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tv   Pandemic Biosecurity Policy Summit - Part 2  CSPAN  May 31, 2019 3:09pm-5:08pm EDT

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place to go gamble. well, that's been basically drying up for the last 25 years. right? we still have this reputation. and so having tesla come to town and build basically the world's largest factory, the giga factory, that changes the narrative. the story is now not reno, a dying casino town. but reno, a town that's reinventing itself as to something new. >> yes. >> watch the c-span cities tour of reno, nevada, this saturday, at noon eastern on c-span 2's book tv and sunday at 2:00 p.m. on american history tv on c-span3. working with our cable affiliates as we explore the american story. coming up, a look at the recent ebola outbreak in the democratic republic of congo. we'll hear from officials from the cdc and the world health organization, who are part of this pandemic and biosecurity forum.
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all right. howdy! hi. have everybody sit down, and we're going to go ahead and resume. i want to introduce quickly our panel speakers for panel two. and this really, again, represents more of an institutional leadership and innovation panel. we have -- we're very honored to have dr. ann schuchat, principle director for the center for disease control and prevention. and dr. daniel salman, professor of international health for vaccine safety at the bloomberg school of public health, johns hopkins university. dr. mauricio bar biscay, he has
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gone above and beyond the call of duty as he has flown in from australia through los angeles and took the red eye to be here this afternoon. so, yeah, he has come really above and beyond the call of duty. and then our final panelist is dr. irene koch, acting assistant administrator for global health, united states agency for international development. so we're going to have a similar format of our last panel. and i would also maybe encourage the panelists if they feel the urge to ask one of their co panelists a question that -- just interrupt me and do it. and if i ask the wrong question, as david said, in the last panel, just restate the question you would rather answer and go for it. and i think we are way behind, so we will probably go to audience q & a much quicker. because a lot of things we have talked about, i know they would like to say, some things have already been said. so we want to make sure we give
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you an opportunity to ask some questions of this esteemed panel. so i want to start first with dr. schuchat. and everybody knows really, i think, the public cdc, and you are our nation's public health authorities. and so we're pretty much familiar with the cdc. if you want to, you know, kind of restate some of that -- the mission and approach and talk about the great things that the cdc colleagues are doing and many are friends of mine, that's great. but maybe one way to do that is maybe you can tell us what did he learn from past outbreaks, and even a pandemic that i know you were in the middle of that in 2009. and other outbreaks we can apply as listens observed for future lessons learned for future outbreaks. >> it's a pleasure to be here and appreciate folks who stuck throughout the afternoon. it is just ten years since the
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h1n1 influenza pandemic struck. and we have learned a lot from that, and in some ways are a lot better off and in some ways there's a lot more to do. i think key -- a key lesson there was the value of everyday systems. i think sometimes we want to have, you know, a fire department for fires and then a whole different fire department for, you know, bio terrorist events, perhaps. but i think the work that we do year in and year out with seasonal flu helped us with the h1n1 pandemic. and our efforts since then to strengthen pandemic preparedness have helped us with seasonal flu. so whether it's the surveillance work, the laboratory work, the communication work, the partnerships, the trusted relationships with public and private sector, u.s. and global relationships, exercising every day instead of waiting for the big one, we -- i think that's a critical theme. in terms of the -- you know, learning from the west africa
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ebola epidemic, as you heard, you know, it's not enough to come in when there is an emergency. the three countries that were affected, the weakest public health systems was about making sure every country could find, stop and prevent epidemic. and that the world could surge when needed. so i think what we learned from that is that we don't want to just come to drc when they're in the middle of an ebola problem, but be working side by side with them to strengthen their systems. we focused on the public health systems. the doctor mentioned the primary care systems. but we use the emergency operation systems to address, you know, trying to eliminate mother to child transmission of hiv. we use them for yellow fever or for other conditions. we try to use the laboratory networks on the work force capacity for the problems of the day. so i think the cdc, we've got activities in 57 countries right
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now. very much focused on critical government priorities, like pepfar or president's malaria initiative, but very much about global health security and strengthening everybody's capacity to deal with the priorities they have. >> thank you, ann. and actually, i would like to -- ask dr. koch from u.s. aid. i know the person who was sitting in your seat at u.s. aid recently traveled maybe over a month now to drc with dr. redfeld and probably came back with some interesting observations that have impact for both u.s. aid, cdc and other government agencies. can you share some of the experiences and observations that you're thinking about at u.s. aid and perhaps how that integrates with -- and dr. sh
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shou schuchat may jump back in, to provide support. >> i echo the appreciation for the chance to be on this panel and be with you all here today. u.s. aid's role, we are the development agency for the u.s. government. so we do work and health is one of the areas we work in, and a number of other areas critical to building capacity of countries. as our administrator talks about, our role is to work ourselves out of a job. and that is to build countries' capacity to do all of the things they need to do, whether it be in health, economic growth, governance, et cetera. so in health, we do work across the board. work are really closely with our colleagues at cdc in a number of areas. and do have a number of -- a lot of programs active in dr congo. as the investor said in the last panel, one of the big issues with this outbreak, it is in the middle of a war. a war that's been under way for a lot -- a long time. so it becomes extraordinarily difficult to do the kinds of
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ongoing programs that you would be doing in that situation. so dr. golden, who was my predecessor in the current job i'm in now, was there in march, i think, with dr. redfield, and actually just last week, tim siemer, now acting assistant administrator for the humanitarian assistant's work we do, was also there, working with the current ambassador in the communities affected. and what's really clear is the kind of complex emergency that's under way in eastern congo is absolutely getting in the way of the kinds of interventions that we would want to do that ultimately worked in west africa the west africa ebola epidemic as you heard, it's not enough to come in when there's an emergency.
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community, what does the community need and what do they want in order to really bring some of the interventions we need around the ebola response but recognizing as talked about in the last panel it's not just ebola that's the issue faced there. people are dying of malaria, of tuberculosis, women are dying in childbirth. there's a lot of issues on the ground. there's lots of fear and distrust of everyone coming in so trying to engage very, very actively with local community groups, local ngos, the faith-based, church and other organizations that are active there to try to reach the community on a much broader scale than around infection prevention control as well as the vaccine. so it really does need to be more holistic. i think that's certainly the impressions my colleagues have come away from from visiting there. >> dr. barbeschi, i would like to turn to you if i could. you are heading up the health and security interface at the
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world health organization. i suspect many are not familiar with the health and security interface so maybe the first if you could give us an overview of the health and security interface and, in fact, how that supports the pandemic, public health preparedness and, with cdc and usaid. >> thank you, jerry, and thank you all. for bearing with us this afternoon. it is a result of a failure for the international system to have a definition on health security. what the strategy has been shown today global security for the u.s. may not be the same definition or understanding of the security receiving treatment or health in our part of the world. there is a dialogue issue for a doctor.
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most of you, intelligence, surveillance, interview, investigate may mean certain things from law enforcement means different things and mixing civilians and surveillance may not be the smart thing to do. there has been intervention where health was central where this understanding was put on the front page. for instance, i led the team of w.h.o. in syria when sarin killed almost 1,500 people during 2013. that would imply certain political and security responsibilities in helping the u.n. in making the case which kind of people, which kind of patients sample, how to handle the sample and so on. a similar thing when there was
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use of chemical weapons during the mosul campaign where not only the epidemiology, how to get people the proper care but how to preserve the fear -- how to maintain the fear of the health workers of the u.n. running the camps, running the refugees to drop and run. also when you have a normal outbreak, the colleague asked the question in nigeria without involving the day one when i landed in nigeria together with david we asked support from the local police. otherwise we would have never go out. if you know the traffic, it is impossible to move and have one contact traced a day without a police escort. now, of course, we have to ask which neighborhood to go with the police and which neighborhood not to go with the police.
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similar problem of drc. we elucidated eloquently before. so in essence, we interface we facilitate over 50. in the w.h.o. to exploit the opportunity that are increasing the narrative. for the relevance of the w.h.o. it is not just funding. if you have a normal response and reply to the pandemic you cannot do public health without roadblock, fire brigade, people bringing food to the quarantine. we should start humbly to recognize that we are just a clock. when you cross the border into uganda or in countries like in
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2013. three different languages, three different health systems, the same tribe which wasn't very friendly with each of the governments. so going back to the dialogue on health security, what w.h.o. contributes is to have those messages across many countries. if there is an event which is deliberate or suspected, which country country or which vaccinating are going to be listened to? the loudest, the stronger. so the reference for the lack of -- we heard this morning during the day for this type of platform. >> dr. salmon, i want to inject a new but very related topic into this conversation.
