1500 women have been dead and their babies have gotten congenital zika syndrome or they get small brains, other developmental
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disabilities including. maassen vision problem. what we've heard now is zika is essentially a laserguided neuron. it looks very ignorant elephant kills your neuron cells. it is not just true in babies. when zika was first described, what we were told was the act, 20% of people will get sick. but get a fever, headache, itchy, red eyes. very quickly it became clear this is a problem for pregnant women. even for adults because of this laser like focus on the ronald cells, we have this disease, a neurologic illness that causes weakness. we know even in a healthy person, zika can cause brain inflammation and information of the coverings around your brain.
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even what we should think otherwise were not pregnant, this virus is a problem. this virus shouldn't be a problem. the virus is spread by something called 80s eject icon a certain type of mosquito. the mosquito is not new to us. the exact same mosquito that spreads yellow fever, that causes about 30,000 deaths a year. the exact same mosquito if we were having this conversation about five years ago, we would be talking about this large outbreak occurred in south america. i think about 30,000 deaths a year. something around that. the same exact mosquito that causes chicken to nearby race here there was a big thing in the news two, three years ago. that didn't mean to cause any deaths. because of the failure since the 70s to keep up with the staffers to decrease mosquitoes
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and kill mosquitoes and not paying attention to people died of yellow fever, now all of a sudden we are all up in arms that we have a disease due to the 80s eject i do seems to be infect in pregnant women. the last 40, series against the known threat that is put us in this current position. at least if you have to be in south america these days. zika has not moved throughout the americas, so it's essentially knocking on the door of africa to say hi, i am mixed. your next good think about what's going to happen once the virus sweeps through in the risk to pregnant women there in africa. father chan, the head of who, brilliant woman who's done amazing work in her time in hong kong has admitted a major policy
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failure over the last 40 years in addressing this mosquito. also, she brought in to talk about nature policy failure is to talk about protect the women and contraceptive rights because there is a big issue in brazil and other places where they don't have the same contraceptive rights as you take for granted in the united states and other parts of the western world. why did it take all this time, people dying of yellow fever to all of a sudden say we need to pay attention because now we may get some cases in europe and north america of women who may have this disease. we will see zika in the united states. i will print a question. hopefully we will not see a whole lot of cases, but we will likely see it. thank you. a lovely comment the other day. the ethics of the delayed response goes back to some of what you talked about here.
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if you think about this marginalized populations, why do we see these delayed responses? the stories the last couple of days is this conversation, probably better turns between let's protect the united states against zika. no one can decide whether they want to do it and how much they want to pay for it. should it be 500 million that congress wants to give, the 1.9 in the 1.1 the senate went to get some version. i don't care what it is. pick a number. we know what's going to happen. we also know that mosquito control in the united states is not the federal function. it is a city and county and district function and unique to get the money out to these people so they can be doing what they should be doing, which is eliminating mosquitoes and make sure they identify cases.
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do you have the money to think about a long-term strategy here to protect pregnant women. why are we still having this conversation six months later? why are we sort of robbing peter to pay paul so my old program at cdc was responsible for essentially keeping americans safe from all public health threat no matter what their nature, if those pandemics, natural disasters and the biological chemical terrorism. my passion was for the public health preparedness program to put money out. we essentially pulled back some of that money for the direct to video with a birdie at 1100 cases. why are you taking my analogy.
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so this is our preparedness infrastructure, why are we taking money out of that to do something like zika? we should be putting money in. what i will leave you with is a number because i'm all about the observable measures. 6.7. in the last three years, the foundation has been doing some great work looking at how prepared the united states is for public health emergencies. every year gets a little bit better. we started at 6.3, but 6.7 out of 10. that is just not good enough for us if we really want to make sure americans are protect it. srs and turn, the responsibility of government is to protect us against threats and that includes public health threats. i'm old enough not to realize you can't completely stripped politics out of policy decisions and it's not always about the science, but maybe sometimes we need to be stripping a little more politics than thinking
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about what are the health needs of our population. thank you. [applause] >> l. is fascinating. you seem so calm. what keeps you up at night? >> i think i'm calling because i decided 20 years ago that fear is not the public health strategy. i know it makes for great price, you know, the sky is falling. there really is it is about education and good science. what keeps me up at night is that the next pandemic is likely going to be. zika is a pandemic, needless to say, but it's not causing hundreds of thousands of deaths. what is likely to cause hundreds of thousands of deaths in the future as flu. we are to know that from 1918. so we get flu every year. i would play right now my public health message of the day is get vaccinated. we get flu every year that
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changes a little bit, which is why we need a new vaccine every year. unpredictably, flu takes off his overcoat and all the sunday of no protection against it at all. if we repeat the same thing we saw in 1918 today, 7.5 million americans would die. 2.5%. think about the number of body bags, how this would completely disrupt our society within a couple weeks to months until 7.5 million americans. the flu keeps me up at night. murders and diseases like murders keeping up at night. i've seen this health systems. we are getting better at our responding. part of my job at brassica national ebola training center was to help the hospitals get better. we know the risk of infections in the united states. a third example i will stop at the third example is the next hiv/aids.
