Name: パネルⅠ「リスクの理解と軽減」｜質疑応答 (Panel I "Understanding & Mitigating Risks" | Q&A)
Uploaded: 2021-01-14T09:34:04.000Z
Duration: 29 min 25 s
Description: VoiceTubeの動画で発音を聞きながら英語表現を覚えよう！学べる英語：

so I'm gonna ask a couple quick questions, then open up to the audience.

And my first question is a point that several of you hit on.

程度の副詞

But we have spent very little time talking about this week and which is anti microbial resistance.

Um, it as an issue comes right up to the issues that we have been talking about around outbreaks.

I would argue that it's sort of belongs and inside the tent of this conversation.

But reasonable people can disagree, given the focus on pandemic influenza that we've had, but really just as a model for threats that can quickly harm human health.

I'd love it if we could all just comment on anti microbial resistance, how big a threat it is and how big of a challenge it is and whether the tools that we are thinking about from surveillance systems, building better vaccines, all of the stuff we've been talking about to what extent is that helpful in this conversation or does am our need a different set of strategies, and I know several of you talked touched on it and Hillary, as you thought about that the national global health security strategy by the security strategy to what extent has am are played into that conversation and then most vocal.

When we get to you, as you guys have thought about your surveillance systems for these very classic diseases, what about a M R.

As a threat to the population of library, so I won't ask anymore?

I'll start with Mike, and then if we could just go down the road.

Well, first, I think we have to just really come to grips with the reality that, like earthquakes, hurricanes and tsunamis and recover resistance occurs.

Um, a very fascinating study that was done in a few years ago when a group of researchers went back into one of most distant areas that calls bad caverns an area that had not ever seen human contact before.

400 million years back in time, and when they sampled the walls accepted Clea, they not only recovered a whole number of bacteria, but they found that the bacteria resistant to 14 of our current leading antibiotics we have today and say, Well, how did that happen?

Well, they were all along competing for space and food as bacteria and they had their own evolutionary pressure that brought them to develop similar resistance issues to what we today capture relative to our modern antibiotics.

What we've done is we've put it on steroids, in a sense, by the dumping of the amount of of antibiotic into the environment that we have, whether it's through humans, whether it's through animals, whatever and so we have to understand is from an evolutionary standpoint, this is going to happen.

It is happening and it's only gonna get worse.

And I think that to the extent that we for a long time have predicted severe challenges around and local resistance, we're now just really beginning to realize in depth the extent to which it's impacting treatment of disease, clinical outcome, how it's being used to cover for poor sanitation, et cetera, which then just accelerates the problem and the roll with the food supply plays, I just would add one last piece.

I think one of the areas that's going to come back and be a real challenge for us also is, and I think this clearly has been well described recently in the Microbiome Studies Animal Crow bills have a lot of downsized to humans that we never appreciated.

They have been lifesaving in so many ways.

But the relationship between those gut bacteria the skin vector that we've evolved with over the last hundreds of thousands of years, were very critical in terms of the human physiologic response and the signaling that goes on between them.

And when we came in and started altering that with Anna McRobie ALS, we've actually created a whole nother other set of Helmand health problems.

And I think that that we're gonna learn one day that how we use anima crow Bealls to reduce the risk of infection disease is gonna be critical.

Just very briefly say to your question, Yes.

We, anyway, say we it's the world, you know, if we don't take this on globally and to follow up on the point just made, if there's a disease anywhere, it will be everywhere.

We're seeing that with chemical resistance.

You know, the Chinese introduced Colistin into the odd population four years ago, and before we knew it overnight Colistin resistant bacteria around the world and So I think that to the extent that we also deal with this, it can't be a coalition of the willing.

It has to be a complete worldwide effort because otherwise we'll just continue accelerated.

I'm gonna put one more a little spin on it, which is so as a practicing physician, I feel like I get bombarded with antibiotic stewardship.

There's like, How do we apportion blame between me, uh, versus our food supply in our food industry and our farming industry?

And I'm not really trying to apportion blame, but I'm trying to get a sense of from your perspective, as you think about, you know, seizes you Think about, um Am are where are the major sources of that evolutionary stress that are creating these problems?