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and would like to ask you how you see the role of vaccine safety and hesitancy and how that may impact response when a vaccine will be essential. >> thank you. thank you for the opportunity to speak to everyone today. it's been an interesting day, so the bar is high for us. it's a great question. my experience with h1n1, and i'm speaking as an academic now. at the time i was responsible for overseeing and coordinating the vaccine safety monitoring program at the national vaccine program office and i think dr. schuchat's point about the value of routine influenza control efforts are really important because what we had to work with is what we had at the time and i'm reminded what secretary of
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defense donald rumsfeld said about when you go to war, you do so with the army you want -- the army you have not the army you want. and that's just the realities on the ground. when you look at things like vaccine safety, for example, vaccines we use routinely are very safe and that's fortunate and flu vaccines are very, very safe. there's always the possibility of something you don't expect as was the case in 1976 with the swine flu affair. you have to always look for that. if you have a vaccine where you have less experience, the potential for a real safety problem to occur may be greater. but you have a problem that if you vaccinate everyone today, every bad thing that happens tomorrow happened within a day of vaccination. and that's a problem domestically and in parts of the world where more bad things happen every day. people will naturally assume
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this relationship is a causal relationship. oh, look at all these people that got the vaccine and then something happened. we need science to separate the coincidental from the true, adverse reaction and it's not -- science takes time. the more infrastructure you have, the better, the faster you can respond with good science and that needs to largely exist before there's an emergency because we don't have time to go, oh, now we need to put this together. and one aspect of this that's really important which is in the report that's been shared is that of trust and trust specifically in public health authorities. and this is very complicated. what makes people trust public health? it's probably a whole bunch of things to transparency and equity and a lot of different pieces make up trust though we don't understand it well. we don't even know how to measure it very well. and we need to do that. that's a cornerstone of public
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health, you measure it, you improve it and we need people's trust. we need their confidence. we need their confidence in our public health measures that the benefits outweigh the risks, that we're doing the right thing. at the end of the day we need their compliance. >> you brought up that relationship though there's not a cause and effect relationship. or we hope it's not. and the trust issue. we seem to be in a state right now where the public has some distrust of public figures. and even public health. how do we rebuild that? how do we go about -- making -- you know, we need to address legitimate concerns. we all as parents have legitimate concerns. how do we rebuild the trust and develop effective education and communication system and who is the messenger? >> those are great questions.
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we're at a point when trust in government is at an all-time low. we're in a world of alternative facts. we're in a world of alternative facts where somehow something can be said and within a short amount of time half of the population questions the birthplace of our president. the problems are complex and the solutions are also going to be complex. i think we need to make sure we have rigorous, objective science. i think it needs to be rapid. if you take the autism example, it took longer than it should have to have good data. we have good data. we have 16 well conducted studies done throughout the world showing vaccines are not associated with autism, but in the time from when that paper was published to when the science became available, you had a charismatic, well credentialed person traveling the world creating fiction. so i think rapid is important. objective, rigorous.
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we need a spokesperson who is really trusted and we need to address it that way. >> maurizio, you're itching to say something. >> even in the united states, in certain countries or certain areas you probably listen to tom brady more than the local ministers of health, there are countries where the politician on the stage will go directly in the other direction. so the messenger issue which has been researched but not that well yet in these -- because by the time the research gets the data social media can really change the opinion of the public is much faster phenomenon. even at the international level, and not just w.h.o. the iteration of the complication you already
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mentioned. >> thoughts? >> i have a lot of thoughts. i need to calm myself. one thing i want to say, we're at a record right now with more measles cases this year than for 25 years and larger, longer outbreaks in areas of the country that are quite difficult to control. i think it's really important for people to know that here in the united states most parents make sure their kids get vaccinated against the things recommended. if you look at 2-year-olds, it's 1.1% that have gotten no vaccines. we're not in crisis mode with everybody opting out of the system but in a delicate period of trust which i think building off the last panel is really local. it used to be people trusted their pediatrician or their family physician. they often trusted their mom or their grandmom. a lot of parents and grandparents haven't seen measles and we're in new
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territory with that and a lot of the pediatricians haven't either. i think there are many other influences and some of them are passive and some are active. in the current outbreaks we're having, some of the influences are active with targeting vulnerable communities with very targeted misinformation. that's quite challenging but it's not a generalizable problem if we look worldwide there's a lot of confidence in the vaccination, the health system or the government systems, and i think this is where we can't put all our eggs in one basket of a spokesperson or the perfect role for a spokesperson. and you need to look locally and then as a public health system we need to make sure we get the best information to all of those partners who might be more trusted than we are. >> just to built on anne's point because it is really about who is the local -- who is the most trusted voice in a begin
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setting, and getting that good quality scientific information in a way that's understandable and absorbable to the people you are trying to reach, the complicated studies that you can understand. the lancet is not something my sister-in-law is necessarily going to understand, or similarly in a community. you want to get that information in a way that's understandable but understanding who are the trusted spokespeople in a given area. there is a lot of evidence from our behavior change colleagues who looked at this, how do you get that information out in a way that does change that behavior and can be understood and trusted and we can look back to some of those approaches and evidence as a way to get on top of these kinds of misinformation and the misunderstanding that's out there. >> we need to be careful not to overrespond and there's two places that i worry about that in particular. one is there has been a plan to
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eliminate nonconventions. i understand the desire and my concern is it doesn't get at the larger issues. the impact based on what we've seen in california which did so in response to a measles outbreak in 2015 is that the impact is really small. it reduces parental autonomy and disproportionately for low income people who may not be able to afford home school or shop doctors. and i think my concern is that of trust. if parents feel we're being more draconian, it may have a backlash. the push on social media, there's a lot of problems with social media but i read a letter to the head of facebook and twitter and it said there's no evidence that vaccines cause serious harm or death. vaccines are incredibly safe but that's not a true statement. and then the argument is to curtail misinformation. the letter itself is misinformation and coming from government leaders. so i think working with social media is great. i would rather see it between
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companies taking responsibility and be careful not to overrespond and feed into the mistrust problem. >> a lot of our over response is probably driving the division on both sides of the argument now. or contributeing to that. >> unlike politics we need 95% compliance across the population indefinitely. we don't want this to be a divided issue. we need to bring people together we need to discuss taken that success. and as ann schuchat pointed out, most parents vaccinate their kids and we need to keep it that way. >> dr. schuchat, could you share your thoughts about how the cdc
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has advanced innovation and technologies and preparedness response and how it's part of the culture of cdc? >> maybe i'll broaden a little bit and contrast where we are now with ebola. 2014, '15. there were efforts to get confirmation of ebola cases because a diagnosis meant you needed to be separated from everybody, implications on your contacts, quite a lift from the public health response, as well as for your certainty, is this fever due to ma llaria or ebola. 20,000 specimens were shipped from sierra leone for the hot zone lab testing. today with the gene expert being used for tb so people know how to use it, you can have a safe way to confirm ebola closer to the point of occurrence.
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there's a screening so just the advance in a few years is transformative. in 2014, ''15, nih, cdc, there were trials of experimental vaccines that i can't believe we did these trials because the trust issue was humongously complex. in sierra leone, a vaccine meant it gives you ebola. it had been given to so few people by the time the trials started. many thousands got vaccinated showing the product was safe and showing it was effective. and in drc today 110,000 people have gotten vaccinated without which we would have had so mmm more cases. as the previous panel said these advances are not silver bullets because you can't deliver them
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without trust, get the staff to feel comfortable providing vaccine or giving care if they're being targeted, if the response has become the target. i think an invasion has a huge role but it doesn't take away the requirement of engagement and mobilization. >> irene, most people think of usaid as only involved in international development. and providing aid. i, for one, have seen firsthand the innovation in many different areas, technology or just approach to the problem. could you expound on that? >> sure. much like ann was talking about, innovation is a hugely important part of a lot of what we do. but it's not the only thing.
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across the work we do in health and every single component, there is a certain portion of the effort given to pushing the envelope on new innovations whether it's development. we're downstream, not the work that nih does. on the upstream work. pushing the envelope on tb or the better drug regiment for drug resistant tb or trying to help with the advanced market commitment working on getting the ebola vaccine into the field, all things we're trying to do. it is not a silver bullet but it can make a difference. one of the things we're seeing is this revolution in data technology can really make a huge difference. how do you build that in and the work we're trying to do is figure out how to take this exciting technology of all of your health information system can be on your phone but make it built into the primary health care system so it's not just
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1,000 apps but it is useful and used by the people who need to use the data. so it gets to -- a lot of the effort is on trying to refine the technology that's out there and really make it the most useful for getting to the end of what we -- the outcomes you need, which is help your population and people who have access to services and health care workers that have the information or the tools that they need to make the difference at the end of the road. >> and how about the w.h.o.? >> innovation doesn't grow semantically in all the world at the same time at the same speed with the same type or not. lack thereof. we should also balance the capacity of the different parts developing and regulating it. and the capacity of regulating
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it. all of the research is positive. there is a debate on research and which should or should not or could not be misused which is not linked with any of the conversation that we have here. we have to try rather than running after the next experiment we should have select what technologies could hurt us in the next ten years. and out of them, before the merger of the two, try to see what it is we need to enhance and manage. >> and, dan, you mentioned the vaccine safety research and sometimes that takes a long time. i suspect there's more rapid, real time evaluation of vaccine safety and efficacy.
