Placeholder Image

字幕表 動画を再生する

  • 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.

  • When it happened But it isn't just about travelers from the region who were infected locally.

  • It's also about health workers and medical relief.

  • Again, we saw this with Ebola, and I experienced it firsthand in Haiti when I was volunteering at same one of his hospital and find a blonde Haiti.

  • Um, I think most of you are familiar with the cholera outbreak in Haiti, but it's one thing to read about it in the newspaper, and it's another thing to experience it first time firsthand.

  • I was in Haiti in March of last year, in 2016 and as an infectious disease doctor who's been pretty much everywhere in the world.

  • I had never actually seen cases of cholera.

  • And so it was shocking to me to go to this wonderful hospitals, a fantastic hospital in the south western part of Haiti.

  • But to see the cholera tents with the you know, the sheets Thorne so that the, um diarrhea can be collected and pots.

  • And we went out to the river where people get their water and we know from some good happy that that little boy is gathering his family's water from water that's contaminated with cholera and so to stand there and watch this and yet appreciate that they really don't have any choice.

  • And they can't even afford the cheap chlorination tablets and safe water vessels in these villages.

  • So this all happened before the most recent hurricane in Haiti.

  • So my colleague, former chief operating officer at the CDC, Bill Jimson, is acting as the managing or the chief operating officer of this hospital.

  • And, ah, you know, of course, the, um, hurricane precipitated a very large increase in the number of cholera cases.

  • Massive cholera outbreak because of what little infrastructure existed prior to that was completely devastated by the flooding, the mudslides and everything else that went for and went forward.

  • So we're kind of seeing, um, the medical tourism link here being that collar was not in Haiti for 100 years until the medical relief workers came in for the original earthquake response and brought the Nepalese cholera to Haiti, which has now established itself in the bay.

  • Interestingly, the bay in Haiti is that the same latitude as the Bay of Bengal.

  • So we have now in dodging this cholera cycling through the algae in the water and when people are not receiving sanitized water, the cycle just gets amplified over and over and over again.

  • I don't think it will be my lifetime before cholera is gone from Haiti, because it's just almost impossible to manage that.

  • So again, an example of a macro trend of what happens when you take the complexities of incursion, the complexities of the dislocation and movement of people from what part of the world, even for humanitarian purposes, and then couple it with social disruption and displacement.

  • Like this slide is a couple years old, and it says, I think, 59 million people.

  • I think the current figures 64 million displaced people in the world today.

  • So obviously that adds to our challenge.

  • And then linking Ms Altogether is, of course, climate change.

  • How many people had heard of zombie anthrax?

  • So you know what is happening in Russia is that the tundra is thawing.

  • And, you know, years ago, when animals had anthrax, they buried them.

  • So as the tundra thought the buried reindeer that had died from anthrax were infected with anthrax when they were killed are then exposed and people are eating them and or coming in contact with them and other ways.

  • So there's been a human outbreak of anthrax as well as ranger outbreak of anthrax in this area.

  • So an extreme example of the effect of climate change, but a very real example of exactly how rapidly our world is changing and why these bio threats are emerging.

  • So I've tried to make the case that, you know, we're not paying a lot of attention to these things, But they're going to continue to emerge.

  • And I predict in greater scale and in more unusual locations, be harder and harder to manage as our macro trends continue.

  • And so the question is, Are we prepared?

  • Or maybe more accurately, how prepared are we?

  • And that kind of brings me back to those anthrax cases that we experienced in 2001.

  • This is just the epi curve for, you know, the letters and the cases, the 22 cases that occurred at that time, and I don't know if you can remember, but I sure remember the incredible disruption that this caused across our entire postal system, the U.

  • S.

  • Congress shutting down.

  • You might not know that the State Department was affected because one of the letters mistakenly went to the postal station, where the diplomatic mail pouches are also handled.

  • So there was concern that powder could have gotten into the international Embassy mail system, et cetera, et cetera.

  • It was an astonishing and difficulty situation and as a consequence of our recognizing at CDC and elsewhere that we had a lot to learn about how to manage such a complex and international outbreak situation.

  • We initiated a whole set of after actions reaction after action reviews that Jim Hughes really pulled together for the National Center of Infectious Disease.

  • And we met with the disease investigation teams that the FBI with state health officers, hospital officials, all kinds of law enforcement agencies, the State Department.

  • We just brought anybody in who had anything to do with this and try to learn from them.

  • What did we do, right?

  • What didn't we do right?

