Think about, you know, possible strategies for moving forward. There is one piece of good news that ill mention, that in the recent appropriations package to talk about threats to Global Health could not be more timely. I am pleased to convene the meeting. Welcome to the council on Foreign Relations meeting. I am frances townsend, the executive Vice President of Worldwide Affairs at mcandrews inc. And i will be presiding over todays discussion. I will have the privilege of leading the conversation for 30 minutes, then i will open it up to questions and answers. We will end at 1 30 p. M. These gentlemen are very busy, as you can imagine, dealing with the coronavirus. By looking back , emergingast decade Infectious Diseases played a recurring and ominous theme, be it ebola, the zika virus, and now the novel coronavirus. The threat is not dissipating. When it comes to nondisease natural disasters the stafford act provides funds to enable Immediate Response by and by comparison there are small Rapid Response funds. Do we need anymore stafford act like mechanism to enable a quicker response to research these new threats . May be i will take the first whack at this, because i think that the feeling in congress, at least from discussions with both house and senate members, that clearly there is a value for having some kind of Disaster Relief fund like activity that the cdc and the cdc has an emergency fund, which has enabled right now, but what is the scale . To give you a sense of this, one andn the last year, the hhs cdc have done a contagion exercise, which was at the local and state and federal government label level that established during a pandemic that you would need a fund in the order of 10 billion, that is what that exercise identified. I think the other side of it is is that there has to be some mechanism by which you can rapidly access funds. This is a little bit different scenario than the pandemic influenza setting. But i think it highlights the idea for speed, agility and mobilization, as the doctor can maybe referring to, the kinds of things he has in his box of tricks, if you want to call it that, to rapidly accelerate products that can be helpful to manage this kind of event. The answer to your question is that we needed some sort of reserve fund and we can actually tap into and also backfill when you tap into it. The two examples, for better and worse i have been through all the outbreaks but when we had the Ebola Outbreak we got immediately the money we put into it, but when the zika virus came out and present obama asked for a supplement, it took many months to get it. That messed everything up. It depleted not only what we were doing but we had to tap out from other activities and finally we never paid it back. Like right now, i am moving resources to respond in a countermeasure way. Fortunately, the things were doing are not that expensive. But they are going to get really expensive really quickly, when you go from a phase one trial, the one million to 2 million, twoh goes to the phase trial, more millions. When you have to rely on appropriations to go through the appropriations process, the only takes take and debate and it does not work. Frances lets talk about the coronavirus. Lets set the stage. The outbreak has set a number of historic firsts, the largest quarantine in World History of the china locking down over 6 Million People. It is the first mass repatriation of citizens, climbing over 1000. Can we level set the basics, how contagious is it, what is the morbidity rate, and how does it compare to others, like sars . Give us the basics. Dr. Kadlec you can judge it by two things. One is transmissibility, the other is morbidity and mortality. As far as transmissibility, is highly transmissible. Sars was less, but had a mortality of 9 to 10 . Dr. Fauci mares had a mortality of 36 . The seasonal flu is very transmissible. And has a mortality of. 1 . That we in our lifetime have experienced, 1957, 1968 and 2009 have a mortality of 1. 3 to 1. 6 . Of catastrophic pandemic 1918 had a mortality of about just shy of 2 , about 1. 8 . Therefore, where do we stand now . We have a highly transmissible calculatedhas a mortality, which we call cfr, of 2 . But there is no doubt it is lower than that. The reason it is lower is because the only things that we are counting with people that come to the attention of health care providers, which means inevitably there will be multifold more people who have symptomstoms or no or minimum symptoms and they are not counted. If it is 2 now with a small denominator, when the dominator increases by threefold or fivefold, you will probably have a mortality of about 1 or less, which means if it continues to evolve into what we hope it does not, a pandemic flu, it will be very much like a really bad flu season or a moderately bad pandemic season. Frances can you be an asymptomatic carrier of the coronavirus . Dr. Fauci without a doubt. The real question we are trying to sort out, because we are getting anecdotal reports, can you transmit it efficiently when you are asymptomatic . We know there are people infected who do not have symptoms, or who have minimal symptoms. We have anecdotal stories of people who clearly transmitted it when they were asymptomatic. That has implications for things like tracking or testing or screening. Because if screening is dependent upon symptoms, then the asymptomatic person throws a glitch into the screening. Frances how efficient, how good and reliable is the diagnostic at point testing right now . Dr. Fauci we do not have pointofcare testing right now. The testing going on is in the Public Health laboratories around the country. At the cdc has come up with an effective test, there are