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i know actually nikki lori, a big champion of occupational research as we were deploying for things. so would you mind speaking to that and your ideas on that? >> no, i'm happy to. one is large databases and ones that contain the medical record. we were able to build a large, active security system for h1n1 called a prism and is now the largest active surveillance system for vaccine safety and with these large databases you can do very rapid studies and that infrastructure is really helpful. i think the other place where there's tremendous opportunity through science is in genomics and adverse-nomics. most people respond well to vaccines. they get a sufficient immune response. they're protected. they don't have the serious, adverse reaction. some people under respond and they're not protected and some people overrespond and have
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adverse reaction and why is that and what is the role of genomics? i think this is really an opportunity to not just push the science further but to bring in the skeptical parents. what you hear from parents are frequently i have a family history of auto immune disease, and i'm worried that even though for most people the vaccine is good, for my child, it's not. they're saying they think they have a genetic risk factor, and that's a place where if we can do science we can address the concerns and the science is hard and it's difficult and it takes time and it takes money, but it's an opportunity for us to go to personalized vaccination to hear the concerns of parents, to respond with science, and maybe avoid the very, very rare but serious adverse reaction. >> we might come back a little bit about how that resourcing is going for some of that work. what i'd like to do now is
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actually open up to the audience an opportunity to ask questions of the panelists. it's hard for us to see but if there's any audience -- we'll get a microphone to you. state your name and organization. >> my name is brandon ball. i work for path. obviously we are funded to work in the drc by cdc with usaid. i wanted to ask questions, we were pleased to see it released and the content included. one of the things was around m&e and i understand that per the strategy there's an internal working group led by cdc and i wonder when you think that might look like practically to your
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point there are so many complex tis here, what does that look like for to you work together on that? and if you look at the requirement, congress asked for five things, future facing financing. that is a little complicated partly because omb doesn't want to put itself on record. could you give us an idea of what the cost of the programming might look like? going forward for each of your agencies? the drc and countries, et cetera, thank you. >> i can't give you the specifics on the working group. around global security working closely together from the very beginning where we talk to each other probably every day and certainly on the ground the plans that were talked about earlier are done jointly.
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the work the u.s. government is going to do is planned out jointly between the two agencies. making sure there's no duplication. >> the m & e piece is really important, so we'll build on the kind of work we've been doing jointly together, as well. on the financing and what it costs today, the levels vary but this is where we do need to look to countries to step up and make the adjustment. it can't just fall on the u.s.
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government to pay all of the costs. this is where the commitment of countries stepping up and realizing how very important this is and it's very important what they need to do in putting in their own investments and a core part of what needs to happen. >> and maybe let me expand a little bit. i think m & e is very fundamental to both cdc and aid culture that building again off the earlier panels, if we can't measure, we don't know how we're doing. if we want accountability, we need to know how we're doing, as well. building on the earlier panel to get ownership of global health securities sustainably we need this not to be u.s. governments doing the whole thing or paying for the whole thing. this has to be partnerships with multiple countries and the multilaterals as well. in some ways, you can look at
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pepfar and say, wow, that's incredibly impactful and success. in some ways it's one single disease you're trying -- a really difficult disease but with great tools one single disease that can have very, very measured tracking and we can be investing in what's effective, cost effective and making sure we're accountable. global health security will be addressing systems improvements and the jee is absolutely fundamental in having an objective way to measure. we're at the early stages of the best way to monitor and evaluate, we want to take the best of the metrics from some of the other global initiatives but build into really a health system strengthening effort, meaningful way to track. so i think both -- we've had a five-year emergency supplemental dollars that have gotten a lot of improvements in a number of countries as well as in global partnerships and cost cutting threats.
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we're not done and this is not something that's going to be, you're done. preparedness is a forever kind of thing. it doesn't mean the u.s. government will be paying for it at a certain level forever. >> there's a question in the back. >> hello. i'm cassidy howell with the save and vaccine institute. i'm working on influenza vaccine innovation particularly universal influenza vaccine innovation. in this work we've spoken to stakeholders from a lot of sectors who have all kind of said the government, academic, research and development, architectures aren't built for accelerated innovation and risk taking. my question to all of the panelists, any of the panelists, is how do we derisk the environment to foster these multisector collaborations and encourage open source, open data collaborations necessary to make these challenges and problems accessible to different thinkers, nontraditional experts
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in genomics and engineering and big data? how do we foster that collaboration and encourage different solutions? >> that's really hard. >> you take this one, okay? >> we can check that box. i think i'm more optimistic about that than i was a few years ago. i think people recognize for influenza we are not where we should be given how much we've been investing for decades and that with innovative approaches to it we could be in a lot better shape. we spend a lot of money vaccinating everybody with the best tools we have right now but you need to give them every year, they don't work as well in many people as in others and there's some incentives to not
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innovate in terms of having a good market, not as lucrative. but a reasonable market. whether it's nih's role or the u.s. government's role or some of the academics role there's a shared sense that we need to do things differently. that doesn't mean i have a solution, but i think having agreement it's a problem is a start and i think there's policymaker agreement that it's a problem. >> to add on that i think there's also -- and i very much agree there's been a shift to move in a much more open source, more innovative approach. i think a couple tools up there recently like the grand challenges which just puts out here's a problem. we need a better ebola suit or a better way to monitor the vitals from a patient sitting in an ebola unit does bring in or did bring in innovative solutions
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from different sources and not the usual sources we look for. some exciting ways to bring in the new ideas from people who aren't usually at the table. and on data i think there is -- the data revolution is under way. pushing on openly sharing that data is still not quite where we need it to be but given technologies and the pushing to share data puts us in a closer to that place where we can have a much better way to have open data. not quite there yet. progress. >> i was looking at some of my colleagues in the room and i know they have certainly tried to be on the front wave of the innovation and actually established some new programs recently in barda. my question, dan, what advice would you have to make sure that
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they bring a vaccine safety issues along with other innovative programs? >> so i'm careful in this regard because a lot of the vaccine research and development and a lot of the work there is clinical work and clinical trial work. i guess one thing i think baryta realized is you have the infrastructure you have when you roll out a product. for example, i was contacted by a vaccine company developing ebola vaccine and asked me the question, well, how can we monitor the safety if it's rolled out in an african country? the challenge was, there was no infrastructure for active surveillance. and i think at least historically barda has been aware of that but in vaccine development it's outside my expertise to give advice on that. >> just a comment. in general, research suggests
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that people don't like new vaccines. we like new iphones but we don't -- >> every year. >> there's comfort in knowing a lot of other people have gotten that and we know something about it and we're not going to get surprised. in the midst of emergency everybody wants something. one of the challenges in drc they've done a ring vaccination and some of the concerns in some of the communities are, well, why are only some people getting the vaccine? what about the rest of us? and yet you know very little about the other vaccine that's proposed to be used in that context. we have a problem that when the public acceptance is the highest for something new and potentially untested we don't have anything and when we have incredibly well studied products like the mmr or influenza vaccine people wonder about its safety. i did mean to also mention that one of the impacts of the 2009
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pandemic was a real change in acceptability of vaccination in pregnancy. we went from having 15% of people get a flu vaccine to about 50% which may not sound like a lot but this is a lot. for objects at this electricians, family physicians to decide this is a good thing and not a risky thing to do. when people see bad events from natural diseases and there are tools to help them acceptance can change. >> yeah, i think this is acutely a problem in low and middle-income countries. >> historically we developed vaccines and then after decades of experience, including a lot of safety science, they would make it to a low and middle income country. which obviously is a problem, because those countries that often need the vaccines most aren't getting them right away. we've seen a shift where now vaccines are developed and rolled out first to low and middle income countries which is great in many, many ways.
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but the challenge is the infrastructure for safety and surveillance is not there. the capacity isn't there as in high-income countries. and that's about infrastructure investment to have capacity. >> maurizio, do you have anything to add? >> i'm fascinated by one of the moments in their response. you don't vaccinate if you don't know who to vaccinate. you cannot vaccinate if you don't have permission in the environment and the vaccine needs to be kept in congo, think of the complications. it appears to be geographically preferred.
