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  • welcome to the third and final lecture of the spring in our series on emerging diseases in a changing environment.

  • My Coaster Home, director of the Center for Infectious Disease Research and Policy, which is an organizational member of the university's consortium in law and Values.

  • This lecture series, as well as two previous ones, are presented by the university's consortium in Long Values and Healthy Environment in Life Sciences is Institute in the Environment, as well as the Center for Infectious Disease Research and Policy and the Food Protection and Defense.

  • All are co sponsoring today's event.

  • I'd like to thank the Planning Committee, which includes Lewis Gilbert, managing director of the Institute on the Environment.

  • Amy Kirshner, who you'll hear from later from the Food Protection Defense Institute and last but not least, Susan Wolf, who chairs the consortium.

  • Who is what I would call the yeoman of all the people who work on things like this at the university and amazing asset to our group here, I like to think the consortium staff for all that they've done.

  • The consortium itself is a university wide center that links 20 leading university centers and programs to address cutting edge societal issues posed by biomedical science and life sciences combined.

  • Our speaker today is Dr Julie Gerberding, executive vice president, chief patient, Office of Strategic Communications at the Global Public Policy and Population Health at Merck.

  • A lot that she does she's here to speak today on combat ing microbial terrorist.

  • How to end are prepared in a stalemate I will introduce for forming a few minutes.

  • Doctor Gerberding will speak for approximately 45 50 minutes.

  • Well, then, here our faculty commentary from Professor Amy Kirshner, who drives I'm luncheon before, directs the Food Protection and Defense Institute.

  • I will then introduce her at that time, and she will speak for about 7 to 10 minutes.

  • In terms of you is the audience.

  • We will open up the floor to questions and comments.

  • After the two presentations, we have two microphones here in the audience.

  • I ask you to go to either Mike, We ask you that you also identify yourself, asking a question before asking the question so we can get to know each other and the great expertise in this room.

  • As with most consortium lectures, this even is both being videotaped and the simulcast webcast occurring the video you posted on the consortium Web site in about 10 days.

  • For free public access, please silence all cell phones and other electronic devices.

  • Anyone's who's goes off first is paying for lunch, so please get that done now.

  • If you need to exit the room during the event, please the doors to the rear of the room and not the doors near so stage.

  • Since this will get into the filming of the Webcast to get continuing medical education credits or continue legal education credits for in person attendance, you need to complete and submit a participant tracker form at the registration table is just outside the entrance to this room.

  • Sally Credit is also available for those participating via Webcast by emailing the consortium at c o N S o r T m Consort him at you mn dot e d u.

  • Other health care professionals considered a statement of participation to their appropriate accrediting organization or state board for consideration of credit.

  • An evaluation form will be e mailed to you right after the event.

  • Please be sure to respond.

  • We do pay very close attention to your feedback by way of disclosures, Doctor Gerberding is an employee and stockholder in Merck and Company and serves on the board of directors of the Cerner Corporation.

  • There are other disclosures to report.

  • Copies of all disclosure statements are on the registration table for those who wish to review them.

  • Our speakers and committee planning committee do not have any relevant disclosures now.

  • It's my dear, dear, dear pleasure to introduce our speaker today.

  • Dr Julie Gerberding and I go back more than 35 years.

  • We've worked close in a number of capacities and sell this introduction.

  • While it has to be formal for the purposes of this meeting, it is truly meant from the heart.

  • Julia's executive vice president, I mentioned in Chief Patent Officer, Strategic Communications, Global Public Policy and Population Health at Merck, where she also is responsible for the Merc for Mother's program and the Merc Foundation.

  • As chief patent officer, Dr Gerberding leads efforts to engage with patients and patient organizations to bring their perspectives and American to help inform company decisions.

  • Dr.

  • Gerberding served as director of the Centers for Disease Control and Prevention for seven years from 2002 in 2009 a time that I was fortunate to work very closely with her in that position.

  • She led public health initiatives in response to crisis such as avian influenza, natural disasters and the anthrax bioterror me that originally joined the CDC in 1998 to lead their division of health care quality promotion.

  • Having previously served as director of the Epidemiology and Prevention Intervention Center at the San Francisco General and a tenured academic faculty at the University of California, San Francisco, Doctor being attended college and medical school at Case Western Reserve University and trained in internal medicine.

  • Infectious diseases in clinical pharmacology at San Francisco General Hospital and you see us out along the way, she earned a master's degree in probably Callous from the universe California, Berkeley without any doubt that among all of the leading public health figures of the last several decades, Julie is right at the top, both in what she's done, what she's thought about and what she's made others think about Today.

  • I can tell you I could give her a lot of credit for any of the things I ever get right, and all the ones that get Rog, I'll give I'll take responsibility for So it's with my real pleasure Niner introduced Dr Julie Gerberding.

