What the global health community learned from ebola, zika, and other outbreaks.

Insights: Global Response to Pandemics

[MUSIC PLAYING] BRYAN WALSH: We had Zika. Before that, we had H1N1. Before that, we had obviously Ebola, SARS, you can keep going back. Why does this keep happening to us? Is there something-- why are we so vulnerable, and why do we seem helpless to stop these pandemics from happening? MICHAEL T OSTERHOLM: Well, first of all, since we've lived in the caves, we've been vulnerable to infectious diseases. Don't forget that in 1900, average life expectancy in this country was 48 years. Today, it's 78 years. For every three days we've lived, we've gained a day in life expectancy. It's largely because we were able to eliminate infectious diseases, particularly in childhood, through the use of sanitation, vaccines, and antibiotics. What's happened, though, since the revolution where we've had such major changes, the world has changed. Today, with 7.8 billion-- approaching 7.8 billion people on the face of the earth, one of every people who's ever lived is on the face of the earth right now, and the fastest growing regions of the world are actually in the developing world, where in some of the larger metropolitan areas of 14 or more million, half the people live in the most desperate of all slums you can imagine. Now overlay that with the fact that global trade and travel is so common today that it's not just we move people, we move mosquitoes, we move all kinds of things around the world. We've eliminated mountain ranges, oceans, and political boundaries as a means to keep things isolated, so we really have a new boiling pot. The final piece of that, though, is the fact that if you look at the potential for pandemics-- and we'll talk about that here-- is we really need to talk about a fast-moving pandemic and a slow-moving pandemic. Fast moving would be, for example, influenza, but we also have a very desperate need right now to understand that antibiotic resistance is a slow-moving pandemic that over the next 20 years could fundamentally rewrite the way all of us in the modern world live with regard to infectious diseases. Take Ebola, and I think Monsef really raises a very important point. Right now, when we look at what happened with Ebola in 2014, this was basically a disease of rural jungles, villages of Africa, where it had very little impact, even if it spread through the entire village, because there were several hundred people. What happened to Africa? Africa's been urbanized. Today, the fastest growing cities in the world are in sub-Saharan Africa. There were more people living in the slums of Kinshasa right now than lived in all three of the capital cities where the outbreak occurred. All it would take is one Ebola match in Kinshasa right now and we would be so screwed. And yet, as he said, the vaccine has almost fallen completely right now on deaf political, economic ears, and we have to change that. We just go from crisis to crisis. We can anticipate these, we should anticipate these. We could have anticipated Zika in a much better way, and we're not, and that's what we have to change, because otherwise, we will see some potentially very major global issues over the next decade. [MUSIC PLAYING]

Insights: How Global Pandemics Occur & Spread

Uncategorized

The global health community should be doing more to prevent.

How Global Pandemics Occur & Spread

The global health community should be doing more to prevent, rather than react, to the next pandemic.

way had VICA for that. We had a tch one n one for that. We have the Ebola stars. Keep going back. Why does this keep happening to us? There's something. Why are we so vulnerable and why do we seem? Help us to stop these from the pandemic from happening? Well, first loss since we've lived in the caves have been vulnerable to infectious diseases. Don't forget that in 1900 average life expectancy in this country was 48 years. Today it's 78 years every three days. We've lived with game today, and life expectancy was largely because we were able to eliminate infectious disease, particularly childhood, through the use of sanitation, vaccines and antibiotics. What happened, though, since the revolution where we've had such major changes, the world has changed today, with 7.8 billion approaching 7.8 billion people in the face of the earth. One of every people who ever lived is on the face of the earth right now, and the fastest growing regions of the world are actually in the developing world, where in some of the larger metropolitan areas of 14 or more 1,000,000 half people live in the most desperate of all slums. You could imagine overlay that with the fact that global trade and travel is so common today that it's not just we move people. We move mosquitoes. We move all kinds of things around the world. We've eliminated mountain ranges, oceans and political boundaries of means to keep things isolated, so we really have a new boiling pot. The final piece of that, though, is the fact that if you look at the potential for pandemics and we'll talk about that here, you really need to talk about a fast moving pandemic and a slow moving pandemic. Fast moving would be, for example, influenza. But we also have a very desperate need right now to understand that antibiotic resistance is a small moving pandemic that over the next 20 years, but fundamentally rewrite the way all of us in the modern world live with regard to infectious diseases. Take you bowling. I think mon cel really raises a very important point right now. When we looked at what happened the bowl in 2014 this was basically a disease of rural jungles, villages of Africa, where it had very little impact even if it spreads to the entire village of several 100 people. What happened after Africa has been your urbanized today, the fastest growing cities in the world are in sub Saharan Africa. There were more people living in the slums of Kinshasa right now, then lived in all three of the capital cities where the outbreak occurred. All it would take is one Ebola match in Kinshasa. Right now we would be so screwed and yet is, he said. The vaccine has almost fallen completely right now on death, political, economic years. And we have to change that. We just go from crisis to crisis. We can anticipate these. We should anticipate these. We could have anticipated Zika in a much better way and we're not. And that's what we have to change because otherwise we will see some potentially very major global issues over the next decade.