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the appeal of cambridge, massachusetts, a certain area, appeal to the young scientist. the same appear in other parts of the planet. the concentration of intelligence, ph.d. was started since i was there. another reflex how to facilitate the movement of neurons will probably follow what else we give to the scientists is not just money, believe me. >> is there one more audience question? i thought so, david. i forgot. sorry. >> if you're going to open it up. it seems only fair.
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earlier darpa was mentioned and i was thinking about the diagnostic -- local diagnostic industry issue. as somebody who does tropical public health research, one of the challenges i've had in partnership with both of your people in the field is trying to do it in a sustainable way when there is no one other than this one person in nigeria who happens to be certified or to certify these issues. it sounds like you two need a capital fund where you with some support from maybe barda and nih and others can do darpa-like spinoffs focused on local market development for biomedical science and health security. >> great idea. >> what do you think? >> i'm sorry dr. giroir is not still here. he spent years at darpa and is excited about the nexus between innovation and derisking and the
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kinds of problems that irene and i are dealing with all the time. i do think that the usual approaches are challenging. we did get congressional support for infectious disease rapid response fund. we saw so many challenged with the long lag between emergency that we clearly have exceeded our funding capacities for. that the resources from h 1 n 1 to ebola to zika. a very different issue is the innovation kind of investments. >> and here the funding to the security sector would bring uncapped capacities for all the public health response because the prize of the fund and our response is supposed to be 1/5 of the warhead or something, so the level of not just the technology, the knowledge, the capacities, not just the funds from the security if this
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dialogue goes well is uncapped. >> the other thing i would add very briefly is i think there has been a lot of interest in bringing -- matching with private sector, you know, investments in this space. and i think there's a whole lot more we can do in that area. >> i have one more question, and we can keep it brief and we have talked about it before earlier in the day, but i would like you all's perspective on this, and the question is, and we'll start mauricio with you. how are we doing today in the ebola outbreak compared to 2014 and 2016? there are different ways you can go about that question. what are the differences today versus 2014 and 2016, not the w.h.o., not your specific organization, but we as a community? >> well, it is complicated question because the anthropology and the history of each outbreak is really different. in 2013, as i said, one of the
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factors is that we all responded to phenomenon that we are local without thinking the tribe was the same family crossing two rivers living in a space of three countries, so we treated geographically or geopolitically. because we followed the ministry of health. that's the only thing we have. while possibly we should be smarter in designing the outbreak. in nigeria, we had a mortality which was 20% less without vaccine than the current one. we enter -- david, myself and others entered the ward to talk to the patient, to speak with them, to joke with them. people are dying of desperations because they are sad, they are sick, they are abandoned in these wards, so there is a whole other thinking. now, today, we have the vaccine, so it should be much easier.
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drc is one of the most potentially wealth in terms of resources and everybody is having a piece of it or fighting for it. so the ambassador, different forces from the political to the community, from the minds, protection and so on. this we didn't have it, so it is one of the complicating programs. last but not least, it flies less. if we were to lose a patient from lagos airport or the response in nigeria, we would be here speaking of a different history. >> that's right. >> so i think, you know, the last panel summed up a lot of this, you know, the big fundamental difference you think between this outbreak and where we were in 2014 is quite
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frankly, it's the complex emergency setting, which makes it extraordinary. i think the kinds of things we have been talking about, some of the similarities are indeed the need to understand, you know, what are the issues at the community level. how can we possibly reach people, given that setting, but that becomes a difficult thing. the other piece that's been talked about is we do have the vaccine which has been said has i think made a phenomenal difference this time, and it is a tool that we -- well, there is no silver bullet. it is an incredibly powerful tool that we have, and reaching people and trying to overcome some of those really fundamental issues of distrust and concern and a whole lot of other issues in addition to ebola that is facing the people who are most affected will be the thing we have to figure out how to overcome. >> you know, i would say there's some really disturbing contrasts to make, you know, despite the country, the global community,
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w.h.o. responding very rapidly, the country identified the virus themselves and surged and so forth, despite that it is getting worse, not better, despite 110,000 people being vaccinated, it's getting worse and not better, and our ability to change that trajectory is very, very limited as both outsiders and as the context of where it's occurring. and beyond the vaccine that's helping kind of keep it, even though it's getting much worse, the vaccine is keeping that at a, you know, a slope is not as bad as it might be. there's also this enormous investment in border screening. with the people -- one tribe, people crossing borders into uganda, you know, vaccinations in uganda, rwanda, south sudan.
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it's really, you know, we cannot stop intensive response and we have to become creative about how to support the community level response because this could get so much worse and it could be in many other communities, it's already in 21 or 22 health zones there's active cases. so -- >> dan is an international health inspector. >> i don't have anything to add, it's been a great discussion. >> i want to thank our panel. it's been fascinating and i appreciate you taking the time to join us this afternoon.
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>> if we could ask our final panel to come up. i have already introduced professor at the start of the day, but professor nahsios will moderate this panel and i'll turn it over to andrew to introduce our panel discussion. >> so we're at the final panel today. we have two people who can manage politics. ron klain was the chief of staff to two american presidents, al gore, chief of staff to joe biden when he was vice president under president obama. he's i think a senior executive in a venture capital fund. he was a czar during the ebola outbreak under president obama.
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he's the top person in the white house which is why we have invited him today. jim greenwood is the president of and the ceo of biotechnology, innovation organization, and a member of the blue ribbon study panel on biodefense. he's a former member of the house of representatives. he was in the house of representatives in pennsylvania, his home state, and in the state senate. he's a career politician. i say that, sir, as a compliment since i was a career politician myself. some people think maybe i'm still a politician. i think, actually, what we're dealing with is political management and these emergencies because we're dealing with issues that are really not health issues, the lack of trust in government, and not just here, but around the world, and the social media now, misuse of that is a political issue, not a health issue per se. it's affecting health.
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in any case, i want to read something before we start the discussion from john barry's great book, the great influenza, which is probably one of the best histories of the pandemic of 1918. one paragraph, victor vaughan. victor vaughan was the dean of the university of michigan medical school, one of the two leading health scientists in the united states, and best friends with william welch who for 40 years was the dean of the johns hopkins school of public health. victor vaughan, sitting in the office of the surgeon general of the united states army and the head of the armies division of communicable diseases watched the virus, the influenza, 1918, move across the earth. he wrote this in his own hand and i quote, if the epidemic continues, its mathematical rate of acceleration, civilization could disappear from the face of the earth within a matter of a few more weeks. now, this is not some crazy
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person. this is one of the two top medical scientists in 1918 in the united states. he wrote that in his own hand. that's the sense of panic that existed. we're going to face the same sense of panic. we had two or three people get sick with ebola in the united states. you remember what happened. it was all over the headlines across the united states. imagine if 650,000 americans died in six months, which is what happened in 1918. 18 million worldwide, 5% of the world's population, so what we're going to deal with a whole series of political issues, which i think we are not prepared to deal with. we have been warned now because of these viruses, the diseases that have spread. we have a new fungus that has spread in hospitals. it's very dangerous, and so we want to talk about leadership in
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vaccine and epidemics and pandemics, which is a political issue. if i could start with you, jim, given your leadership role now, but also your previous career in politics, could i ask you to begin by looking at the question of the complexity of the enterprise with the public sector, the government, the nonprofit sector, and corporations in developing the biodefense capabilities of the u.s. to meet one of these crises in the future. >> sure, that's easy. >> so i come from my recent perspective has been to lead the national trade association for biotechnology companies and we have as membership about a thousand of them, and a good number of those are in the medical measure business and a
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lot of our companies in the vaccine business. i guess the first thing i need to say is that inventing invading a drug of any kind is extraordinarily difficult. we fail 90% of the time. if you look at alzheimer's, we have failed basically 100% of the time. science is galloping, but it's really complicated and one of the reasons drugs are expensive is because of the high failure rate. so now imagine you're a company, and particularly a small company and what you would like to do is make counter measures for against pandemic and a bioterror attack, and you know that essentially your only purchaser, the only entity that's going to buy your goods is the federal government, so now you're at this highly risky enterprise, trying to make a need that's not been made perfectly clear by the government.