  • Good afternoon or good morning and thank you.

  • Um, it is truly an honor to be back at the University of Minnesota.

  • Um, I was actually born in Minnesota at ST Mary's Hospital at the Mayo.

  • So it is really coming home, even though that was a long time ago.

  • Um, it is wonderful to be here among friends and to have such a welcoming introduction from my dear friend, Dr O Sir home.

  • I also acknowledge that my family lives in Minnesota now.

  • My daughter in two grandchildren live in the cities, and later this week I will see my granddaughter for the first time, So that's very exciting.

  • So today I'm going to talk a little bit about the broad perspective on antimicrobial preparedness and really get to the heart of the issue of why do we keep having meetings on this subject?

  • Why do we keep talking about the threats and the problems?

  • And yet seemingly we're just not making the progress that we need to make.

  • And I will review again my interests and conflict of interest because I'm required to do that from a legal perspective from my own corporate vantage point, but also because I like to share the fact that I have a history of being academically involved, involved with business, but also involved in some non profit and global health organizations.

  • But the most important thing is in the picture, which is the last time I attended at San Francisco General Hospital and had a wonderful patient who told me his story of infectious disease and reminds me that at the end of the day, my main interest is in medicine and being a doctor in it the end of the day That's really why we're all here together is to help protect people and ultimately to make sure they get the care and health protection that they need.

  • So my objectives for this conversation are very simple.

  • I first want to just review the issues that drive the emergence of bio threats to describe a little bit about what I call the bio preparedness paradox to try to understand why we have such a difficulty in bio preparedness and then what can we do about it?

  • Going forward saw on My history in this world really did begin on September 11th in 2001 11 days into my tenure as the acting deputy director of the National Center for Infectious Diseases, a position that Dr Jim Hughes, the director of the center, asked me to assume temporarily while he recruited for a permanent deputy.

  • And on September 11th I came to work, I turned on the television.

  • I saw what was going on in New York, and I was like the rest of the nation incredulous at what had happened.

  • But that moment in time, in that sort of coincidental position that I had having some accountability for the overall infectious disease out look at the CDC really brought me to the front line of what followed the 9 11 attacks.

  • And, of course, that was not just the sadness that those events brought, but the aftermath of anthrax and then ultimately, ah, whole series of issues.

  • So for me, it started on September 11th very quickly.

  • A month later, the anthrax letters were sent and we were immersed in a absolutely incredible investigation in response to that confusing and chaotic tragedy.

  • You may recall that there, after we were immersed as the West Nile virus marched its way down the east coast of the United States.

  • Then there was a small problem over the summer vacation of monkeypox, followed in March with the SARS outbreak.

  • Then we launched a smallpox immunization program, which was obviously very controversial and challenging.

  • Avian influenza popped again in Asia.

  • Mad cow disease ruined my Christmas, and pretty much this was how I experience my time at CDC.

  • So I was really immersed in the crucible of the outbreaks and the public health emergencies that were occurring and very quickly came to realize that bio preparedness was critically important.

  • Part of the CD sees global leadership role and that we had a lot of work to do to bring ourselves to full capability from that perspective.

  • But during my tenure at CDC, we had many public health emergencies beyond those that were accounted for by infectious disease threats, and 43 times our emergency operations center was activated.

  • And while most of these involved infectious disease, there were also a series of hurricanes, including Katrina, Wilma and Rita and several others, um, the space shuttle explosion, which resulted in the potential for chemical hazard exposures in the fallout from that, there were issues related to political events such as the national conventions and a lot of things that go on behind the scenes the coming through the threat assessment agencies that don't necessarily make the news.

  • But we're reasons to activate and prepare for a potential need for a public health response.

  • So I became very familiar with kind of the crisis environment that we operate in on the front lines of public health, and it caused me to try to understand and really study what is a crisis.

  • What are the kinds of crises that leaders have to understand and deal with in a public health sense?

  • And where are we in the world?

  • So in preparation for this talk, I Googled crisis just from the beginning of April until Sunday and looked at what kind of crises are we currently experiencing in the world?

  • And this is what Dr Google told me, Um, we have the deal.

  • Political crisis in Venezuela, which is tragic if you're in that country, were dealing with certainly the complexities of the North Korean crisis.

  • We're dealing with the Syrian crisis as well as the Russian crisis that goes along with it.

  • We have the financial crisis related to our budget and potential shutdown, the need for tax reform and improvements in our capitalization the United States so that we can deal with the tremendous infrastructure crises that we face all over the country.

  • We have a social crises such as the heroin crisis that is so serious in some communities that the morgues are too full of young people dying that they can't even get the autopsy's done and prepare for appropriate assessment and burial.

  • We have the crisis of student debt, which is potentially an issue here in Minnesota, certainly was when I visited U C Berkeley a couple of weeks ago the health care crisis we are all familiar with, um, the violence, crisis, the guns, the school shootings, all of those crises and again remind you what I'm just talking about the first 10 days of April, the U.