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hiv/aids, nowadays you think of it in terms of behaviors or iv drug abuse. but let's remember hiv/aids is one of the zoonotic diseases. they came from nonhuman primates probably multiple times in one time it was the right version that made its way to humans and spread from human to human. i worry that another virus like that the spreads through transmission with a long incubation period before you get sick by the time you discover it is fair to spread widely. those are the things that keep me up at night about what the next pandemic would be that would have really significant brutality. >> well, thank you petabytes open the floor to discussion. when i call you, please introduce yourself. >> susan kittles. alice to a fascinating. especially in the morning. we have to be concerned about what can be done.
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you are the most experienced person. the question of first love, what is the cdc doing to educate people and control the diseases as soon as there is an indication they might be serious? on the other hand, you are now a nebraska. what is the difference between control measures in an agricultural state the relatively small population than washington or new york, the large urban areas? how can the u.s. do more to prevent these outbreaks? >> thank you very much. that is an excellent question. how we can do more starts for me at multiple levels. you always tell people they are more powerful than they think they really are. so let's start with something very simple. helpful or acquired infections in drug-resistant microbes.
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the paper came out last week that suggested one third of all the antibiotics we are using are unnecessary. one third of all the antibiotics we are using are unnecessary. as a patient when you go when it's not your patient, talk to your doctor, you are powerful to say do i really need this antibiotic or is it something we can work out a couple days and if it doesn't get better i should take an antibiotic. you have that power any doctor or or nurse or respiratory technician walks in to say did you remember to wash your hands? you are powerful. do not forget that. you have the power within your community when you think about personal preparedness. it's a pandemic register your community or natural disaster, are you prepared personally for that? not just in terms of having a kid in your home and be ready, but are your vaccines up-to-date? how many people in today's cell
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phone ages no physical phone number? the one number for us to memorize is my wife's number. somebody has to remember, thought the cell phones could telephone, not so good in terms of numbers. i'm a part of a response within the community? have i taken a cpr course so something bad happens i don't need to call 9-1-1. i can take care of something small myself. my blood donor? all the things we can do and things we should expect from our government and that is where we're powerful. it's about a new city we decided let's lay off half the police force. my guess is you will tar and feather that they are because you think public safety is so important. but the same thing is happening invisibly to your public health safety workforce here in the united states which is not always.
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nobody's target that to anybody when you get a score of 6.7 and how prepared your community is or how prepared your date is. to demand this same thing from your representatives and national representatives is one a little bit less politics. why is there still 30 million from a 20-point expenditure at american unit is right now given the fact we pass the affordable care. 19 states have not passed medicaid expansion. you are powerful you need to expect more and ask for more at every level including your own level. when i was at cbc i did a talk in cheek thing about the zombie apocalypse to get people to be prepared for natural disasters can somehow they weren't paying attention but you mention zombies and everybody wants to do hunter know what to do for zombies. don't ask me. we took a popular meme and converted it. one of the things i did use it
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for. the one thing you can do without from them. so make sure you stay personally healthy so you cannot run zombies. again, something you can personally do. that changes whether i happen to be a nebraska agricultural state or washington d.c. with greater risk of importation of diseases from international travel. the local public health entity needs to take the appropriate things into account including for climate change. we are not coastal. what if an application going to be for flooded water supplies and stuff like that? thank you. >> maker nick, long island coming university. long time, better new science reader. i remember an opinion piece of years ago to the effect that if only this spring's publication had been delayed for three
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years, and ended ddt use had continued another two or three years, we wouldn't have malaria. he stressed was ego control. i was wondering what your take on that thesis is. >> so we need to use every tool available to us when we think about mosquito control. we were fortunate here in the united state. cdc is one of the only federal agencies outside of washington v. it took me a while to figure out why that is. the reason is malaria. malaria stood in the southwestern united states. what was happening after sending troops to be trained in the south and they were getting infected with malaria. so this program is set up in that program became cdc and malaria was very quick eradicated in 1945-46.
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so we see amd on the texas border to the mosquitoes. we don't see it in the night stays. it is due to screens and air conditioning, one of the reasons that will protect us against the guy. when we think about what does it take to protect us, we need to use every tool available. for mosquitoes it's about killing baby mosquitoes. it's about killing adult escaped us which caught in fact decides. then it's about source reduction, which means total sources of water out there. we need to be thinking about every tool available to us including that way with a rifle for the right area and what are they not resistant to you? >> and christian. i thank you for the
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presentation. dr. khan, as you know, a number of societies have had against animal proteins. the city grew up then, beef and pork were forbidden. you made the connection that there's a lot of connection between these kinds of viruses that come from animals. i wonder for new studies have been done to show that societies for the consumption of animal protein is limited or not at all, the ability to resist some of these illnesses, the ability to take a connection between our consumption than the likelihood of our continued ability with the deep consequences. i wonder if you can comment on this very >> that's an excellent and extremely complex question. when they break it down into these two quick pieces. one is we know the people who other predominantly vegetarian
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diet live longer and do better. that is pretty much well-established at this point and i make it to this beef and animal consumption. the somatic infection has to do more at the close contact we have with animals, not necessarily their consumption. if you think about it, i say this all the time because i get challenged about that because i don't eat pork. if you heat it to the right temperature, there is no risk. so the risk comes not from the consumption because all you have to do is keep the right temperature. the risk comes from the daily interaction you have with these animals touching them. routine set of interactions here to do enough in them, keeping them in your house this. that risk is there. while coach chicken burger affiliate chicken isn't going to kill you. handling these chickens that had chicken flu will potentially kill you.