[MUSIC PLAYING] PETER SANDS: If you talk about the broader business, community all of companies across multiple sectors, banks, consumer goods companies, airlines, and things, they're not really engaged in global health in the way that they engage in issues like the environment. We looked at the Fortune 500 companies and looked at how many of them had strategies or targets around the environment and how many of them had it around global health, and it was really quite striking-- around the environment, 74% and around health, 10%. And if you stripped out the pharma companies and so on, it was ridiculously low. CAROLINE BUCKEE: From in the context of pandemic preparedness, this is something that companies have to think about. If the Philippines has a massive epidemic, then all of international shipping goes down. PETER SANDS: They don't nearly enough. CAROLINE BUCKEE: Yeah, they don't. PETER SANDS: Companies don't do it nearly systematically enough. The activist community in the environmental climate change space took a very different strategy from the global health community. The activist community in environment space decided to engage with corporates, both collaboratively and also in a challenging way. And they use things like regulations, regulations on disclosures about carbon footprints and things like this as tools to get companies to think more about these things. I actually think that the global health community needs to take a long, hard look at the way it's engaging with the private sector and say, what can we learn from the way the environmental community did it to get that kind of specificity and directness in the interaction? Because at the moment, at the moment, there's deep antipathy and huge amounts of mistrust. It's one of the things that surprised me is a relative newcomer is just how distrustful of the private sector much of the global health community is. And you're just not going to get-- that's a really poor starting point from for any kind of collaboration. [MUSIC PLAYING] 

Insights: Multinational Corporations Must Prioritize Global Health

A global pandemic could disrupt every economic sector.

Multinational Corporations Must Prioritize Global Health

A global pandemic could disrupt every economic sector, so why don't corporations seem to care?

What are you talking about? The broader business community, All of companies across multiple sectors banks, consumer goods companies, airlines, things. They're not really engaged in global health in the way that they engaged in issues like the environment. We looked at the Fortune 500 companies and looked at how many of them had strategies will target around the environment and how many of them had it around global health. And it was really quite striking around environment 74% and ran health 10. And if you strip tag the farmer companies and so on, it was ridiculously low from in a context of pandemic preparedness. You know, this is something that companies have to I think about, You know, if if the Philippines has a massive epidemic, they don't nearly enough to really think about, companies don't do it nearly systematically enough. The activist community and the environmental climate change Spain. It took a very different strategy from the global health community. The activist community and vomit told place, decided to engage with corporate but collaboratively and also in a challenging way on they use things like regulations, regulations on disclosures about carbon footprints and things like that as tools to get to get companies to think more about these things. I actually think that the global health community needs to take a long, hard look at the way it's engaging with the private sector and say, What can we learn from the way the environmental community did it to get that kind of specificity, um, and directness in the interaction? Because at the moment, a moment, this deep antipathy on huge meant to mistrust, it's one of the things that surprised me is a relative newcomer is just have distrustful of the private sector. Much of the global health community is, and you're just not going to get. That's a really poor starting point from only kind of collaboration.

[MUSIC PLAYING] NAHID BHADELIA: Anyone who was working in the field in summer 2014 was not surprised by either the fact that the mortality was high as it was or the fact that the epidemic was out of control, because really, the way you control it epidemic is to isolate people who have disease, you quarantine people who are exposed to it, and you make sure more people don't get exposed to it. But we didn't have enough beds to isolate people in Ebola treatment units. And here's the crazy thing. People would come to the Ebola treatment unit because they fit the clinical description of Ebola. Clinical description of the Ebola is fever, nausea, vomiting, for the most part that's how people presented. Everything looks like fever, nausea, vomiting, diarrhea in West Africa. And so you would put people with malaria, you had people with typhoid into the suspect ward, wait until they're confirmed, and then put them in the confirmed ward. It took about three days to get laboratory results back. So people were sitting around. If they didn't have Ebola before, we gave them Ebola in ETU-- in Ebola treatment units until they left, then got sick in their communities. And just the dearth of care and the mortality in expats was less than 25%, people who were returning responders who got sick who were brought back. The mortality in most ETUs were 60% to 70%. And yes, somewhere in between maybe expats are a little healthier and things like that. But that was a description of how where you're born decides how you die of a disease. And it was really the lack of resources, I think, more than anything else. [MUSIC PLAYING] 

Insights: Ebola Doctors Explain Why Only Sickest Should Seek Hospitals

Some patients were infected with Ebola while awaiting tests.

Ebola Doctors Explain Why Only Sickest Should Seek Hospitals

A number of patients were infected with Ebola while in clinics awaiting tests to come back when they didn't have the disease.