  • N humanitarian crisis, description of the food security or insecurity.

  • I should say environmental issues such as this example of what's happening with salmon populations and the environment.

  • Reputational crises.

  • YouTube, Most recently, United Airlines, suffering a huge 1,000,000,000 plus dollar, hit its financial valuation, not to mention the reputation, the crisis associated with natural disasters.

  • Again, from a California perspective, the flooding is still an issue in San Jose.

  • The dams are still at risk for disruption, ungh, going local crises, even in our own backyard, so to speak.

  • So, um, from a Google perspective, we're dealing with a number of local, regional and global crises simultaneously, all in the news in just a few short period days of time.

  • But notice what was not included in the list.

  • I had to get to page 15 of the Google search response before I got an infectious disease outbreak listed as, AH, crisis in the world.

  • And this was what it was.

  • The cholera crisis in Somalia, which is sort of a juxtaposition of a lot of different kinds of Gracie's, including geopolitical, humanitarian, natural disaster and so forth.

  • So while we live in a world that is constantly being exposed to very important issues and challenges in the minds of the people who are using Google, or at least the minds of the people who have designed the algorithms that lie behind the Google search engine, um, the kinds of things that bring us together here are not necessarily top of mind, and I checked to see if it was this a fluke, or is this something that is prevalent?

  • This is a longer period of time Looking at in the Blue Line, Google searches on a relative scale for various crises and in the red Google searches for infectious disease.

  • So you can see that, you know, infectious diseases air not ranking very high in terms of level of interest that people have in them.

  • And you can go back for any period of time on Google trends.

  • And you'll see pretty much the same pattern everyone said about.

  • There's a tiny little blip in the red, but it's still piney compared to everything else that people are looking for.

  • So thank goodness for organizations like Sid Rap, who, despite the fact that there's a generalized lack of focus on these problems in the media.

  • There are places where people are tracking the ongoing outbreaks that we're experiencing and trying their best to keep them in the news.

  • This was just, um I forget what day this was a couple days ago from CID rap, but, you know, mentioning the H and 92 in pigs is anyone hearing about that on the front page of the Star Tribune, probably not.

  • Age seven and nine cases in China.

  • If you dig deeper, you'll hear about more cases of MERS, avian influenza and so on and so forth.

  • So these problems are ongoing.

  • They're just not grabbing the attention.

  • And this is the most recent healthmap on a global basis that illustrates where outbreaks are occurring today in the world.

  • Because I took this off the map this morning.

  • So these problems are occurring there, just not experienced as crises, and I think it's really important for us to understand why.

  • So, first of all, why should we care?

  • These things are part of our nature.

  • They're part of our eco system.

  • They go on from time to time, sometimes severe, sometimes not so severe.

  • Do we really need to be concentrating on them when there's so many other important crises in the world that are of immediate relevance to large numbers of people?

  • My own view, of course, and I believe I'm probably preaching to the choir in this audience is that we absolutely must do more to focus on these threats because if anything, we're going to see more and more of them, and the scale of their impact is going to get larger and larger because of the macro trends that are going on in the world.

  • One of the most important macro turns is urbanization and the incursion of human beings into environments that previously were relatively privileged so that things circulating in a zoo, not IQ or even the ah plant world environment.

  • We're not coming in contact or not becoming vulnerable to spread and rapid movement from one location to another.

  • But just look at the projection of the Red Line, which is the world's urban population were just here at the crossover point in 2014.

  • But as the next decade progresses, we're going to see an ever increasing proportion of the world's population living in large cities and pushing into, um, the what previously would have been rural areas.

  • I live in a semi rural area in Pennsylvania, and I watched this unfold in my little seven acres, where we now have coyotes who patrol the river front.

  • We have lots of fox.

  • I have acquired pastorello infection.

  • My husband and I have each had Lyme disease twice, and we're living.

  • I'm I've had Barton Ella.

  • We're living sort of in a micro tax book of zoonotic diseases because we are pushing into nature and, um, not giving animals enough room in space to occupy their normal habitat without our presence.

  • Um, certainly, first and foremost in this environment are the mosquitoes and the mosquito borne diseases.

  • And I've illustrated four of the most important mosquitoes in the world, in part because there's a little less and this these air such good photographs, which I believe I captured from the CDC.

  • But it really helps you identify mosquitoes.

  • So if you're looking at a mosquito and it has a hunchback, that's a cue LX mosquito like that went up there.

  • If the mosquito appears to be standing on its head, it's a monopolies mosquito.

  • You can see it's almost perpendicular to the skin.

  • And if it's ah, um, a new eighties mosquito, you can see that they're sort of event like this sort of a cricket mosquito.

  • This is the tiger mosquito here.