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not sure that it's going to be approved and very uncertain about whether it's actually going to be acquired and whether it's going to be acquired consistently and whether the funds will be there. and so now imagine trying to attract investors into this enterprise saying so i'd like you to invest in my company. we're going to try to make some important measurements. we probably will fail. if we do succeed, we may or may not get it approved and if we do get it approved, we may or may not have it purchased by the federal government. it's a risky proposition. nonetheless, companies are busy doing that, and in an effort to participate in this effort, i joined this blue ribbon panel that's cochaired by former senator lieberman and governor and health secretary, tom ridge, tom daschel, and ken waynestain is on there. i think we have made great
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contribution. the biggest problem is that, a number of problems, one of the problems is that this is one of those things where the last big pandemic to which you referred was a hundred years ago. congress is not good at long range thinking, even though the experts will say there is an inevitability to a horrific pandemic. there's an inevitability to terroristic attacks. the thousands and thousands of items on the agenda of the congress are such that this doesn't take come to the fore, and when we wrote our first report at my suggestion, we began with a simulated hearing. it was a congressional hearing after the fact when thousands and thousands of people have died, and the members of congress holding the hearing
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were calling representatives of the federal government basically saying why did you not see this coming, why were you not prepared, why did all of these people have to die, and we did that as a message to congress saying let us not wait until the horses have left the barn to prepare. and so that's what we're desperately trying to do. we're desperately not tying to be another report that sits on a shelf somewhere. this goes to the leadership question. one of the things that we really zeroed in on is that the responsibility for these issues is scattered throughout the federal government. and there is no unified budget. there's no unified chain of command, and so therefore it's siloed. there's contradictions, the left hand doesn't know what the right hand is doing throughout the federal government. we thought that what was important was to have a centralized individual who had ultimate responsibility, and we thought that the best way to do that was give that responsibility to the vice president of the united states.
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that has not happened. we have not succeeded on that. right now, the leadership is with the secretary of health and human services, alex caesar, the problem he has is if he has a conflict with the department of defense or homeland security, he doesn't have the clout as just one of these secretaries are his peers, he doesn't have the clout to say to one of those other agencies, those other departments, you will do x and y. that's why we felt it needed to be in the white house and in the hands of the vice president in order to provide a leadership that we think this issue desperately needs. >> ron, you, in fact, were the closest thing to the vice president being chosen because the chief of staff and president obama appointed you as the czar for this. in some ways you had the authority of the vice president. >> i had left the vice president's office a couple of years before. >> but you came back.
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>> i came back but i didn't report to the vice president. the vice president wasn't involved. >> okay. >> look, i think a couple of things just to kick this off. one, i want to commend texas a&m and everyone involved for the white paper that's associated with this. i think it's an exceptional document that collects a lot of really powerful recommendations from across the space and puts them together. that's really a great work, and i think that the single best thing, if every policy in the united states read it and followed it, it's really an exceptional piece of work. >> we are here at the 100th anniversary of 1918 spanish flu epidemic, and i think, as andy said, it's kind of startling to think that it's an event that very few americans know about but took more lives than world war i and world war ii combined. yet, hundreds of memorials to world war i and world war ii,
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lots of stuff in the curriculum. you can barely find a word about it. forgotten memory in our country. that's one reason policy makers don't respond to, don't react to it. there's actually some things that make us less safe than a hundred years ago. globalization, and the rapid transit of people, if something happens like this, it's going to go around the world a lot faster than 1918. a lot more complicating factors than in 1918. so what to do about it. first, the recommendations in the report are absolutely spot on and essential. i think second, i think there's no replacement in tackling this global problem for u.s. leadership. it's not to say there isn't a multilateral or global problem. it is a global problem. the leadership of the w.h.o. is very important, no question about it. leadership of other multilateral
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institutions is also very important. but for better or worse, we are an indispensable nation in addressing this global challenge, whether it's our technical expertise at chc, our resources or health care system, our experience, there's no replacement for the u.s. being at the forefront of this. and i think we're at a place right now in our country where there's a lot of questioning about whether or not the u.s. is still going to be at the forefront of this. and i think we've got to get past those questions and make sure we're leading. third thing i want to say about it is this should not be a partisan issue. i'm partisan. i'm unapologetically a partisan, and democrat, proud of it, and on lots of issues, i'm quite outspoken on that. i think on this question of fighting pandemics, this should not be a democrat or republican issue. these viruses don't ask for people's political affiliation before they infect people. mosquitos don't ask to see your voter id card before they bite you. this should not divide ds and
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rs, the commission jim has been a part of that is a good example. you talk about the bipartisan leadership on that commission, and i think during the ebola response, we had a certain amount of politics in the end, democrats and republicans came together and funded a $6 billion response that we spent some here, some around the world to turn around the ebola outbreak in 2014. i hope that we can keep it that way, keep it bipartisan. having said that, it's not a partisan issue. it is a political issue. when we talk about public health, we're talking about engaging the public. and we engage them in our country through politics. and whether that means some of the issues the panel before was discussing about responding to anti-vaccine sentiment, responding to isolationism, anti-immigrant sentiment. all of these things that complicate our response to infectious diseases, i think that politics has to be a part of it, and people in the public
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health community have to be unafraid, and willing to step into the political arena and provide the kind of force for the kinds of actions that this report and others recommend. now, last report on this white house leadership thing. i absolutely believe we need leadership at the white house. i do not think it should be the vice president. the vice president has a full-time job. getting ready for and responding to pandemic threats is also a full-time job. and the idea the vice president would do it in his spare time, doesn't seem like a good idea to me. president obama after he brought me in to do the ebola response, when i left, we're getting close toe to zero cases, appointed a senior member of the nsc staff to be in charge of the pandemic response, and president trump continued that for the first year of his presidency. admiral zimmer's leadership on the staff. that position has been terminated. i hope that either president trump changes his mind and brings someone back or the next president, whoever he or she is
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does that. we need someone leading this at the white house for the reasons jim said. i think it should be a full-time position on the nsc staff, not just the vice president with a sliver of his or her time. >> that's a debatable point and i think the fact that we haven't succeeded placing this in the hands of the vice president is indicative of that but the thinking we used is the vice president is going to be doing the things vice presidents do. would be focussed on this all the time but the vice president would appoint someone that was capable and qualified to do that leadership and would then be able to, when necessary, simply turn to the vice president and say, i need some juice. i need you to knock some heads together here. and we think the vice president has the political clout to do that, and also influence on the budgetary process in the white house that maybe the nsc might
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have less clout over. >> most scientists say the biggest threat we face that scares people the most is still influenza in its various iterations. last year was the worst in 20 years. for influenza or the flu. 88,000 people died. i bet most people don't know that. that's from cdc, 88,000. in 2009, cdc reports that 1.9 billion people in the world, it was a pandemic, but an extremely low death rate, 1.9 billion people got the disease in six months. that's how fast it spread. we have created globalization, our airports by the way are the best thing that ever happened to a pandemic because they will spread the disease all over the world overnight even before we know it's going on because of the nature of transportation in the world. two questions for both of you,
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both related to influenza or the flu, one is the national strategic stockpile was established 20 years ago before 9/11, before the anthrax attacks or sars. it's evolved. is it really the model we should be using to protect ourselves, particularly against the flu. that's one question and the second question is what would we do to create the incentives for industry to perhaps invest more money in research on this for a universal flu vaccine which of course companies are working on now. is there anything we need to do to change as the senator said this morning, senator burr, the architecture of the system and the incentives been the system so we can get some kind of a vaccine before it happens, before the next pandemic takes place. >> so those are obviously very closely related questions.
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i don't think that the problem is so much with the architecture, although i yield to the senator on that. he's been an absolute leader on the issue, as much as the funding and the reliability of the funding. i think, unfortunately, if you 535 members of congress here and asked them what the likelihood of a 1918 era pandemic, i would guess that the vast majority of them would not think that was possible. they would think we have so many medical advances in the past hundred years, of course that could never happen and they see the flu, they see people get sick. they know some people die, but they think they were probably old people who were going to die anyway. they don't recognize that an apocalyptic scenario is possible.
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and so for that reason, they don't feel the sense of urgency. and, again, this is -- no aspersions on my colleagues and former colleagues who were in congress. this is not top of the issue, top of mind issue for the public. so there is no public pressure to do this. so i think that if the structure were well funded and the industry could rely on that, as i said earlier, the investors could rely, the money will be there, the procurement can happen, it's worth the risk. when ebola the first round occurred, companies lost money. they did the patriotic thing, more than patriotic, it was the humane thing to do. they turned away from other products. they are behind in projects because they devoted attention to this, and the epidemic was over, and then there they were, with no one to procure the products and so they do this at great risk.