Anyone who was working in the field in summer of 2014 was not surprised by either the fact that the mortality was highs or the fact that the epidemic is out of control because, really the way you control it epidemic, you isolate people who have disease. You quarantine people who are exposed to it right, and you make sure more people don't get exposed to it. But we didn't have enough beds, so isolate people in new military units. And here's the crazy thing, right? People would come to the military minions because they fit the clinical description of Ebola clinical description of the bullet fever, nausea, vomiting for the most part of how people presented everything. Looks like fever, nausea, vomiting, diarrhea in West Africa. And so you would put people with malaria, people with typhoid into the subs. I poured wait until they're confirmed and then put them in the farm work. It took about three days to get laboratory results back. People were sitting around if they didn't have Ebola before, we gave them Ebola, any to you units, we need to be able to treatment units until they left. Then that's sick in their communities and just the dirt of care. I'm, uh, immortality. Next was less than 25% People who were returning responders who got sick mortality and musty to use for 60 to 70%. And yes, somewhere in between. Maybe you'd expect for a little healthier and things like that. But that was a description of how were you born? Decide how you die of the disease. And it was really the lack of resource is, I think, more than anything else.

[MUSIC PLAYING] MICHAEL OSTERHOLM: I don't have any problem with scaring. But instead of scaring people out of their wits, we should be scaring them into their wits. I mean, look at this room right here. When you think health care today, and I mentioned this issue of life expectancy, we did a study not long ago where we actually surveyed a group of PharmDs around the world. And we said, what are those life saving drugs you have to have everyday or people die right now? What's on the crash cart? We came up with 30 drugs. All of them were generic. 100% are made outside the United States. And for 100% percent, there's no stockpiles. It's just in time delivery. It's all right now in the 62,000 ships going between China, and India, and the United States. If we had one influenza pandemic that caused a hiccup around the world, the number of people that would die from just the loss of those drugs in our everyday hospitals would almost impact the world as much as the pandemic itself. In the business community, you have to wake up and understand the vulnerability you have if we don't take the steps. And let me just come back one point to one month or so. Right now if there's an event in the south Mediterranean, the Sixth Fleet is there. We have an aircraft carrier, three destroyers, a number of battleships and aircraft. Today, in public health, if we have an event like that, we go out and say, OK, let's put a call out for building an aircraft carrier. And by the way, build it, we're not going to tell you what to build. And then when you deliver it, we'll tell you if we're going to buy it or not and how much are going to pay for it. Imagine how crazy our defense budget would be. That's exactly what the industry has to deal with today in the vaccine world. We've got to stop this. And [INAUDIBLE] is obviously from a company. You say, well, he's representing the company. I'll tell you somebody with no ties to these companies, we need them badly. They have been burned so badly over the last several situation with Ebola, SARS, and so forth. We're going to lose them completely. And that's going to come to your bottom line as much as it's going to come to your family. [MUSIC PLAYING]

Insights: Businesses and Governments Must 'Wake Up' to Pandemic Vulnerability

If we don't pay for prevention, we'll pay the consequences.

World Must 'Wake Up' to Pandemic Vulnerability

If corporations and governments don't start paying for prevention, they'll pay for the consequences of a global outbreak.

I don't have any problem scaring people out of their way into their look at this room right here. You think healthcare today and I mentioned this issue of life expectancy. We did a study not longer. We actually surveyed a group of Farm D's around the world, he said. One of those life saving drugs you have to have every day or people die right now. What's on the crash cart? We can't with 30 drugs all over generic 100% or made outside the United States for 100%. There's no stockpiles just in time delivery. It's all right now in the 62,000 ships going between Shine and India in the United States. If we had one influenza pandemic that caused a hiccup around the world, the number of people that would die from just the loss of those drugs in our everyday hospitals would almost impact the world as much as the pandemic itself. In the business, you know, you have to wake up and understand the vulnerability you have. If we don't take the steps, only just come back 1.21 months. Right now, there's an event in the South Mediterranean. The Sixth Fleet is there. We have an aircraft carrier, three destroyers, number of battleships and aircraft. Today in public health, we have an event like that. We go out and say, let's put a call out for building an aircraft carrier and by the way, build it. We're not gonna tell you what to build, and then when you deliver, it will tell you we're gonna buy it or not. How much you gonna pay for it? Imagine how crazy our defense budget would be. That's exactly what the industry has to deal with today in the in the vaccine world. We've got to stop. This monster is obviously from a company to say. Well, he's representing. I'll tell you, somebody with no ties to these companies, we need them badly. They have been burned so badly over the last several situations Ebola stars and so forth. We're gonna lose him completely. And that's going to come to your bottom line as much as it's gonna come to your family.

 BRYAN WALSH: But for the public sector, for the government, when you hear something like that, I mean, what is a better way, actually? I mean, certainly, to be able to produce-- we can make the vaccines, but of course, actually getting them manufactured, actually getting them distributed is a whole other story. Can we do that faster so we can actually use these the next pathogens emerge? DR. BRUCE GELLIN: Well, it's as you say, it's really all about speed because as these epidemics start moving, you want to have the preventive which is one of the themes here, get out in front of that, and that's one of the things we need to do. We need to do better at. Clearly, as Moncef said, this is an all-hands-on-deck opportunity and an all-hands-on-deck need, and we need all these partners. We need to have the companies, we need to have the regulators, we need to have the countries as well as part of this. And we can talk some more about some of these models. But clearly, it's going to require a different model because the one we have now is not working. 