  • And what do we need to learn to do better going forward?

  • And we came up with sort of ah ah list and I won't go through them in detail, but just to give you a flavor of what some of these issues were in terms of coordination and collaboration just how difficult it was for the CDC as a medically oriented epidemiologic investigation team and the FBI investigation team.

  • Who is there to try to find the killer with the criminals and bring them to justice, How difficult it was to develop unity of effort and who really was in charge of something this complicated.

  • And how do we interact with state locals, where the action really is going on and what kind of overall strategic and tactical integration is required?

  • We also looked at competencies.

  • It's one thing to manage a relatively small US outbreak.

  • It's quite another thing to manage an outbreak that's going on in multiple jurisdictions and the kind of decision making.

  • And I'll say the Team B effort, meaning while you're in the middle of responding, it's very difficult to step back and think, Um, are we asking the right questions?

  • Is our approach evidence based?

  • Are we making the right decisions?

  • So how can we create cells of people that are onlookers to the process and help judge our performance and help us correct as we go forward?

  • In that context, so many areas of competency that required development not just at CDC, but across the whole system also capacity.

  • You know, again, small things are easy.

  • Big things are much harder just in context.

  • This are a number of specimens that are US State laboratory network, Little Laboratory Response Network was asked to handle and powders and environmental samples during the anthrax investigations.

  • You know, no lab can accept search capacity at this level in a timely way, which has had no capacity to really manage.

  • What if you remember we're just a few letters and 22 cases of disease, so it really the multiplier here is immense communication.

  • And what did it mean to be able to kind of go through the progression of really not saying anything initially?

  • Because as a scientific culture, we were more concerned about getting the science right to estate were actually understanding that we had to be out in front of where the next public is.

  • She was going to be, because that's really what restored confidence and credibility in the process so fast forward to Ebola.

  • Well at all of these, after action reviews with anthrax, we went through this again with SARS, mentioned several other outbreaks and experiences that we had Zika after action reviews haven't been done yet because we're still in the middle of it.

  • But here we are, most recently with the Ebola and the after action review from Ebola, which is in a much nicer format.

  • Nice report looks really good, Um, but you know, what did we learn from the Ebola after Action review?

  • Well, if you go through and read the highlights of the report, you'll see that there is a great deal of discussion about coordination, about collaboration, coordination, communication, scaling and capacity.

  • Um, the black of countermeasures, the difficulties that we had with managing travel, personal protection equipment, different jurisdictions.

  • Who's in charge, Um, and fundamentally that Health and Human Service is, and its agencies were not funded to sustain a long term, prolonged public, healthy, emergency overseas or at home.

  • So, amazingly, it's the same list.

  • It's exactly the same list that we saw after the anthrax attacks and that foundation.

  • Aly is why I'm here today because we know they're threats exist.

  • We know that they're not going to go away.

  • We know that we need to do something, but for some reason we're actually not getting it done.

  • So why is.

  • Well, if that really was my message over here, deja vu all over again, again and again.

  • Why do we keep going through this cycle of a problem occurs, we respond, we learn we invest and then time goes by.

  • Problem occurs, we respond, we invest the cycle repeats but not repeating in a way that really gives us confidence that we've solved the real underlying issues.

  • So I refer to this as the bio preparedness paradox that despite all this evidence that these human and animal pathogens that can cause significant local, regional and global humanitarian, social, political and economic damage, it's pathogens are emerging and or re emerging at an accelerated pace.

  • But bio preparedness remains alarmingly inadequate, not just in the US but certainly on a global basis.

  • So, um, you know that, um, Mike and and, um, Mark have published a recent book called The Deadliest Enemy that really puts thes threats into four main categories of prioritization, and I certainly agree with this categorization.

  • I thought this was a really nice way to bring the threat assessment into ah uniform package.

  • But more importantly, this book lays out nine things that can be done to improve our preparedness on that.

  • This is a very good list, and I agree with everything on this list.

  • A cz well, I also think this list resembles lists that have been published before.

  • In some ways, that may be not as comprehensive.

  • The blue ribbon panel has a list of recommendations on the global CG.

  • I has a list of recommendations.

  • There are many people have tried toe pull this picture together and really say, What do we actually need to get done?

  • There's not a lot of disagreement about what we need to do, but the question still remains.

  • Why aren't we doing it?

  • Why is it that we know these things and we know what could be done?

  • But we're still not succeeding?

  • Well, um, in a sense, one of the main issues is that we do operate in the spirit of complacency.