Well, it's unfortunately in both categories, and they do accelerate different kinds of problems.

Uh, the animal husbandry industry clearly has contributed a substantial amount, and there's been a defensive posture there that has made it very difficult for us to try to deal with that issue, but humans have contributed their own.

I would also add, though, that what we don't understand is on the global level, whether it's animals or humans.

They are basically the 1st 2nd and third line of medical care is to go to your local quote unquote store because frankly they don't have except health care.

And because of the diseases, particularly of low and middle income countries, this becomes by default what you do so that house to also be added.

Let me just add one last piece because I was involved with this and some of the people know about this.

There turns out that there is a very major trade in dogs being sold in pet stores throughout the United States and as a result of the exchange of goes on between these animal breeders and so forth, we now have bred a strain of campylobacter that we have no antibiotics for.

If you get infected with this thing, good luck and we have seen numerous infections, particularly young Children that have been very severe and acute that we don't have anything to treat it with, and it's now part of the dog breeding industry in the United States.

So there's an example where it wasn't even livestock.

It was pets and and the concern that we have with it, let me first bring the discussion back to 1918 because what's the difference between 1918?

And if it's similar viruses to emerge in 2018 this upcoming spring of 2019 and in 1918 What didn't we have?

Uh, if we were to have a similar event for as long as it takes to get the vaccine, we would still have antivirals and antibiotics.

And that's significant because when you look retrospectively at 1918 you know half or so of the deaths were due to the virus.

Half were secondary bacterial infections, so anti virals antibiotics will be a very fast frontline response.

If we move into a you know, a post antibiotic world, we're moving back to 1918.

And so just to tie the circle back, you know the vulnerabilities are extraordinary.

Thea, other about you know what's the relative balance of influence at livestock, aquaculture?

And largely because we've spent a lot of our effort over the last two decades really zeroing in on clinical practices, right prescriber users.

This is a big black hole out there in terms of what's the contributing factors around animal husbandry, aquaculture and environmental contamination in an environment where, as Mike said, you already have just a natural dynamic of evolution within bacteria we don't know.

And that's one of the really important one health agendas, which is to bring a much deeper evidence based understanding.

And you really need to be smart about that because Mother Nature is doing her own independent of us evolution as well.

Hillary, have you got sad about this in the national strategies?

So I will add a just a few things to the comments my colleagues made, and that is when I, from my perspective, we think of things in terms of policy.

S government or the global community towards specific actions and Aymar will certainly continue to be a critically important issue.

Um and so from the vantage point of organizing actions, one of the effective ones has been the global health security agenda, which you heard Osaka mentioned in terms of a group of over 60 countries working together towards specific technical actions as defined in the joint external evaluation.

And a M R is one of the action packages under G.

There is a working group that is it's a global working group that is very active and they're trying to identify different new solutions and trying thio put in place actions to counter this problem.

But it certainly will continue to be a, um a critical issue.

And I'll just take a moment since you asked about the global health security strategy which I didn't have time to mention in my previous remarks.

We've been the National Security Council in particular, has been tasked with coordinating the development of a global health security strategy.

This was in the F 18 omnibus and so we're working on that.

There are specific things that it asks the U.

S government to dio, but we're taking a comprehensive approach similar to what we did with bio defense toe.

Look at how do we define global health security?

What does it include on doesn't go beyond some of the things that we've traditionally thought of.

But it's a really great opportunity to think through these issues and specific to global security.

Respect to surveillance for antimicrobial resistance Within a rough analysis off the total number off a cute free brocades illnesses in Liberia For one year, we found out there were 2.5 million cases of fever off the 2.5 million cases, one million off those cases where confirmed to be malaria and what they're calling it.

The rest of the one confined really know what to tell antibiotics.

So basically there were no positive agenda skull where they were giving antibiotics, so that's telling the low off the lack of stewardship for anti politics in the country.

The second child is that there is a lack of data, and so because we have like that, it's hard to convince this.

But because I'm trying to commission a research to look at underpowered, it's a susceptibilities and want to run a five without real diseases has even in traction.