Insights: The Current Model for Fighting Pandemics Is Broken

We need to start fighting them before they even happen.

The Current Model for Fighting Pandemics Is Broken

public sector for the government. When you hear something like that, I mean, what is a better way? Actually, I mean, certainly to be able to produce waken make the vaccine, but of course, actually, getting them manufacturer actually getting distributed the whole of the story Can we do that faster so we can actually use these the next pathogen to emerge a Z. It's really all about speed because of the epidemic. Start moving. You wanna have the preventive, which is one of the themes here. Get out in front of that And that's one of things we need to do. You need to do better at Coolio, Monster said. This is this is an all hands on deck opportunity and are all hands on deck need and we need all the partners we need to have the companies we need to have the regulators. We need to have the company of the country's A CZ well, as part of this and we can talk some more about some of these models, but clearly it's gonna require a different Malala because the one we have now is not working

[MUSIC PLAYING] BRYAN WALSH: When we're trying to fight infectious disease, whether it's Ebola, whether it's something else, why is it that closing borders in that way would be counterproductive? Yeah, NAHID BHADELIA: I was actually a coming out of one of my shifts and I turned on the TV and I say-- v see Donald Trump saying, oh, they shouldn't be brought back, you know. It was very personal to me when I heard that. I think one of the least helpful terms that came out of this was abundance of caution. People don't realize that abundance of caution carries its own weight. One was through abundance of caution, airlines stop flying, the consumer supplier stop shipping. We start running out of personal protective equipment in the field. There was a week in August where we cut up tarp to wear aprons. So our choices where do that and go in or not go in and there are a hundred something patients that get no care. It has a direct impact and when you change trade and travel, right? It also decrease the number of people coming in to volunteer. It has an immense impact. BRYAN WALSH: Great, Raj? RAJ PANJABI Yeah, I mean as far as the last time I reviewed the literature, you can't bomb Ebola, you can't pull up a wall to stop Ebola, and you can't really close borders to stop Ebola. So the science doesn't support it. I think the good news is science does support other things that the CDC has been really great about prevent, detect, and respond. And Nahid echoed that earlier. I think as we look at right now, the cutback in foreign aid and foreign assistance that's being proposed, I think one of the places where we would really hurt ourselves would be to ignore the signals that have come from Ebola. I mean, creating jobs for primary health care workers and equipping them in rural settings in Africa would be a great security initiative if that's all you cared about. Of course, there's many other reasons to do it. So you can't bomb Ebola basically. BRYAN WALSH: You can't bomb Ebola. Take that away. [MUSIC PLAYING]

Insights: Will Closing Borders Stop Infectious Diseases?

Make sure adequate healthcare is available.

Will Closing Borders Stop Infectious Diseases?

Doctors who fought Ebola say the most important thing is to make sure adequate healthcare is available, especially in rural communities.

We're trying to fight infections, disease. Whether it's a boulder, whether something else, why is that? The closing borders in that way would be kind of productive. Yeah, I was actually coming out of my chest for me, to you and I turned on the TV and I say I see Donald Trump saying, Oh, they shouldn't be brought back. You know, it was very personal to me when I heard that. I think one of the least helpful terms. They came out of the abundance of caution. People don't realize that abundance of caution carry his own weight. One was through an abundance of caution. Airline stopped flying. The consumer supplier stopped shipping. We tired running out of personal protective equipment in the field. There was a week in August where we cut up tarp to wear aprons. Our choices Where do that on go in or not? Go in and they're 100. Something patients I get no care has a direct impact. When you change trade and travel, right, it also decrease the number of people coming in to volunteer. It hasn't an immense impact. Yeah, I mean, far last time I have reviewed the literature. You can't bomb Ebola. You can't pull up a wall to stop Ebola, and you can't really close. Borders stop Ebola so the science doesn't support it. I think the good news is science does support other things that CDC has been really great about. Prevent, detect and respond. And night echoed that earlier. I think, you know, as we look at right now, the cutback in foreign aid and foreign assistance, Uh, that's being proposed. I think one of the places where we would really hurt ourselves would be Thio. Ignore. The signals have come from a bowl. I mean, creating jobs for primary healthcare workers and equipping them in rural settings in Africa would be a great security initiative if that's all you cared about so many other reasons to do it so you can't bomb Ebola's can't Flammable will take that away