  • As soon as something is off the first few pages of the Google search, it goes away in our mind, you know, like the ostrich burying its head in the sand, refusing thio actually acknowledge and confront a problem exists and failing to act.

  • If you google this, um, you will learn that the behavior of an ostrich sticking its head in the sand has never been observed because, of course, they are not likely to survive very long if they buried their head in the sand.

  • And that really is maybe the take home message of everything that I'm saying today.

  • But, you know, that's just take, for example, the MERS outbreak that's going on primarily in the Middle East, although certainly a huge spill over into Korea and other countries around the world.

  • I'm here we are in April, seeing that we're still seeing cases of murders we're not out of the woods on.

  • Murders in any one of these cases could end up in our hospital tomorrow, right the same way One of those patients ended up in Korea and precipitated an enormously challenging outbreak situation in Korea.

  • But who's talking about MERS?

  • Maybe.

  • Besides, said rap, it's really not on the radar screen.

  • So we've become complacent about this problem, not really focusing on it, except for a few people in in a few locations.

  • The second issue, I think, is that we have competing priorities.

  • I went through all those crises at the beginning to say what share of mind is left over to think about infections when you've got all these other frontline issues going on, and that's a fair concern.

  • You know, people can only manage so much bandwidth on so much attention for any given crisis mode at any given point in time.

  • So we do have competing priorities.

  • But I think a bigger part of this problem is there's actually confusion about risk.

  • Um, I used to use this list as a partial explanation for why people are complacent that, you know, people don't know who to believe about the risk.

  • There's a lot of fact confusion and a social media has become more dominant in its influence.

  • There's less editing unless adjudication of the information people are seeing and when the one thing that confuses people more than anything is when they hear two.

  • Experts argue up different sides of a factual issue, and you know, our media, particularly our television media, are very good at doing this.

  • They love to take some reputable expert and then some person who's a kook and put them side by side, as if there was a 50% probability that each knew what they were talking about so they artificially endorse or enhanced the credibility of people who really have no business talking about things that they don't know anything about.

  • There's also the issue of, you know, the our desire to keep threats away like, Oh, that's happening in West Africa.

  • That is certainly not going to be a problem here or if it happens here, no problem.

  • We're prepared.

  • We can handle it.

  • Our hospitals are ready just a lot of over confidence in what we can do.

  • And I think here, Justin, under appreciation of the overall context in which were operating.

  • So it is really important to understand how human beings think about risk, and they're really two platforms for this.

  • The first is what I, as a scientist, think of as risk assessment, which is this very, You know what the are You know, that what's the transmission coefficient was the mortality?

  • What's what's this population impact?

  • How fast is it spreading all the things that could be either measured or modeled or somehow quantified in terms of mass that I can understand and compare and taken to a consideration?

  • And of course, all that is amenable to testing and revision versus risk.

  • Perception, which is a very different mental processing misperception, is intuitive.

  • It's more visceral and were designed as human beings to be pretty good at this because we need to be able to respond quickly if the threat pops up.

  • But the problem is was very influenced by prior experience in context.

  • So if your prior experience was the last time, we they said we were going to have a terrible flu pandemic.

  • Nothing happened.

  • Your experience is that I don't really feel this as a threat because I've been here and done this before and the last time everything turned out okay.

  • So this is also very obviously influenced by the media and by the social context in which it's occurring.

  • Although truly trusted people can break through this perceptual framework of risk assessment and help people get, ah more, um, assessed version of risk.

  • And I want to take this just one step further because I think how we talk about risk as professionals really influences how well we do in shaping that risk perception.

  • As scientists and people who do risk assessment, we tend to use the same sort of format that I'm using here today, which is very didactic.

  • You know, it's a sort of talk about the data and what they mean, and then we have a discussion and would use a lot of power points.

  • How many people here have teenagers in their family?

  • So if you wanted your teenager to not text and drive, would you show them a power point presentation?

  • Of course not.

  • I mean, it's just not a very persuasive form of motivating.

  • Communicate beh behavior change.

  • It's a form of providing information, but it's not a very effective form at motivating or incentivizing people.

  • And so we have to have a different platform for communicating about risk to people who are responding in that risk perception model.

  • And that is to just get to the point.

  • What is the message that we're trying to communicate?

  • Maybe we have a few data points or evidence points to support it.

  • Can we make a persuasive argument?

  • But foundational e.

  • The value here is in stories, and when we think about who we want to influence most, I think we need to remember that politicians and policymakers are people, too, and they very often respond to these kinds of issues from a risk perception point of view, not a risk assessment point of view.