issues in terms of some of the agents, but in terms of it spreading it around the country we have locations where they can do the testing. Dr. Kadlec but there is a lot concernnd that is a making it available to clinicians. Everyone wants to know, do i have it or just someone i love have it and what is the risk of having it with someone else in the family. Frances are we close to or working on that point of examination testing . Dr. Fauci with the cdc did was a very soon after the chinese put the sequence on the public database, we pulled out the gene for this protein to make a vaccine. The cdc took the whole sequence molecular a pcr, a test. They developed it at rocket speed. It was amazing, like in a couple weeks. They perfected that. And the answer to your question, that is a good test. So if you test me and my test is positive, i am affected. If my test is negative, there are a couple of explanations either i am not infected or the level of virus is still so low in me that you are missing it. It becomes a matter of sensitivity. It is pretty sensitive. The pointofcare test that bob was mentioning is the one you want to get out there that you can actually get an answer, just like that, and it is sensitive and specific. We are not there yet. We have a good test, but it is not pointofcare yet. Dr. Kadlec to your question about timing, we would hope in a few months you could have a test that would have to undergo fda evaluations for the same reasons he talked about, sensitivity and specificity of the test, giving you a true positive or potentially a false positive, or worse, a false negative. Frances i am getting the sense from both the testing point of view and diagnostics, and what you said earlier about the cases we are aware of, that we are at the beginning of the beginning. We do not have a sense of size or scope or scale yet of the magnitude of the worldwide infection. Dr. Fauci right, it is even more disturbing because not only do we not have, uh, an appreciation of the magnitude, even more disturbing is we do not have an appreciation of where the magnitude is going. It is we do not know yet what it is. You can do sampling and figure it out, but the critical issue now is how countries and that have travel related cases are going to prevent them from being sustained transmissibility. Once you hit sustained transmissibility, you have a real problem. We have handled travel related cases very well. We have 15 cases, we now have 14 extra people, we flew 14 over from the cruise ship. But we have done identification, isolation. So to our knowledge there arent individuals in society in the United States that are infected. We do not think so, but we do not know 100 because they may have come in under the radar. So what we are doing to mitigate that is that we are taking five cities, representative cities york,s los angeles, new san francisco, chicago and seattle and with those people that present with flulike symptoms, who do not have the flu, we will test them for the coronavirus. If they do have it, it indicates we are missing some. If not, we are in good shape. But what about the countries at that do not have the capability of doing that identification, isolation and contact tracing. Once they cascaded into sustained transmission, the more they do that the more you get closer to a classic definition of a pandemic. Frances lets talk for a moment because we are a andally i interdependent world and not all Health Systems are as capable as the u. S. How good a partner have the chinese been . They closed the market where this started. They sequenced the gene virus on the ninth, they did not share it until the 12th. How transparent have they been . How transparent have the chinese been about how they are handling it and what they are doing to cooperate with the United States . Dr. Fauci [laughter] dr. Kadlec [laughter] dr. Fauci you could talk about 2003 and i could talk about today. Dr. Kadlec if you compare it to the sars outbreak, they were egregiously nontransparent. They had a new infection, it was in november, and it they did not say until february until it reached hong kong that this was not the flu, it was not a typical flu. That put us behind a fair amount. Today, at least from the standpoint of publishing the in the database, the sequence, that was good. They did that. But when you talk about transparency, it depends on who you mean by the chinese. We have colleagues that we have dealt with for years, if not decades, some of whom trained in the United States. They are very transparent on the phone about what is going on. The official numbers that come out, it is opaque where that is coming from. I am not saying it is wrong, but i do not know for sure. Dr. Kadlec i was going to say, another way to look at it is if you think our bureaucracy is big, china is bigger and the manner by which these things are basically handed from the local province or city and whatever else, and obviously at least according to the press that there may have been either confusion or deliberate decisions at the local levels, may be not to report it, you can imagine something that is novel, and this is, gets lost in the noise of the regular flu season and it may not become apparent. So i think there are reasonable reasons, but to that point i think that we are getting information, and now that we have a team in beijing with the who and a couple americans on there, that will enhance opportunities to understand better and really work collaboratively to really manage this. Because quite frankly, as he said, we do not know what the magnitude of this could be, but we certainly know it is very disturbing. Frances it makes clear what you are saying, that we are going to depend on information