 BRYAN WALSH: So many of these viruses do emerge from animals jump to human beings. Can we do anything about actually detecting those diseases in the animals before they actually make that crossover, that's spillover? DR. MICHAEL T. OSTERHOLM: We could do a lot more than we're doing right now. I gave my first lecture on Zika 39 months ago. I have, number one, said it was coming to Americas. I said that it was likely to cause great havoc. At that time, we didn't even understand the issue microcephaly and I had no special knowledge, except we connected a few dots. We have a list, and in fact, this group that Moncef and I are involved with now, simply, we've actually come up with the diseases. The one I wish we had included which we have is the flu vaccine. We surely need a new much better flu vaccine. New flu pandemics are like earthquakes, hurricanes and tsunamis. They're going to occur, and so we need that. But we could do much more. And this is what the group we're working with right now is trying to anticipate. But no, there's no market. Nobody would have paid to make a Zika vaccine or buy a Zika vaccine five years ago. But that's too late to wait. We need to anticipate these as we can and that's where the business community, along with government, needs to come together and say, as the old oil frame or commercial used to say many years ago, pay me now or you will pay me later. And I think that's what we're trying to help the world understand. That that's the option we're offering them, is to take many of these off the table. BRYAN WALSH: We have one last question, actually, which is about the flu and the flu vaccine. Flu is always with us and we always worry about when it's going to make that jump to a 1918 kind of situation. And yet, Americans really don't really take the flu vaccine, and it's not been that effective in recent years. What can we do to change that? I mean, right now, the flu obviously change, it evolves. But is there a technology, is there a way to find one, the key that will fit all locks when it comes to this particular virus, this devil to human beings? DR. BRUCE GELLIN: Well, I think it has to start with the way we do surveillance we're always chasing what happened last year to decide what to make next year. I don't think-- we should better understand viral evolution to see where the virus might be going rather than where it's been, and better predict that. There's also the opportunity to look at different parts of the virus that are not as variable year to year and to try to develop immunity to that. Essentially, as actually Dr. Fauci has described, that you're trying to create unnatural immunity. Natural flu doesn't give you lifelong protection or protection against all of them so we have to look to some of those as well. There are a number of technologies available as well. We've been working on flu vaccines in eggs since it was first recovered in egg in 1930. BRYAN WALSH: We're still making as much the same way, yeah? DR. BRUCE GELLIN: We are still making much the same way. We're doing some different things now, but essentially, they're pretty similar. We need to look at different parts of the virus to create a different kind of immunity. DR. MICHAEL T. OSTERHOLM: If I could just add a context to that, right now, we spend between $30 to $50 million a year globally researching new better flu vaccines, and we clearly have evidence that we may very well be able to make a much better flu vaccine. Meanwhile, we spend a billion dollars a year on research in HIV vaccines, which I wouldn't take dollar away from, but we just haven't put the importance on that issue. And just think about this, six months of even a moderate flu pandemic will kill more people than HIV has killed since its earliest days. Sometimes what scares us versus what concerns us versus what hurts us versus what kills us, we get them all mixed up. And what this group we're talking about, what we're working with, is actually trying to correct that. We're trying to lay out what are the diseases of greatest impact. 

Insights: What More Can Be Done to Prevent Pandemics?

More needs to be done globally to prevent pandemics.

What More Can Be Done to Prevent Pandemics?

Doctors says more needs to be done globally to prevent pandemics and influenza.

so many of these choirs do emerge from animals, jump to human beings Anything about about actually detecting those diseases in the animal before they actually make that crossover that spill over? You know, we could do a lot more than we're doing right now. I gave my first election Zika, 39 months ago. I'm number one said it was coming to America. I said that it was like that. It caused great havoc. At that time, we didn't understand the issue. Microcephaly and I had no special knowledge except we conducted connected a few dots. Well, you have a list. And in fact, this group that mom stuff and I are involved with now sippy we've actually come up with the disease is the one I wish we had included. Which we haven't is the flu vaccine. We surely need to do much better. Flu vaccine. Flu pandemics are like earthquakes, earthquakes, hurricanes and tsunamis. They're going to occur, and so we need that. But we could do much more. And this is what the group were working with right now is trying to anticipate, remember, there's no market. Nobody would have paid to make a zika vaccine or by a Zika vaccine five years ago. But that's too late. Wait, we need to anticipate these. We can. And that's where the business community, along with government, needs to come together and say, You know, the old oil fram aur commercial used to say many years ago. Pay me now or you will pay me later, and I think that's what we're trying to help the world understand. That that's the option we're offering them is to take many of these off the table. One last question, actually, which is about the flu in the flu vaccine fluid is always with us, and we always worry about when it's going to make that jump to a 1918 kind of situation. Indian Americans really don't don't really take the flu vaccine, and it's not been that effective in recent years. What can we do to change that? But I mean, you know, right now, the blue obviously changes involved. But is their technology their way to find one that a key that will fit all locksmith comes this particular virus devil human beings? Well, I think it has to start with the way we do surveillance. We're always chasing what happened last year we're gonna make next year. I think way should better understand viral evolution to see where the virus might be going rather than where it's been and better predict. That is also the opportunity to look at different parts of the virus that are not as variable your year to year and to try to have developed immunity. Immunity to that essentially is active. Dr. Fauci is described that you're trying to create a natural immunity. Natural flu doesn't give you a lifelong protection or protection against all of them. We have toe Look, look to some of those as well. There are a number of technologies available as well we've been making. We've been working on flu vaccines and eggs. It was first recovered in an egg in 1930 would make the most of them were still making the same way. We're doing some different things now, but essentially they're pretty similar. We need t looking at different parts of the virus to create a different kind of immunity. You know, if I could just add a context of that right now, we spend between 30 to $50 million you're globally researching new, better flu vaccines, and we clearly have evidence that we may very well be able to make a much better flu vaccine. Meanwhile, we spend a $1,000,000,000 a year on researching HIV vaccines, which I wouldn't take a dollar away from. But we just haven't put in the importance on that issue. And just think about this. Six months of even a moderate of flu flu pandemic will kill more people than HIV has killed since its earliest days. We sometimes what scares us versus what concerns us versus what hurts is versus what kills us. We get em all mixed up. And what this group we're talking about that we're working with is actually trying to correct that. We're trying to lay out what are the diseases of greatest impact.