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[inaudible] >> island not confirm cornell medical college. i appreciate the clarity of your presentation unimpressive work you are doing. one of the things that came to mind was a delay in identification and response to ebola. my question really is what does the cdc to to try to increase collaboration with countries, health department in countries around the world to begin to do something about early identification and response. and then, something may be about the world health organization in terms of weather plays a part in this area. >> that's a great question that links back to the earlier question about what can you do. the u.s. government has embraced something called the global health security agenda and so
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should we. that is a way for us to work internationally to make sure they have the right tools and systems in place for the early diagnosis. you want to find a first set of cases. and other countries has gone into who. cdc is a technical agency that does this work is cdc has people all over the world. cdc has a global mandate to do this. they are the world help the nation did. they have recognized the failures of ebola and what happened, especially not just a failure from the early detection, but it's a nine-month until they've called it an international public health events of international concern because they say this is a problem in the spring of 24 and they misread to think that things are getting better. they were the midst of a
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complete reform process right now to be able to better respond to these emerging infections, including for the first time in the international health regulations, if they are ready. the world bank is setting up a new brand -- a brand-new pandemic response fund. i have a story in my boat from a good friend of mine who was asked to come to sierra leone. he had no resources to do so. he just wanted a handful of cars and the dollars to do some work and i was in already sent the resource. and somebody can get their hands on a couple hundred thousand dollars.
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>> and hollander said that the club of new york city. one of my client has the city sent out mosquito inspections. new york city is looking for mosquitoes. you mention the political aspect of the house situation. we have two candidates that are diametrically opposed on a number of health issues from a care or marcher and scare for people and also on the issue of women's reproductive rights, which are in my opinion are all peoples rights. everything that happens to a family happens to everybody in the family. could you comment a little bit on that and how this issue can be brought up in a way that affects the political outcome? >> you know when the health person and not the politics or sin, right? i open the door.
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i looked for the expertise. mosquitoes in new york. i went to med school down there before. we have never gone to the city because why would she go to the city? everything he wanted in brooklyn. so i know a little bit about the city from having grown up you. so you are very fortunate in having some of the best public health fissures in the world here. i will do a shout out to mercy ladin. in 1999, west nile started where? right here. you know not. west nile is another good example. it belongs in the west nile. it doesn't belong in new york. another example of the disease example of a deceased hamas became a decided america was home. we need as individuals have to
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make choices about who we elected who is the port and the offense we write, to find people who say that health is an important factor. you're much more eloquent than i could ever be about reproductive rights. it is not just pregnant women and we need to make sure women have their appropriate reproductive rights. we talk about brazil, but let's not forget the united states. there's a lot of things going on across the united states who need to make sure women have a full set of rights. >> ron behrmann. i want to ask a question about a developing global problem and also potential developing response to that problem. the problem of course is refugees and i will just leave it at that. as far as the global responses concerned, i think one of the things that has been overlooked has been the role of pharma and
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the lack of incentives in the pharmaceutical biz is for responding to these kinds of emergent these and to make a really wild suggestion that perhaps it is time for farmers to close to be considered pretty much as a public utility, a public good like the military, like the water system and like all the other things we have that we take for red and then are not incentivized by profit. >> thank you. i assumed the refugees was an issue to infectious disease issues. my comment to that as i know people often frame it in terms of what risk do i have because of refugees? the refrain that in terms of how i make sure i don't want them
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getting measles. measles is an horrific disease. what are we doing to help make sure the refugees have protected themselves? how do we make sure they are protected in any screening processes to make sure these people are dead. so people have recognized this problem for a very long time. offering some of the stories they tell about and tracks. there is zero incentive for anybody to build a medical countermeasure against anthrax due to bioterrorism and smallpox to something else i worked on. the u.s. government established the biological advance resource agency with a specific person in the department of health and human services to make sure somebody understood how to work with big pharma and make sure we have the excellent products that are now available to us against them like anthrax. we have enough smallpox vaccine if somebody decides to re-engineers catastrophe make it
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in the lab. we do have some ends that are available to us. it's a challenge. trevor cistern intimate groups. i do make sure you continue to have new drugs available to just get smarter and harder all the time. >> thank you. >> you have addressed the biological threat issue. i was going to ask you about that. i would like to thank you for an exciting journey took us on. [applause] [inaudible conversations]
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[inaudible conversations] >> nonbook debut on to int

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