from our foreign partners around the world. Termsere obligations in of reporting outbreaks around the world, and what are those obligations and what should we expect from our International Partners . Dr. Fauci when you get in outbreak, you have to, that is a responsibility of any nation when you have an outbreak of a new infection, that you obliged to make it public so that you can let people know. Frances presumably not all health not all Health Systems are equal. We know there is a large Expatriate Community in africa. Do we have the same level of confidence at that those Health Systems will have the ability or capability to observe those requirements . Dr. Fauci almost certainly they do not. Knowingt a question of and not telling the rest of the world, it is more a question of not even knowing what is going on in your own country. Dr. Kadlec i do think it is really a good shot out to say that the Global Health security agenda, there is a policy that is important, which is how do we build greater capabilities around the world, particularly in areas where they know that they are not only vulnerable, but they have less than capable systems. So small investments can mean a lot in those settings. Frances how does the current outbreak affect our domestic medical supply chain . What does it mean in terms of our domestic supply chain . Dr. Fauci ruh roh. [laughter] we are seeing that play out in real time here. Clearly, there is good news, but also more chilling implications. First of all, for the manufacturers and distributors, typically before lunar new year, when it is anticipated that the factories in china will be closed, they order more and shape more in terms of making sure that we have an adequate supply. That factors things and like the flu season. I just saw something in the post that said that theyve estimated about 22 Million People with the flu this year, 12,000 deaths. So the distributors and suppliers, right now they are ok, but how this plays out in the longer term is still a matter of concern. Let me give you examples. So this is a joint team effort that we are leading at hhs with our fda colleagues and with dr. Han and others and with our Veterans Affairs colleagues as well as the private sector, sharing information and understanding where we stand. There are things that we could need for this outbreak, things masks. Spirators and 95 we know 90 of the Raw Materials come from china. We know that the supply, a supplier of masks come from has a factory 3m that has been commandeered by the Chinese Government nd they are not exporting those masks. That goes with other health care products. So there are significant things. Same thing with antibiotics, there could be a risk with generic products. But a lot of her health care, 80 have a 90 of our products, the Raw Materials, the ingredients or finished products, they come from india and china. India gets its Raw Materials from china. So there could be significant events, depending on how long this lasts, and how it affects the chinese a system going forward. Dr. Fauci we cannot see them cr ash. We will have a real problem. Frances that is a vulnerability whether or not you have coronavirus. That is a vulnerability that we should fix with where without this. What is the fix . What do we need to do . Is that congress, legislation . Dr. Kadlec it is a whole government approach, congress and everybody and quite frankly the private sector. If you have not read the book read, rx, it is worth a because part of the Strategic Plan of china is to basically become the source of these products. So there are issues at hand. So if you believe in domestic capacity and domestic jobs and having an uninterrupted supply of things, it is clearly a matter of National Policy and support by congress and involvement by the private sector to figure out a solution set to do this. Is interest in the house to see how we can address this, there will be a hearing with energy and commerce. That will be coming up. But the notion that we probably need to kind of change in the way that we do business in these areas, because of this and advocate risks and vulnerabilities that are being highlighted by this. Frances over the weekend, we saw another 14 americans repatriated who were infected. If we are at the beginning of the beginning, we will see more. Do we have the medical infrastructure if the quarantine expands, if there are more americans repatriated do you have the infrastructure that will be required and how quickly is it likely to be overwhelmed . Dr. Fauci i think that 14 americans repatriated does not stress our system. You could have. A lot more and it wouldnt but probably buried in the question is if we really get a pandemic, then you will get into mitigation, which is very different in many respects than containment. You will have getting people to stay in their own homes, because he will run out of institutional quarantine capabilities, which i think is the question you are asking. And once you do, then you will require social distancing, keeping people at home. Using teleworking, closing schools and things like that. Frances we looked at that when i was in the government, we looked at the context of pandemic flu. So how are we thinking about that now . Are we working with the private sector . The difficulty is, how do you execute against that and implement that. Dr. Fauci thank goodness for the pandemic flu plan that we put together, really, because we did that in response to prepandemic, if you remember, what happens when you have the emergence of a pandemic. Much of that is easy to apply to what we are doing now. Dr. Kadlec we are doing that now in terms of interagency work and modeling out what it would mortality rate versus the 1 mortality rate, to see what happens. The one thing that is embedded in that question is the fragility of our health care sector. In terms of the ability of hospitals to manage cases depending on the severity of the situation. In light of what is flu season already, it does not mean if you have the coronavirus on top of the regular flu season, it is additive it does not subtract the flu problem. I think that is one of the issues. Tomorrow, we will be meeting with Senior Health care executives across the country to basically talk about what they need to do in preparing for this. I will highlight one thing. To share oneortant important message. We talked about the respirators. 