[MUSIC PLAYING] BYRAN WALSH: So Moncef, how can we do it better when we see the next-- it's going to Zika right now and might be something else in a year's time. Both working with the public sector, from your perspective, how do we respond quicker but also I think maybe not let things fall off the agenda the way they sometimes have the past? MONCHEF SLAOUI: Yeah. So we gave this quite a lot of thought. And I would just start by saying last time I took a car insurance, I didn't take it while I was having an accident. I usually take it before. And it's the same principle. what we're proposing is to say for a company like GSK but others have also stepped up but not everyone but others have done to is to say, we as private enterprises hold technologies, know-how, capabilities that have the capacity to save the world. We can't only use them on the purpose of making returns to shareholders. That's what we do on a daily basis. But there are instances where there is a bigger picture. Now the issue is when we are reactive, we have to stop what we do to sustain ourself returning to our shareholders in order to help save the world, whether it's antibiotic resistance or vaccines against pandemics. Let's try to do this in advance of an outbreak. So we made a very specific proposal saying we have platform technologies that we know allow to make vaccines. We know they are safe. And we know how to make them industrial. That's very important. Making a vaccine and running a clinical trial and making a publication in the scientific journal is very important and shows that you can make the vaccine. But you don't have a vaccine for millions of people. The technology is needed to make a vaccine for millions of people over many, many years are very different than those experimental technologies. That's what I call platform technologies. We offered to make these available at no cost to the community. To build an organization, only the cost of running it would be borne by the community. And to put an organization with these platform technologies, with the know-how, et cetera under the governance of an independent body that would, based on science, decides there is a list of 15 or 13 or 11, depending which list you look at, pathogens that are known to be potential outbreak agents. Let's take this organization-- it has about 200 scientists and we sized it and costed it-- and let's have it go after making a vaccine for each one of these pathogens. And the reality will unfold, and an outbreak will happen. And two scenarios are possible. Either we are lucky and we made the vaccine already, in which case we can immediately deploy it. Or we will not likely, we didn't make a vaccine. But here we have an organization has no opportunity cost, it can instantly be fully dedicated with platform technologies that are validated to make as fast as possible a vaccine against a new outbreak. We find this proposal compelling, frankly. Everybody we spoke to found it compelling. It's been two years, great progress-- not as fast as we wish it should be-- has been made. A new organization has been created called CEPI, or Coalition for Epidemic Preparedness Innovation. We're both heavily involved in helping create this coalition. And this coalition could very well be the body that can finance a series of such organizations that can be dedicated proactively, permanently to make vaccines against outbreak agents. 

Insights: Tips From GlaxoSmithKline On How To Streamline Epidemic Vaccine

The global partnership to get ahead of the next outbreak.

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The global partnership between businesses and governments is trying to get ahead of the next outbreak.

way, do it better. I mean, when we see the next, it's going to be right now. It might be something else in the years time. You know, both working with the public sector from your perspective. How do we respond quicker? But also, I think, you know, maybe not let things fall off the fall of the agenda the way they sometimes had passed. Yes, we get give this quite a lot of thought. And I would just start by saying Last time I took a car insurance. I didn't take it while I was having an accident. I usually take it before, and it's the same principle. What we're proposing is to say for a company like G S K with others have also stepped up. But not everyone but others have done to it to say we have private enterprises, hold technologies, know how capabilities that have the capacity to save the world. We can't on. Lee used them on the purpose of making returns to shareholders. That's what we do on a daily basis. But there are instances where there is a bigger picture. Now the issue is when we're reactive, we have to stop what we do to sustain ourselves, returning to our shareholders in order to help save the world, whether it's antibiotic resistance or vaccines against mimics, let's try to do this in advance of an outbreak. So we made a very specific proposals saying We have platform technology that we know allowed to make vaccines. We know they're safe and we know how to make them industrial. That's very important. Making a vaccine and running a clinical trial and making a publication in Santa Journal is very important and show that you can make the vaccine, but you don't have a vaccine for millions of people. Technology is needed to make a vaccine for millions of people over many, many years are very different than those experimental technologies. That's what I call platform technologies. We offered to make these available at no cost through the community to build an organization, only the cost of running it would be born by the community and to put an organization with these platform technologies with the know how, etcetera under the governance of an independent body that with basil science decide there's a list off 15 or 13 or 11 depending which you look at passages that are known to be potential outbreak agents. Let's take this organization has about 200 scientists and sizes and costed it. Let's have it go after making a vaccine for each one of these pathogens, and the reality will unfold on an outbreak would happen, and two scenarios are possible. Either way, you're lovely and we made the vaccine already, in which case we can immediately deployed or we're not lucky we didn't make a vaccine. But here we have an organization has no part in it because it can instantly be fully dedicated with platform technologies that are validated to make a fastest possible vaccine against a new outbreak. We find this proposal comparing frankly, every body we spoke to found it compelling. It's been two years. Great progress, not as fast as we wish it should be, has been made. A new organization has been created, called Happy or Coalition Coalition for Epidemic Preparedness. Innovation. We're both heavily involved in helping create this coalition on this coalition could very well be the body that can find Siri's off such organizations that can be dedicated proactively, permanently to make vaccines against outbreak agents