  • So, you know, should you be interested in what mosquito is biting you?

  • Um, this hopefully will give you a clue, but I would discourage you from allowing any of these mosquitoes do bite you because none of them are friendly.

  • Um, so hopefully you won't actually get that close.

  • But the the point here really is that mosquito in vector borne diseases are becoming extremely important.

  • We've seen that with Zika.

  • This gives you the global map of where both Egypt I and Elbow picked us are located in the world.

  • And I'm particularly interested in this map right here because it tells us certainly where we would expect Zika to go next If albopictus really becomes an efficient host in Vector for that pathogen.

  • But as we move into, um, sylvan environments, we can expect more contact with mosquitoes and more opportunities for mosquitoes to transmit diseases.

  • So we need to pay attention to them and have much better surveillance.

  • One of the most exciting parts of the CDC is the vector borne disease unit, which is not only in Fort Collins, Colorado, led by some of the best scientists I've ever met.

  • But also I'm thankfully in the field station in Puerto Rico, where they were just ideally positioned for the advancement of these vector borne diseases.

  • In some of the sentinel work that helps us understand and evaluated in a population basis.

  • What's going on?

  • Went One of the most exciting things I did at CDC was to go to Puerto Rico with the team when we were looking at Denkinger transmission there and going to people's homes with a little vacuum pack on my back and vacuum out the mosquitoes that were in the closet or behind the curtains because the team was conducting ongoing surveillance of what mosquito species were in people's homes and what viruses were those mosquitoes carrying?

  • So just keep in mind in the background of the world that we're living in today, there still are the frontline disease.

  • Detectives are doing old fashioned field epidemiology, but then, when something happens that epidemiology becomes so critically important.

  • And yes, I'm making a case here for why we need a strong and well funded CDC.

  • Let's talk about you know, the tragic situation of Ebola and and the outbreak that occurred in Africa.

  • You know, up until that time, there have been 23 outbreaks of Ebola, very small in relative terms, until this giant outbreak occurred in West Africa, and I know you've heard a lot about that, so I won't dwell on it, but suffice to say that the main issue here again is incursion, where we have people moving closer to vectors in this case bats, um, and the spill over into the primate population, or perhaps other mammals, and then the, um greater and greater connection with people and intermediate hosts or the reservoir.

  • The back and same principle applies.

  • Look at where the distribution of bats lies in Africa through Equatorial Africa and then think in your mind.

  • Where are the largest number of people?

  • That region includes Nigeria, and it includes the populated cities in the West African continent.

  • So you can see that the bats that harbor the hemorrhagic fever, viruses and people are increasingly located in the same place.

  • So we have to follow the bats.

  • And I would say that we probably have much better mosquito surveillance than we do bat surveillance.

  • But bats are extremely competent.

  • Vector off human pathogens.

  • The list is long, mostly single stranded Arnie viruses, but many very serious diseases besides Rabies and Ebola are harbored, and rats need Mahendra, um, the Marburg and the various species of Ebola, just to name a few.

  • And you might wonder.

  • Why do bats, um, have so many viruses that are so deadly to people?

  • And I don't think we actually know the answer to that, and we probably haven't invested enough in that kind of mammalian research.

  • But there are a few things about bats that intrigued me.

  • And if there any bet ologists here, correct me if I misspeak.

  • But you know bats fly and that they're really the only mammal that flies and when mammals by their body temperature goes up.

  • So by definition, any virus that lives in the bat has to be relatively temperature tolerant, right, or it wouldn't survive the bat movement.

  • So when that temperature tolerant bad is introduced into a different host, what's the first line of defense fever?

  • Well, fever for these bat viruses is not a particularly effective defense mechanism.

  • There are other things about bats that are worth studying.

  • They rarely get cancer kind of interesting, and they don't seem to get sick with the same virus is that they can pass on to other mammals and cause fatal disease.

  • So we have a lot to learn about the bats, but the one thing we know for sure is that they're on every continent except maybe Antarctica.

  • And they are a very important positive influence on our eco system in terms of what they do it for combating mosquitoes and transporting seeds.

  • But also they are vectors of some pretty important diseases, and I just want to point out this little frightening article and emerging infections describing the confident bat antibody antibodies in bats in Bangladesh.

  • Think about Ebola in Asia.

  • Let's think about what that would mean if we were to see the same kind of spillover in Asia that we saw in West Africa because we've already seen how rapidly diseases can be transmitted in that environment.

  • So we need to be prepared for these these opportunities for devastating outbreaks now, second macro tend, I know is also familiar to people here.

  • 93,000 commercial flights a day.

  • So the translocation of people just through the normal process of global travel is absolutely astonishing.

  • Um, and it should have been a predictable surprise that sooner or later, someone from South their Western Africa was gonna end up in the United States and cause a great deal of difficulty for our health care system.