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i think if the funding were there, if the sense of urgency were there, the industry would respond. on the partisan issue, you're absolutely right. this is nothing partisan about this issue. but there is a way in which partisanship creeps in, and it is this. what is desperately needed is oversight. i chaired the oversight investigation subcommittee of the energy and commerce committee. and the oversight committees and all the committees in the house and senate have a dire responsibility to look into these programs they're funding. the oversight function is the kind of function that doesn't have to be an emergency in order to occur. it's the kind of function that congress is supposed to do on a regular basis to look into all of these programs that are important and oversee them. as long as both parties and
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let's not get into the politics of it, as long as both parties continue to monopolize the oversight function on political matters, then there's not enough time for the things that are important and there's no need to go into what has been justified and what has not been justified many years in congress. in many instances, i think the public would be better served by making sure that there was time for the oversight committees to do that kind of important work. >> i have a couple of things. i was in the white house in 2009 and 2010. i was working for vice president biden. i wasn't involved directly in the h1n1 response, and i lived through it as a staffer a bunch of really talented great people working on it, and we did every possible thing wrong. and it's -- you know, 60 million
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americans got h1n1 in that period of time and it's just purely a fortuity that this is not one of the great mass events in history. it had nothing to do with us doing anything right. it had to do with luck. if anyone thinks it can't happen again, they have to go back to 2009, 2010, imagine a virus with a different lethality and you can just do the math on that. what did that tell us, it told us that the vaccine will arrive late, told us that if it's not prepared in advance, if we don't have the answer before, we're not going to get the answer in time, and told us that our systems for deciding how to distribute and administer a vaccine in a time of crisis are going to be badly, badly tested. it also told us one other thing, that we lack a global policy mechanism for dealing these untested vaccines in an emergency situation. now we saw this a little bit in 2014 in west africa as towards
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the tail end of the outbreak, obviously we got new experimental vaccines, had some phase one testing here, phase two, wanted to get them into the field of west africa, and immediately had issues about who would be liable if the vaccine made anyone sick, who would be liable if there were different claims. who would own the intellectual property from the resulting tests of the vaccine, and we kind of found a way to band-aid through it in that instance, it's clear in the united states we have the prep act. there's no global prep act. there's no global structure. a lot of constituent companies were very worried about their exposure in that circumstance. and you can imagine a scenario -- kind of faced this a little bit in 2010 with h1n1 where the vaccine didn't arrive for us in time. it got in time to europe and there was a big controversy over whether or not it could be administered, what was the regulatory approvals, so on and so forth. this has been a life or death
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situation. the policy would have killed people or the absence of policy would have killed people. try to figure out a solution on the liability issue that works worldwide and not just in the u.s., and that deals with this because one thing we know for sure is if we have to deal with it in the moment, it's got to be very bad. >> and i agree with all of that. you know, on the global nature of this, as prepared as we are, i don't think there's a country in the world that's better prepared, and so that's not good news. what's really frightening about it is should you have an outbreak somewhere else that could readily arrive here, and we have let's say counter measures, political counter measures that could be responsive, how do we tell our fellow earthlings in other continents that i'm sorry but we have to hoard ours in case, to protect our own people.
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that's a very difficult humanitarian decision to make, but it's one i think we probably would make and so it's -- it really does require a lot more global coordination, and a lot of work by other nations as well. >> i would say as a development professional, the first line of defense, is not the borders of the united states. there's no way we're going to prevent this from getting into the united states. the infectious nature of whatever the virus is, like measles, has a very high infection rate. ebola has a very low rate, and influenza has a high rate. it's going to get into the united states. the first line of defense is in the developing world, not here. so for me, at least, we need to respond immediately to try to stamp the thing out before it gets outside the country that it starts in, and that's a hard sell in the united states because people say, well, why don't we worry about ourselves, the reality is we can't, if we
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want to worry about ourselves, we need to extend that help to the rest of the world. >> i think, i alluded to this in my opening comments, the isolationist sentiment in our country right now is one of the most dangerous dynamics we have. we can't have public health safety in the united states out of the context of global health security, and as andy said in the event of any kind of pandemic or whatever, and certainly we saw this with h 1 n 1, we had millions of cases in the u.s. before we knew it was here, and that's going to be true for whatever comes down the road. and the only way to keep our people safe is to engage globally in making other people safe. that's why u.s. leadership is so important, u.s. engagement in the world is so important. this is an area where the public health community needs to speak out.
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i'll just be very honest about it. we saw when we had zika in 2015, and 2016, very slow action in the congress in funding the response that president obama sent to the congress, ten-month delay, and again, i'll be honest. i spoke out a lot about this. a lot of the reaction was zika is an immigrant's disease, why don't we keep the immigrants out. we shouldn't spend all this money. we should keep the immigrants out, and that mindset really impacted our response. i feared that that mindset a little bit colors our reaction now to different global health challenges and how we engage in the world, and i think that we've got to get past that. we've got to rally people in both parties. we've got to rally people of goodwill across the political spectrum. we understand this with terrorism. we understand with terrorism. the only way to keep american people safe is to engage on
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issues around the world, by the time the threat gets here, it's too late. we have to have the same mind set with a much more positive attitude in terms of building global health security around the world as the best way to keep people safe here. >> and even if the sentiment is, well, the europeans and asians have to pull their weight and make their contributions scientifically and financially and so forth, and let's assume that's the case, you don't get there by retrenching, you get there by leadership, by having those conversations around the world, contributing but also encouraging the participation by the rest of our neighbors. >> can i get both of you to comment on something we spoke on in our first white paper three years ago, which we released at this conference, the first one. which is the fact that w.h.o. did not perform well in west africa. i think it's performed much better since then but it's not quite there yet.
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what needs to be done to finish the process of reforming and strengthening institutionally w.h.o. because they need to play a central role in this in terms of international coordination in the event of an emergency. can both of you comment on that? >> not very well. >> let me start that. i'll give this a shot, jim. >> to be honest, i don't know. >> w.h.o. did a very bad job on ebola in 2014, i have been outspoken about that. i think congress has been doing a superb job in their response on drc. they have been fast, they have been transparent. they have been candid. and they have been quite responsive, and their leadership is exceptional, and i think what this outbreak is showing is the limitations of w.h.o. it is not a response organization. if the biggest problems we have right now in drc is the security
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instabili instability, is attacks on health care workers, the attacks on responders, the community resistance and the community resistance getting violent and dangerous, the w.h.o. has no capacity to respond to that. that's not their mandate, and they're never going to have that capacity. we have a big debate about how much bigger checks the country should write to the w.h.o., that would help in the drc, but it's not going to solve the core problem. since 2015, i've been a public advocate for the idea of having some kind of white helmet security battalion maybe under the leadership of the eu that could provide assistance in the event of an epidemic response. 2014, 2015, president obama did something that has never been done before. he ordered u.s. troops into the field to help with an epidemic response, operation united assistance. 3,000 troops from the 101st airborne from kentucky and
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tennessee over to liberia. it worked marvelously in liberia where american troops were welcomed as friends and as a blessing to have. that solution is not going to work in congo. okay? that solution is not going to work in a lot of other places in the world. we would have to literally fight our way in. seems like a bad way to do an epidemic response but some sort of global security force is needed. what we're seeing in congo is new but likely to be the new normal. the combination of infectious disease outbreak and regional conflict fighting over resources, fights over control, that's more likely to be the scenario in the future than what we saw in west africa in 2014, and we have to have the tools as a planet to deal with that. if we don't solve this thing in congo, you know, it is going to spread. it's going to spread to someplace that's much more populous, and much more connected to the outside world
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and we're going to regret that we lacked the tools to deal with it right now where it is. >> let me add something, actually, almost everything that's happening in the congo has happened before but not in the context of epidemic disease, it's happened with famines and civil wars in south sudan, somalia, yemen. it's been going on for 30 years. there's huge literature on this. but none of it deals with the complications of infectious disease. and that's what's new. what's not happening is the u.n. is not using the emergency response functions of the rest of the u.n. system to help w.h.o. deal with these instability issues, which we have been dealing with for a long time now, and we have put in place some things -- you're correct -- the biggest factor, in my view, is the lack of a powerful -- the mechanism for putting together a peacekeeping operation in the u.n. is very dysfunctional. i would never use that for this at all. without going into the details
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of this. it does not work. i have been involved in it for 30 years, and we need a different model. i think your idea of having the e.u. do it i think is a very good idea because they would be disposed toward that, philosophically and in many respects. >> i didn't feel qualified to respond to the question about the w.h.o. i am largely critical of the organization. for a couple of reasons. i think they are very political in ways that result in lack of good science prevailing. i think that they are a very political in that they, for instance, really seem to be the enemy of intellectual property, which is a -- easy to do under certain ways of thinking, but without intellectual property, there won't be any innovation to meet the health needs of the world. and so i think that the world health organization needs a lot of work. >> again, i'll just briefly say, i was unsparing in my criticism of the w.h.o. and dr. chan in