[MUSIC PLAYING] BRYAN WALSH: What do we take from this? Because this is not going to be the last time we face this disease. There will be other ones out there, ones we know about and probably more frightening diseases we don't know about yet, we haven't discovered yet. So what lesson should we take as a global health community to make sure that we're better prepared the next time before face this. NAHID BHADELIA: Yeah, I think we're a culture of outbreak response. At best, we're a culture of outbreak preparedness, but we are not a culture outbreak prevention. We seem to chase one pathogen after another. It's Ebola, then it's Zika, and then it's yellow fever. And the truth is, pennies on the dollar, if you could invest in some of the basic things that, you know, really allow continued surveillance for infectious diseases in communities, you would actually increase that yield and catch everything that comes along. I find it interesting that your organization is Last Mile Health because I always talk about the fact that at the terminal end of all international surveillance for infectious diseases are communities that have no access to care. I mean, the way surveillance works is there is a cluster of people who get sick, they go to health care, the clinician picks up the fact that there is something abnormal, the clinician reports it to somewhere up, to a functioning public health system. Then that public health system responds up to WHO, and the alarm bells go off and there is an efficient response, right? Within the country and WHO. But that first mile or last mile, however you want to put it, a majority that people are not getting to care. And if they are, one thing that sort of makes a lot of people surprised when I speak about this is that in resource-limited settings, you are diagnosed by treatment. You go in, you have a clinical syndrome of some sort, and they give you malaria medication. If you don't get better, then they say, oh, it might be something else, maybe it's typhoid, right? Because of that, it takes-- there's a built-in delay for us to pick up outbreaks or clusters before they become outbreaks. RAJ PANJABI: Yeah. Well said. I think I'd build on your point in terms of lessons learned. Look, if we still can't learn the lesson from the first patient, Emile, patient zero, 2-year-old boy who gets sick with fever, vomiting, and diarrhea, December 2013, in the rainforest across the border from where Nahid and I were working in southern Guinea, he dies December 2013. A few weeks later, his sister dies. A few weeks later, his mother dies. And this mysterious disease at the time would spread from one community to another in the rainforest borderlands between these countries, Sierra Leone, Liberia and Guinea, and it wasn't until three months later in March 2014 when this was identified as Ebola. When every minute counted, we're losing months. When every year accounted with HIV disease, we lost decades. In the case of Zika, we've lost many years, as well, to understand this disease. Every one of those illnesses were zoonotic diseases starting in animal reservoirs. Those animals are interacting with human populations in forest communities, all in the same rainforest belt throughout west and central Africa in these particular cases. The amount of loss of life, the amount of billions of dollars this cost the economies has been tremendous. And if you ask, what is common? Well, one issue is that 60% to 75% of new emerging infectious diseases are zoonotic. And if you ask then what else is common in addition to epidemiology of disease, is this-- is the investments in health care. There's been a, you know, as our friend Paul Farmer would call it, a clinical desert in these settings, right? Where there's just not enough investment going into these places, and you're seeing massive costs from it. I mean, that one child, his disease killed him, killed his family, killed a number of communities. It wasn't until March 2014 we caught it. It spread like wildfire across West Africa, reached the shores of this country, cost billions of dollars. We lost 500 health workers in our three countries and places where there were things like 50 doctors after the war. And companies shut down, airlines started cutting off their routes, routes to West Africa. So you know, there is a real consequence of not investing in the basic idea of getting health care for everyone everywhere, and it turns out, you know, probably one of the big lessons is that blind spots in rural health care can lead to hotspots of disease. That places us all at greater risk. [MUSIC PLAYING]

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"We Are Not a Culture of Outbreak Prevention"

Doctors from the Ebola front lines explain how to get ahead of the next outbreak.