55 of them are reduced every year, there are millions of them, and if you go to home depot today you cannot find them. 50 are used by the Health Care Industry and 50 by the private sector, people for painting, sanding and everything else. The problem is there is a huge demand and supply will be constrained because of the Raw Materials. And what we need to make people understand is those kinds of masks do not need or are not needed by the general public. For people buying them, you are depriving the healthcare industry, the doctors and nurses and people who will take care of you and your families and we have got to get people to understand that the run on these kinds of products is really going to hamper the ability of the Health Care Industry to protect itself, so they can treat you and everyone else in our society. So there is very simple things and messages we need to get out. I think that is one of them. He can even say a better one about you do not need the mask unless you are sick, right . Dr. Fauci i do not want to denigrate people who walk around wearing masks, but the fact is the mask is probably for somebody who is sick to prevent them from infecting somebody else. The one thing you want to do during an outbreak, when somebody comes in coughing and sneezing, put a mask on them, not on yourself. Frances folks often paint Infectious Disease and bio defense in separate categories. The truth is there is significant crossover in terms of preparedness and research, understanding it is a sensitive topic, talk about how we should approach these risks in a comprehensive manner so that we can achieve Public Health and National Security. Dr. Kadlec they are inseparable, meaning Public Health, security and National Security are inseparable. You look at the events what china will do with its economy and what it will do to our economy, we will see a loss or a decrease of expectations in the First Quarter based on the parts they can get from china, and they are not unique in their dependency. This will have anna normans impact on our economy. And if it is unabated and goes on a trajectory it seems to be going on. The thing is, one, i make this an affirmative fact and it goes back to money. The strategy that the president signed in september of 2018, it basically shows we spent about 8 billion a year on the whole kit and caboodle subject to our investments, the institute, the local and state and Public Health. That is half the cost of an aircraft carrier. We have 12 aircraft carriers. We probably could benefit from some kind of thoughtful investment at all levels of government to build capacity, to make sure that we can have a domestic manufacturing capability for vaccines, so that we could rapidly, as identified in the influenza plan, that we need to have domestic manufacturing not only for vaccines, but for other Vital Health Care components. So there is a real need to take a different approach to this. Because of the global interdependencies, because of the risks to our livelihoods, as well as our social stability, and our National Security. Remember 1918 happened during world war i. More people into more soldiers died of the flu than combat action. So they are interconnected. You cannot separate them. I think that some of the issues we have to get our heads around, and it is incremental, is we have to somehow understand that we need to kind of engage, particularly now with this on the table, in the long term fran, which was started by and her colleagues in 2005. Frances let me take one minute. We wanted to meet and talk about bio weapons originally, but let me ask before i open it up, you know, bio shield was written in 2003. We had the national stockpile. One of the things we worried about was bioweapons like smallpox, that sort of thing come and we have a strategic stockpile that protects us or tries to at least begin to protect us against those sorts of threats, but we have seen other emerging threats like north korea, that assassination using a weapon. A russian assassination. How do you stay on top of the emerging threats and how do you think about the Strategic National stockpile . Dr. Kadlec emerging threats are the next potential bioweapon. Dr. Fauci you have to think of it as a continuum. Mother nature serves up agents at that we are susceptible to inconceivably could be used by somebody in a way that could be to optimize that natural agent into something that could be certificate. So number one. Number two, the stockpile, we must think of it not as something that is static, because the worst thing we could have was a medical maginot line, a stockpile that is not agile, anticipatory, and i will use the micro microbial resistance as an example, some of the antibiotics we have, the ones we identified in 2002 to address the anthrax problem, we know that there is a microbial problem in the world. Somehow we must use that engine of Public Health to also support the need for National Security. How do we do that . We are thinking through that, but it does make it difficult in saying, i