  • So then we are trying to influence them to make the kinds of investments or two carry out the nine points that Mike has in his book.

  • We're going to have to convince them on terms that they understand.

  • Let me just illustrate this was the CDC Emergency Operation Center during anthrax.

  • That's what it looked like.

  • It was obviously an auditorium that over a week, and we threw in some, you know, boards and computers and liars.

  • And this is what the operations center look like.

  • When the president of the United States came to visit the first time a president ever been any president had ever visited the CDC, he took a look at that.

  • This was his public health agency, and this is how we were responding to the anthrax outbreak.

  • So this is what the operations center looks like today because we were able to show not just the president but a lot of other important political leaders as well as business leaders in Atlanta that we needed help in order to have what was necessary to do the job that we needed to get done.

  • So our ability to tell the story of what was necessary to solve this threat really helped the politicians and the leaders understand that investments were necessary to build out this capability.

  • And we see this kind of thinking repeat itself over and over again.

  • Some of you are familiar with what is known as the all hazards strategy, which is basically an investment we make in planning for something ordinary, like flu is also investment that will help us with the flu pandemic or even a terrorism attack.

  • But the reason this comes into this conversation is because many politicians understand terrorism and defense, but they don't really understand public health and emerging infectious diseases.

  • So by talking in a language that gives them more for their money, particularly if they're fiscally conservative, it really gives you a broader opportunity to inform them and motivate them to make the investment.

  • So this has had a name perfect track record, and we kind of have fits and starts with it.

  • But I just bring it up because I think it again illustrates that we've gotta learn how to communicate with the people who have to make these investment decisions in ways that are much more real to them than our risk assessment methodology would normally dictate.

  • The last point I should make here is that it really takes more than a government to solve the problems that we have in front of us.

  • This is from the former secretary general of the United States who was talking about crisis funding and how, in this case he was talking about Ebola.

  • You know, we can't get the resource is ahead of time.

  • We wait until there's a major disaster and then we scraped together resources.

  • But what he was saying at the bottom line is that we have to draw on the experience of the private sector to help us innovate and measure risk and results.

  • And I really want to emphasize this because of my career.

  • Have sort of come full circle, having been an academician than the government worker I've said on the boards of a number of NGOs and now I am in the private sector and I've come to understand the power that businesses have in leveraging action, whether it's local action in the community or global action in something like taking on the agenda of the United Nations.

  • I participate on behalf of my company in the business, um, contributions to achieving the sustainable development goals and in that environment, sort of Ah ah, situation today where there's a lot of skepticism about the motives of business and why businesses would be involved in some of these issues.

  • I think we need to get past that because if we don't involve our business leaders and I'm not just talking about pharmaceutical companies or the health sector, I'm talking about business with a capital B.

  • We need the people who move economies and influence economic capital allocation to understand that if we don't do this right, not only is their business at risk, but our whole social fabric is at risk and until we align those two points of view, we're missing the opportunity to really get done.

  • What needs to get done and included in this agenda has to be the global leadership that we need.

  • This is the World Health Organization international health regulations, which our great regulations never really been in force and never really been funded, and I could go through a whole list of things that again we know what to do.

  • We don't do it.

  • Why is that?

  • It's because we don't demand the leadership, the investment and the sustainable focus on these things over time.

  • So there is progress.

  • This is a picture of a new organization called the Coalition for Epidemic Preparedness Initiative.

  • I disclosed that I sit on the board of SEPI, but it is a private public partnership, which includes the Wellcome Trust, the Gates Foundation, the governments of several countries and several businesses who are coming together.

  • And so far, I think we have around $700 million available to invest in vaccines for pathogens of global health threats.

  • So MERS loss of fever.

  • We're working on how to move promising vaccines through the early stages of clinical development.

  • So the next time on Ebola hits there'll be something in the freezer, much more available to go if the problem emerges.

  • So this is just one example, and I think that model is gaining momentum, but it takes a lot of input and understanding and ultimately participation among people like you who are privileged to have a much broader understanding of the true nature of the threat and hopefully can be activated to go beyond describing what needs to be done to really the kind of political action, an engagement with the policy makers in the business leaders to make it really happen.

  • So I believe that closing the buy prepared this gap.

  • The things that would allow us to complete the crisis agenda really depends on first of all, truly understanding how people perceive risk.