way take from this because this is not going to be the last time we faced this disease. There will be other ones out there one's way know about and probably more frightening disease. We don't know about you we haven't discovered yet. So what lessons should we take the global health community to make sure that we're better prepared, the next country faces? Yeah, I think we're a culture of outbreak response and best were culture outbreak preparedness. But we are not a culture of break prevention. We seem to chase one pathogen after another. It's Ebola than a zika and yellow fever, and the truth is pennies on the dollar. If you could invest in some of the basic things that you know really allow continuous surveillance for infection diseases in communities, he would actually increase that yield and catch everything that comes along. I find it interesting that your organization is last mile health because I always talk about the fact that the that the terminal end of all international surveillance for infectious diseases are communities that have no access to care. I mean, the way surveillance works is there's a cluster of people who get sick they go to health care. The clinicians accept the fact that there's something abnormal. Clinician reports it somewhere up to a functioning public health system. Then that public health system response up, the W, H. O and the alarm bells go off. And there is an efficient response right hidden within the country and w h o. But that first smile or last mile help however you wanna put it. Majority of people are not getting to care. And if they are one thing that sort of makes a lot of people surprise when I speak about this is that in resource limited setting, you are diagnosed by treatment. You go in, you have a clinical syndrome of some sort, and they give you malaria medication. If you don't get better than they say, Oh, it might be something else, maybe type of great. Because of that, it takes there's a built in delay for us to pick up outbreaks or clusters before they become outbreak. No, well, said I I think I'd build on your point in terms of lessons learned. Look, if we still can't learn, uh, the lessons from the first patient, the meal patient zero a two year old boy who gets sick with fever, vomiting and diarrhea December 2013 and the rain forests across the border from tonight and I were working in southern Guinea. He dies December 2013. A few weeks later, his sister dies. A few weeks later, his mother dies, and this mysterious disease at the time would spread from one community to another in the rain forest borderlands between these countries Sierra Leone, Liberia and Guinea. And it wasn't until three months later, in March 2014 when this was identified as Ebola. When every minute counted, we're losing month. Uh, when every year accounted with HIV disease, we lost decade. Uh, in the case of Zika, we've lost many years as well. To understand this disease, every one of those illnesses were doing not ick diseases starting in animal reservoirs. Uh, those animals are interacting with human populations and forced communities all in the same rainforest belt throughout west central Africa. And these particular cases amount of loss of life, amount of billions of dollars that cost the economy has been tremendous. And if you ask what is common well, one issue is that 60 to 75% of new emergent emerging infectious diseases are zoonotic on. If you ask, then what else is common is. In addition, the epidemiology of disease is this is the investments in health care. There's been a you know, our friend Paul Farmer would call it a clinical desert in the settings right where there's just not enough investment going to these places on dure seeing massive costs from it. I mean, that one child, his disease killed him, killed his family, killed number community. It wasn't till March 2014. We caught it. It spread like wildfire across West Africa, reached the shores of this country, cost billions of dollars. We lost 500 health workers. And there are three countries and places where there were things like 50 doctors after the war. Uh, in company shutdown, airlines started cutting off their roots, uh, t to West Africa. So you know, there's a real consequence of not investing in the basic idea of getting health care for everyone everywhere. And it turns out, you know, probably one of the big lessons is that blind spots in rural healthcare can lead the hot spots of disease that places all at greater risk.

[MUSIC PLAYING] BRYAN WALSH: For someone who actually has to deal with vaccines and, you know, trust is a big issue there-- and we talked about that before-- when you deal with a new disease, how do you make sure that people actually trust those vaccines, especially if you're trying out new technologies to make them, perhaps test them even faster than you did before? BRUCE GELLIN: So in 2009, when we used the same technology to make flu vaccine for the pandemic, the only thing different about it was the virus. Everything else was the same. It was referred to as a novel virus and, somehow, people thought it was now a novel vaccine and were wary of this novel technology, so we had to get our language right. At the same time, I think it's also important that people expect that these vaccines are safe and proven safe and have the kind of systems in place to be able to say, yes, they are safe. I think that's where this-- the kinds of things you bring here might actually be a help to that. And we don't know when and where a pandemic will occur, but we know that when we're going to give a vaccine that may not have been tested in thousands of people ahead of time are given to millions of people, we need to have systems in place that are going to measure and monitor safety. That's where some of the big data can be great. I think that's where being able to comb EHRs if it's in a developed world to try to find that out sooner than we might otherwise, because we want to have the luxury of the perfect randomized clinical trial ahead of time. [MUSIC PLAYING]

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Dr. Bruce Gellin explains public fears during a pandemic.

Helping New Vaccines Gain Trust During a Pandemic

Dr. Bruce Gellin, director of National Vaccine Program Office, explains calming public fears during a pandemic. 

someone who actually I have to deal with vaccines and trust is a big issue there, and we talked about that before. When you When you deal with the new disease, how do you make sure that people actually trust those backs, especially if you're trying out new technologies to make them testing, even fasting before So in 2009 when we use the same technology to make flu vaccine for the pandemic? The only thing different about it was the virus. Everything else was the same it was referred to is a novel virus. And somehow people thought it was now a novel vaccine and were wary of this novel technology. So we had to get our language right the same time. I think it's also important that people expect that these vaccines are safe and proven safe and have the kind of systems in place to be able to say yes, they are safe. I think that's where this, the kind of things you bring here, might actually be a be a help to that, and we don't know when and where of pandemic will occur. But we know that when we're going to give a vaccine that may not have been tested in thousands of people ahead of time are given to millions of people. We need to have systems in place that are gonna measure and monitor safety. That's where some of the big data could be Great. I think that's where being able to call me h ours. It's in the developed world to try to find that out sooner than we might otherwise, because we want to have the luxury of the perfect randomized clinical trial ahead of time.

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