have this box on a shelf and hopefully it will not expire. But the thing is we need to keep rotating the stop, and new items on the shelf that can address these things. Quite frankly, i think this example of a coronavirus, and the doctor can talk about what happened to his great vaccine for the sars event, that kind of lost speed. Theres another side to the coin of stockpiling things you know are countermeasures for something you anticipate, and that would be to take, which we are doing in it taking to the stockpiling, it is not one or the other, to take a more generic approach and develop what we call platforms of diagnostics, therapeutics, and vaccines, so that when you get a new microbe, a new pathogen that you have not anticipated, therefore, you could not stockpile anything. You just did not anticipate. You need the ability to move extremely quickly to get a vaccine for that. Waythat you do that the you do that, you dont rely on having to identify it, grow it, or attenuate it. That is a day of sequencing. You could get the gene, stick it into whatever you want, and go for it. We have an example of that, right now, with the Coronavirus Vaccine we are working on. We are not the only ones working. There are about 10 candidates. What weve done from the time we got the sequence to the time we going to phase i trial will be about 2. 5 months, which is overwhelmingly a record, because that would have been years before we did that. Then, you go through a phase one trial and you know the platform , or ae using, via mrna particle, and you could move much more quickly than that then if you would if you went back to the 20th century, find the organism, identified, grow it, its ezra. There are etc. There are two things, you anticipated, and stockpile countermeasures, or you develop a quick moving process to make a countermeasure more quickly. You have to have both of those things together. You cannot have one or the other. The last question, the fbi recently arrested a harvard scientist for excepting undisclosed grant money from china have her research for scientific research. There are similar investigations into a number of universities, including yale and m. I. T. , and the grant money is in question. What are grant Companies Looking for . Why in the u. S. . And is this a bioweapons concern . Why should we be concerned about this and what is the force government interest, do we think . It is a stealing technology issue. It is very clear. It is unfortunate, because it has put a taint on all chinese, and that is too bad because it is a small fraction of chinese scientists who have, in this country, taken fellowships, gone to study sections, and taken confidential issues, brought it back, and developed it in china. That was picked up by people at the nih and other places. It is an unfortunate situation. I dont think it has anything to do with bio defense. But it does have to do with economics. Stealing our best ideas and innovations and translating it overseas so they can do it may be better, cheaper, faster. I dont know about better, but certainly cheaper and faster. That is the issue that is where the issue of National Security comes in. At this time, i would like to invite members to join their conversation with her questions. A reminder, this meeting is on the record and wait for the microphone. Speak directly into it, one question, not a speech. Be as concise as possible to allow as many members as possible to speak. We will start here. Thank you for the panel. Aboutd princess confirmed 540 cases of infection. That is out of 2400 tested. The concentration of infection is 50 to 50 to 25 rate, depending on how many remain 15 to 25 rate, depending on how many are remaining to be tested. What does the study tell you about the virus, and does it help us to understand the prognosis of what is going to happen to the rest of the world . I think it just confirms the high degree of transmissibility of the virus, and when you create a beautiful setting for the virus, people on a large ship, altogether at the same time, all of the time, you couldnt ask for a better incubator for infection. It confirms what we already know, that this is a highly transmissible virus. That is one thing of concern. You amplify that when you put it in a closed space. It could also tell us something about maybe some modalities of transmission that we didnt appreciate before. Experiencenteresting with sars in hong kong in 2003, in an apartment complex. Correctly, that sars was spread predominantly by respiratory droplets, the majority thats the way the majority are transmitted. There was something the way the majority are transmitted. Likely due to the plumbing, because the virus gets into the stool, and feces, and when people were flushing toilets, they didnt see this invisible error so that vertically transmitted, so people on the second floor were giving into people on the 10th floor. Even a wave that went across to another apartment. That is rare that happens. That is something that could possibly have been going on on the ship. We dont know, but that vessel was an incubator for infection. Doctor, does the virus survive on a surface, and for how long . Do we know . Is know, the answer last week i wouldve given you the history of the influenza with x number of hours, coronavirus with x number of hours. Host of the time, it survives for hours, not days or weeks. Coated he mucus could survive longer. Myt we are doing at Institute Laboratory is we are doing the experiments. We are taking the virus and putting it on stainless steel, wood, cardboard, trying to find out how long it lasts. Yes, sir . [indiscernible] [laughter] could you talk about the treatment of those infected . What works and what doesnt