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2014. i think what the doctor has done with w.h.o. has been a dramatic change. not saying there's not room for improvement. there is always room for improvement. what they are doing in congo is amazing and heroic, and again i think this we have to tow it up where we're falling short, i think the u.s. is not doing its part right now, and that means both in terms of resources and putting together solutions. i think we need to recognize a dramatic improvement in the w.h.o. and a lot of that needs to go to dr. tedros. for that, in my view. >> let me race another issue, which is the role of social media, which is complicating this very substantially. it is clear that social media is being used for very good things in the world, openness,
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accountability, however, it's also being used for rumors and antiscientific. not just this field but the g.m.o. field. a whole bunch of other fields. there's a lot of stuff on the internet that's complete nonsense, and so the question is what we do about it. i might add there's a new study out in one of the health journals, a peer reviewed article done by computer engineering scientists, looking at tweets to see where a lot of the anti-messaging is coming from, and it's not coming from random people, and there's a legitimate -- when i say legitimate, people are genuinely concerned about it, among the people. i don't think they're right. they're wrong. but we need to understand the domestic sources of it, they go back to the american revolution. however, it has now become a function of great power politics, and what the study shows is that tweeting is now being used to spread anti-vaccine messages, 90% are anti-vacc messages, 10% were pro
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to cause more conflict around the world and it's not just -- it's directed against the united states. it's from russia, actually. and it doesn't appear that it's from russian civil society, the opposite. it appears that it's a public source, and this study, you can read, in a public health journal. it just came out a couple of months ago, and it's based on a comprehensive study with algorithms that were used to look at mass numbers of tweets to see what the source of the information was. huge disparity between the tweets in the west and the tweets coming from russia on the measles outbreak. so the question is what do you do about it? if this is being used, a cool of -- a tool of geo strategic, the american scientists made a deal to wipe out the diseases, one
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thing we cooperated on that worked heroically. and so the fact that now this is happening in the opposite way for strategic purposes is very disturbing, i think. so can you comment on the social media and how do we deal this issue of social media being used for very destructive purposes for geostrategic purposes that are destabilizing in terms of pandemic disease. >> i'll make a few comments. i think probably most of us at the earlier stages of the internet were filled with hope that what a fabulous tool this would be to educate the world and to unify the world and to bring knowledge to all. and now we find ourselves in this strange moment in history where virtually everyone in the world has a device in their pocket that enables them, handled well, to find the truth
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and real science and real facts and reliable information. but at the same time, we're getting dumbed down by it at an alarming pace. it's one thing to think about how destructive it is in the world of the anti vaxers and anti gmo and the fake science out there. but the real terror is what happens in the midst of a pandemic or bio terror event when people are desperately looking for, what do i do, where do i go? and imagine the flow of bad information, disinformation, malinformation that could occur that would just make -- people would be almost better off throwing their devices in the river. so how do we deal with that? i think the lord only knows. you can talk about teaching
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critical thinking and teaching people to find their way through the miasma of disinformation. we have been talking about that for decades and getting nowhere in terms of public education, private education, as far as i'm concerned and how we get a handle on this, how we educate people to go beyond the first tweet or the first facebook posting that they see and actually find their way to real facts is a huge challenge. >> a couple things on this, one, in the west african ebola response, it was a multilateral response. obviously the front line responders, a lot of them were people from west africa, sharing the lion's share of the credit for turning the disease around with their courageous work and willingness to change. a lot of them were from other
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countries, not just the united states, france, but also cube and china. and i sat in the situation room as we saw photos of chinese military planes landing on runways being unloaded by american troops. it was an amazing example of global cooperation. wile that was all going on, we believe russians were on the ground in west africa spreading misinformation, telling people that, you know, not to go to the ebola treatment units that they would die there, tell people not to trust the health care responders and so this issue of the russians using uncertainty and fear about disease as a geopolitical tool has been around for a while. and now we're seeing it on social media. deliberate attempt to spread diseases, spread uncertainties, spread resentment. spread division. spread social strife. now, what are the solutions? look, i think it goes back to
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what was discussed on the last panel about voices of authority, and where that authority comes from in a crisis. and we'd like to think it comes from up high, way up high. we'd love to think it's the president and the oval office and the surgeon general or the secretary of health and human services. what we saw in west africa in the middle of this was authority came locally from local clergy, local healers, native healers, traditional healers, local community leaders, local tribal leaders. so on and so forth. and social media is its own kind of community. and so i think what we have to work on in public health is really a very -- ironically, in a world of global connected social media, local social media authorities that take -- that persuade people of the right information, locally prominent doctors, locally prominent religious leaders, locally prominent social leaders. that people know and trust off the platform.
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people outside the twitter world that they will listen to and have confidence in. we have to build a network of those local leaders who can use social media to drive messages, drive these messages effectively. but this unquestionably in the face of a deliberate effort to disrupt a response and to spread misinformation, this is going to be challenged. we're going to have to have authorities that people really know and trust to push back that information and that's probably more likely to be local than global or national. >> i suppose it's gratuitous to say this. i think it should always be said. when you have a president of the united states telling people that real news is fake news, and fake news is real news doesn't help. >> the republican on the panel, not the democrat said that. trying to keep myself out of trouble here. >> can i open it to questions now. do you have a question or comment?
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>> please identify yourself. >> again? >> yeah. >> i am dr. mauricio from the world health organization. which i have, but the capital of two or three reflections to complement what has been said. internationally, which is, with all the problems that come with denominator of excellence that nations can avoid with good politics. so i wouldn't look to the u.n. in general as the mother that comes and fixes everything. there is room for improvement. there are draconian transformations in place as we speak. we learned our lesson in ebola
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and it shows. so it's far from perfection, a work in progress, and is the sum of the contribution and the political contribution to all of its members. so if each of the members could keep bashing on the head a poor child, it's like having a child with 156 parents. and each of us, which are having -- married know exactly how difficult it is. i hope that can be edited online. the second reflection, the smallpox eradication had been a different era. there are villages where you keep the door open, take the child, vaccinate the child. in today's world, you don't vaccinate anybody without a lawyer, a legal agreement, somebody and the grandmother in law who says, yes, please, do it. let alone in any part of the
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world. so, again, exporting one-to-one to the rest of the planet at times may be more costly to -- for remedies than having a bottom-up approach, more holistic from the beginning. but thank you. to close the day with your comment today was very insightful. >> other questions. yes, sir. >> my name is -- my name is dsh my is zumer shandy. executive director to it harris county public pelt the public healthy just flew in from houston i missed almost the entire day if it's completely off what i say i wanted to apologize. i wanted to say that up front. i have a question for you. i'm also associatewood the association of association of
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local and national melt associations close to three thousand health associations across the u.s. we are interested in the global learning that really impacts domestic local public health and best public health practice in the u.s. as we go through the process we learn that a lot of organizations that we're getting to are very much very interested in the global health space. so they're doing global health work but not interested in domestic health or doing domestic health work and not interested in the global health aspects. and so as, you know, we talk about pandemics it seems this is this really gulf as between -- the three of you have been spoeg satisfying about between global health, domestic and how they come together. do you have ideas how to wrij the gap in terms of models of practice and practice at that local level, not at the national or federal level but really at the local level where we can
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really share across the system that would help us for pandemics and beyond. thank you. >> let me just tell you something that started in the early 1980s going op on. it's a school run by the office of foreign disaster assistance called ofdaniad to train first responders in latin america. it's a train the trainer program. and it's been going on for what almost 40 years now. and it is dramatically reduced the need for the united states to do emergency response in latin america. there are a couple of exceptions without mentioning countries there are a couple of countries so dysfunctional you need monk response from the outside. most latin american countries don't need the help anymore. and i attribute it to the very quiet program, almost unknown outside of ofda to run and fund the center. and it's also done at the local level. i mean we do -- there are people who participate at the national health ministries and the police
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and all that. but it's mostly at the community level and it was a 40-year effort to do it. i don't flow why we can't do the same thing in africa, why we can't do -- you set up the school in of course a. you don't have it in the west. and you fund it over a very long period of time and you do a train the trainer approach. so we have done one thing. now they don't train for pandemics. they do it for fast onts natural disasters like earthquakes and storms all that. but there is no reason it couldn't be expanded to the larger community. and i went down there and saw it 30 years ago and i took over the directorship of that- -- of the office under bush 41. there are models. >> if i could just very quickly say, andy introduced me as the ebola czar. can i tell you there is nothing as unczar-like as being in charge of a response that involves the u.s. health care
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system. and you know, when we had one days of ebola in texas where we had unthe texas system most of the ke decisions were being made by a state court judge, claygenicens a great man, but he was the commissioner essentially that oversaw the county in a county that was in a state with governor perry as the govern and a state public health director, and county public health director, and you know, very, very unczarry in washington was how this worked. and -- and so one thing that i took out of that was one great way for local -- and i think the -- the plurality -- the pluralism in our health care system, u.s. has a great strength and weakness. right? it's a great weakness in that there isn't that kind of command control that you really love to have in crisis. during the ebola response every week i did a call with the counterpart in the uk.