  • Secondly, involves improving our communication of threats and and the opportunities in terms that people can understand and respond to from their perspective, and then finally, really catalyzing the power of business to motivate the investments in the sustainability of those investments.

  • We need to be successful, so I'll stop here.

  • Thank you.

  • Oh, thank you for that simply outstanding overview where we're at today and now to provide some commentary, we have one of our own Dr Amy Kirshner, who is the director of the Food Protection Defense Institute, a department Homeland Security Center of Excellence in a cz well, she's assistant professor in the college dinner and medicine here at the University Minnesota.

  • She leads a very talented staff and coordinates the research consortium of experts dedicated protecting the food system through research and education.

  • Her current research includes identification, warning of food disruptions for data, fusion and analysis.

  • But prior to coming to the University of Minnesota and rolls that I had the good opportunity to work with Dr Kirshner show an uptick in Epping Allergies positions at NORAD, the U S Northern Command, and with the United States Air Force, where she worked on health informatics, bio surveillance and Data Analytics on a number of infectious disease issues.

  • She has an extensive background in homeland security and defense, supporting preparedness and response for real world and exercise events to include Hurricane Katrina and H one n one.

  • Dr.

  • Kirshner concluded her doctorate in public health at the University of North Carolina for commentary.

  • Kershner.

  • Thank you.

  • Well, thank you to both and for the opportunity.

  • As you heard, I came from the Department of Defense, a cz an epidemiologist working on homeland security.

  • So first, let me say how thrilled I am to have Dr Gerberding with us at the university today.

  • I had the incredible good fortune of watching Dr Gerberding lead the transformation of public health post 9 11 And at this time I was a young public health professional at US Northern Command.

  • I was assigned to then caught per the coordinating office for terrorism preparedness and emergency response.

  • I spent many a day with her colleagues in that operation center.

  • But what I saw was Dr Gerberding boldly lead her agency to understand in meet new threats that we hadn't anticipated.

  • I should also publicly acknowledge that what a gracious host she is.

  • I'm being in the military.

  • I had a new boss every two years.

  • And now, mind you, my bosses were fighter pilots and tank drivers.

  • And when they would come to me, they said, We have to go see CDC.

  • They also had their own airplanes.

  • So it didn't matter whether I said yes or no.

  • They were going and you were a very gracious host, Um, and a tremendous collaborator to a new type of partner that was the military.

  • So we we greatly appreciate that I want a point specifically to the slide with the timeline, with all the events CDC was responding to simultaneously.

  • What the slide represents, I think, is a complexity of public health in our efforts, from acts of Mother Nature, like hurricanes and earthquakes, to the man made attacks such as 9 11 and Amerithrax.

  • It includes preparing for national security events like our presidential conventions and Olympics.

  • And sometimes those public health events were the disaster, like monkey pox and other times, public health crisis was a derivative of a disaster, such as what we've seen with cholera in Haiti.

  • Now, as I reflected and looked at that slide and thought more about commentary today, the book predictable Surprises by Max Bays, Erman and Michael Watkins comes to mind.

  • They refer to these events predictable surprises.

  • Is the desk disasters you should have seen coming.

  • These events seemingly catch us by surprise.

  • Yet there have been continuous warning signs, often highlighting their likelihood.

  • Now, in our office, we call these warning signs drivers, and by that I mean there are events or conditions that create an opportunity for the public health disaster to occur.

  • And, as you've seen in Dr Gerberding slides, these include weather anomalies, political instability, climate change or perhaps weakened infrastructures.

  • Often, these drivers co exist and amplify the opportunity for disaster to occur.

  • So to eliminate these predictable surprises, I would argue we must start critically excess ing assessing these drivers and perhaps follow the bats.

  • I'd like to spend just a few minutes and the rest of my commentary to talk about how we might overcome this deja vu from my perspective, having been in public health so that we don't repeat lessons observed, because it doesn't feel like we've gotten to the point of lessons learned yet.

  • So Number one, I think, and in full agreement we must do it's timeto act.

  • There are numerous after action reports and hypotheses on what should be done, and in recent years, several strategies and recommend recommendations have presented

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

字幕と単語

ワンタップで英和辞典検索 単語をクリックすると、意味が表示されます

B1 中級

微生物テロリストとの戦いどのようにして私たちの「デジャブをすべて繰り返す」準備のパラドックスを終了するには (Combating Microbial Terrorists: How to End Our 'Déjà vu All Over Again' Preparedness Paradox)

  • 2 0
    林宜悉 に公開 2021 年 01 月 14 日
動画の中の単語