work . We hear the old succumb more quickly. What you find out and what do we need to know about the treatment . Lets start with the second part of your question first. Like influenza, similar to influenza, influentials individuals who are elderly without other conditions or anybody with an underlying medical condition, those are usually chronic pulmonary disease, congestive heart failure, diabetes, obesity, immunosuppressive therapy for underlying diseases like cancer. They overwhelmingly are overrepresented as the individuals who get serious dizziness disease and ultimately died. There is no proven, direct antiviral drug for the coronavirus, so treatment is generally symptomatically, and if you get into difficulty with pulmonary problems, it is supportive there is supportive therapy. That could mean oxygen, it could mean intubation, anything that gets somebody through an acute stage of pulmonary decompensation. We are doing, and others are doing, Clinical Trials of repurposed drugs, drugs that were developed for other viruses, to see if they have activity against this virus. At the same time, as we are screening small molecules and doing targeted Drug Development but the bottom line is that there are no antiviral therapies. Yes, sir. [clearing throat] hi, tom, director of the global panel at the council. I wanted to ask about the cruise ship. Several hundred passengers disembarked. I gather only 20 on the ship were tested. One passenger has, after the fact, tested positive as being infected. What is the current strategy for the passengers that did disembark, and how far along are we in executing it . You ask the right question, because you are the gather makes the right decision. Simply those individuals on the ship are being tested. There are a couple hundred people in the hotel evaluated, so the thing is that one of the things that is an important issue to figure out is, where does that individual get infected . The incubation period could be as short as two days or as long as 14 days. There are a lot of unknowns, but i think everyone is going through it in a deliberate fashion to say, what can we do to assure we just dont send the people around the world and say everything is fine . The state department is doing an admiral old job with the government of cambodia to work with them to evaluate folks appropriately. Before we kind of send them on their way. Dr. Fauci it creates a difficult situation when you have an exposure that is low to medium risk, and then you have to ask yourself, do you have the resources to go trace everybody . I dont want to be pejorative against cruise ships, but there it cruise ships. If theres one thing you dont want to do right now is take a cruise in asia. [laughter] yes, back here. Stokes, last week, the who hosted a meeting with multiple Tech Companies including facebook and google to address the issue of medical misinformation, impeding the response. What are some of the strategies being used for combat this Information Online with the respective Public Health, specifically whats working, what is not, and what can we be doing to mitigate the impact of info demings on contemporary app breaks and future outbreaks outbreaks and future outbreaks. I dont know its being done to counter that, other than what is being done in the normal things you read about, about how to get this information off of social media. With all of the problems of reluctance to do that because of freedom of expression and freedom of speech, i think medical information, the only thing we do, as physicians and scientists, the way bob and i are, is to try and get out the facts as often as you possibly can. In other words, to counter misinformation with correct information, as opposed to yanking out misinformation. Thekadlec i will highlight fact, having trusted spokespeople doing that, like dr. Fauci and i think th thing here is to not follow facebook but to follow the doctor because he is not wrong. Tim from the u. N. Foundation. That was a terrific program. Could you drop away for a minute . I want you to focus on Climate Change. Has Climate Change, and are you projecting for the institutes for what you are responsible first for significant changes resulted of Climate Change. Related to that, is the Research Agenda and are we pursuing that Research Agenda as aggressively as we might be . I will for you refer you dr. Fauci, first. Dr. Fauci Climate Change is always problematic to try and relate Climate Change directly to things we are doing. If you look at my responsibility as the director of a Research Agency that involves Infectious Diseases, some of the things we are really interested in is the expansion of vector range and vector capability, with even slight increases in global temperatures, things like ticks, mosquitoes, overwintering. One of the critical issues, when you have a mosquito Borne Disease in a region in which you get cold enough at one part of the year that the mosquitoes cannot overwinter, they go out of action, and then they come back the next warm season. If there is enough change in temperature to allow them to persist even longer, you could have the extension of a season of a vectorBorne Disease. That is just one example of where Climate Change clearly has a direct impact on the things we do. All the way in the back. Hi. Im with radio free asia. Kadlec, are the experts among the huawei io team, and according to the chinese horn apparent office, they say that expert team are visiting beijing , not the epicenter of wuhan. Do you think we are able to get the full picture of the epidemic . And dr. Fauci, yesterday, you d you dont think china is the number, but you are on the white house force, and we have seen them come to china like a