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every week we benchmarked who was sending more health care workers to west africa to respond. i would report on the 52 calls i had done to 52 health care systems begging them to send people he called teld me he would call the national health service and sending 60 more pan they took five minutes. and i got very envious of the you know i tear health care system. until at one time the nurses came home with ebola and the union voted to send no one else. and we were still sending people and they weren't in the uk. there are strengths and weaknesses to the patchwork system we have in america. but i think one thing i took away from the ebola response was that it would be great if people upon the local level organized exercises where you put everyone in the room, the local public health people, the local providers, the private providers, the public providers, the first responders, community
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leaders, the political leaders, the state political leaders, and you saw what would happen in the event of one of these -- of some kind of incident like this in your community. and nothing is going to make the people in that room more connected to global health than going through the exercise and understanding that by the time it gets to houston it's too late. and the kind of problems you're going to have are too late. at the end of everyone of the sessions everyone says hey with what we need to do is go to washington appear get nanld in global health. if wed kind of go got -- it's one of the things think locally act globally in the sense when you see how hard it is to manage city by city in the u.s., county by county, town by town, you realize you need to take all the different players and plug them into a global health awareness. >> one of the concepts we use at bios is what we call one health. and by that we talk about the interrelatedness of health of wild animals and domestic
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animals and domestic crops and the global health community and the domestic health community, bus, gwen, as the world shrinks and it's increasingly interconnected, the ability ability of path agains to travel across all boundaries is greater than ever. all health planners and administers, managers have to think that way. it's a lot of thinking to do. and it's hard to get out of your local responsibilities. i understand that. but a number of have to be thinking that way about all of that and all of those interconnections. >> another question here. >> thank you. i'm month eek manseur with the meider corporation had the prifrmgs of working for. i'm asking you to envision a where we have the structured replaces and the effective communications and a health care system works for us i want to focuses on the meld medical countermeasure the conant and ensuring we have the asset to
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saves lives. and ask the question if we could view the suppliers of that asset as a critical element of our industrial base, the way we think about the defense industrial base and all the components that make the jet fighters and the aircraft carriers. it doesn't seem like we view it that way. it's a series of transactions. we have a threat. we have a requirement. we enter into a transaction. but we don't have industrial based policy. we don't have industrial based assessment. we don't look at the fragile nature of some of the companies and supply chains. so i would ask you, sort of your sort of perspectives on that lens on the medical countermeasure enterprise and also this idea database mr. klain you just remarked on exercising, right. can you imagine exercising making a vaccine -- actually making -- having a system where that industrial base in the biopharmaceutical sector is tested and evaluated upon a
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regular basis so that if we establish that capability even if that event doesn't emerge into the next outbreak, major outbreak or pandemic that we have tested and evaluated that capability. thank you. >> by the way, we have -- we did a simulation at our conference in october of last year by students -- ph.d. students, masters students across the texas a&m. and they wrote up a paper in your folder in addition to the white paper. frankly it's as good as the white pap is. it's very well done by our students who went through this simulation and recorded after any did it more research on what their conclusions were. i actually think simulations are very valuable. just one little story. i went on a simulation -- this is about ten years ago in north korea. and there was an admiral, a friend of mind a retired admiral. i said soum of those have you been through.
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he said 22. he said how do they all end? everyone ends in a nuclear war. >> i said really. >> he said do you know why we're in south korea? it's because of the simulations. there are so scary that the policy makers who see the results of the simulation prevent the two countries from going back to war again because of what it's going to mean. it's going to escalate. it zlated in the one i participated in. there was a nuclear war. not a real one but obviously in the simulation. so i have to say one thing we could do that's not politically impossible is to do what the dod does all the time is to do simulations of wartime training exercises. i think a. id and c.d.c. ought to manage it because they have roles in this and do it on a regular basis with the community but also in the developing world and the u.n. system on a regular annualized basis with pennsylvania regular budget and get the reporting out to policy makers is what comes out of the simulations. that's my little --
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>> i would respond, just as i said earlier on that the federal government's responses as well as the state government responses pr siloed and not interconnected and not coordinated. the private sector, the companies that are members of my organization do a grand job but what is needed is a level of coordination that is bigger and bolder to create new platforms to have the capacity to -- to surge, to have the capacity to share manufacturing facilities, and turn around in realtime and very quickly to have a more ewe i fieed system unified system of diagnosis capabilities around the country and the world. and the bioterror system we have the systems developed after 9/11 where we had sensors all over the place supposed to be able to pick up when events are occurring, complete shamables. virtually useless.
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and no matter how many times you've been banging on the heads of the federal government to modernize and update the systems they are woefully neglected and incompetent. >> the only thing i'll add to that is i agree. we need to think more strategically about this. i grow with the idea of thinking about the critical countermeasures as a sector and wlar the things we should do governmentally to increase capacity in the sector, increase responsiveness. barta is supposed to have the role in some respect but they need more funding and more strategic leadership and more strategic empowerment to do that. again, it's why i think there should be someone at the white house whose job is every day, seven day as week, 10 hours a day to get up in the morning and think about how to build a plan to do this, and how to make it happen. i think, you know, i had a lot of great teachers taking over the eebl oi response.
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unwith thing tom always emphasized was that you're going to respond to the crisises by flexing up the existing system if you are going to be ready what you can't do is hope you're going to build a magical capacity in the emergency moment. you have to have strong robust health care systems with a lot of capacity doing well and then, you know, try to amp that up in the event much crisis. and it starts with what the day to day looks like. and there are things process the health care system that are strong on a day to day basis. things less sfron strong on a day to day basis. but vechg in the core health care systems is the best way to have the capacity you can flex up in a time of kriez. but capacity is a critical issue. everyone says to me, well why don't we have hundreds of hospital beds someplace we could put people with the the infectionuous decease and isolate i said can you imagine building hundreds of beds and keeping them echt, empty.
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imagine having the vaks on a mchgt capacity and not use going. so it's sitting there. we have so many health care needs and that you'd have spare capacity is a hard thing to imagine. it's a hard thing to consider. and if that's true in our country think how true it is in other countries. doubly and triply true in other countries. i think it's really about investments and the core system making a stronger health care system and having the ability to die dial it up and amp up in the event of crisis. >> i would like to thank the staff of the scowcroft institute and off the veterinary school and dr. parker's leadership and our staff for their efforts and the -- texas a&m students here, checked everyone in for all their work. please. [ applause ] . >> well, we have come to 1,700 and that's 5:00. and this has been an outstanding day. we -- we have i think learned a
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lot. unfortunately some of these issues are not new issues. like i said in my opening remarks. and we have simply got to find a way we can turn these longstanding lessons observed into lessons learned. our nation and the international community deserves it. and i want to thank our last panel or getting in some of the strategic issues [ applause ] and everybody that's made this possible, the scowcroft team of course. everybody back at the bush school. college of med, and of course our time to pay tamis federal relations office here in washington, d.c. this concludes the third annual pandemic and biosecurity forum. we will keep in touch and continue this dialogue. thank you very much. november 11 -- november 11 to 12th. please join us at the anna byrd
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conference city at the bush school of government service at texas a&m university for our pandemic and biosecurity summit that again will be in chat ham type rules that will begin our policy process once again. thank you very much. [ applause ] well congress will wrap up its weeklong memorial day district work period this coming monday. the house meets at 29 p.m. eastern to consider the $19 billion aid package blocked during the recess leaders tried to get the senate bill pass approved by unanimous consent however it's expected to pass in regular vote and and then sent to president trump. the senate golfs in monday
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at 3 eastern and will continue work on executive and judicial nominations with andrew salt to have the social security administration coming up first. watch the house live on cspan and the senate on cspan2. watch commencement speeches all week on cspan. tonight, at 8:00 p.m. eastern. speakers include supreme court justice sonia so the mayor at manhattan college in the bronx. cindy mcmcmahon delivers remarks at the jornl washington school of international air force. looking back to june 1990 and former first lady barbara bush speaking at wellesley college. >> watch commencement speeches tonight at 8:00 p.m. eastern on cspan. watch online any time at and listen on the free cspan radio app. up next, the naval chiefs of germany, new zealand and romania talk abo


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