transparency. Why do you trust the information china is providing . Do,fauci today, today i for the following reason that what has changed in china is that the chinese officials have been more than adamant about actually punishing people who are holding back information, whereas, early on, there was a reluctance and hesitancy on the part of the scientist to talk about what really is going on there. There was a phase early on where the people that i knew, people i had dealt with for years, who were very concerned about speaking out publicly. They would speak to me over the phone, but they would not speak publicly. Now, they feel the government is giving them the free range to be completely transparent. There really isnt any discrepancy except what was set at the white house before and now. With regard to the people in china, we are sensitive to the chinese wanting to be the ones that make the statements where these people are and where they are going, because we are guests in their country. Although it is an understandable question, tell me who is there, where they are, where they are going. We would prefer to have you hear that from the chinese, because you do not want to get ahead of the chinese. What we dont want to do is for them to pull back on the offer of having our people there. Yes, sir . Thank you. Im with the Chinese Agency of hong kong. How would you evaluate the efficiency and effectiveness of the chinese approaches to contain the virus . From the standpoint of the expert, not from the politician. Not take alle did of these measures to contain the virus, would you be more concerned that the virus will spread more quickly all around the world, and secondly, now oft the new cases are out , the nationwide cases have disk line have declined. What is your next step for the chinese . Thank you. China has done, in response to this outbreak, is unprecedented. One could describe it almost as draconian. To shut down 50 Million People from traveling in and out of an area, essentially shutting down the entire city of wuhan, of 11 Million People, from a pure Public Health standpoint, the conventional wisdom would have been that that is overreacting because there are so many potential downsides to that, but as a matter of fact, even though it was unconventional and is subject to understandable criticism, it very well may have dramatically slowed down the exit us and export of cases out of china. So at the same time that we imposed an unprecedented travel chinese werea, the being even more dramatic in what they were doing in their own self containment selfcontainment. Since the evolution of a pandemic, when you have a single region that overwhelmingly china is the epicenter, unlike a pandemic flu where it started off, remember the 2009, and california and texas, within a week it was all over the world. Unusual, unprecedented, accessc restriction of in and out, i think at the end of the day, saved us from a lot more travel related cases. And, with more travel related cases, inevitably, you would have had secondary and tertiary transmission. At the end of the day, i think they did something that really helped a lot, even though it was unusual, and quite draconian. Dr. Kadlec i just put it as a strategic context like this. You have an annual flu season like we do, and superimposed on that is an anomaly agent that you cannot detect or cant account for what is happening. If it happened in our country, there would be a moment in time where we say why is the spike in incidents . Then, it becomes a race to , the root framework of the epidemiology, to begin what would be the appropriate interventions. Addon to the fact that you dont have a therapeutic or vaccine, so you are left with nonpharmaceutical interventions. This idea of quarantine, closing schools, look at japan. They are addressing this in a way that addresses the reality of the virus, right . Try and quarantine it, limit the spread. In ourould look at it, country today, in lieu of maybe a vaccine, and we are working on therapeutics using the same mechanisms that dr. Fauci identified, trying to produce antibodies like we did in real time with ebola to have a product like the cocktails that mib114. This scenario and what china did is extraordinary for sure, but the doctor should not the brakes on this but probably slowed the risk of widespread, rapid spread. Will it continue to spread . We see cases everyday continue. If it gets embedded in a place like we talked about earlier, or other places where Health Care Infrastructure is not very good, that could be the next source of the risk, if you will. Even though china has done extraordinary things to clamp down. Again, this we are living in an historic time, if you want to think about it, and terms of the race against the microbe, and again, i think the challenge we have is how do we do i recall a piece of work emerging, Infectious Disease by dr. Letter and dr. Stokes in the 90s that highlighted the risk of this happening. That was kind of like the piece of work of National Academy of sciences that started this intellectual race to say how do we address and we are 20 years into that conversation, and now is a critical time to do what we need to do to limit the spread as well as prepare for the next one. We know in the 20th century, how can how many pandemics where there . Three to four. This will not be the last one. On something you said, it triggered a question. Do we know if there are existing therapeutics or drugs that could be repurposed, and might work against the coronavirus . Yes, we are testing two of them. One that we developed for a number of other viruses. We used it against ebola and it was not successful. There is an antihiv drug that has inhibitors that we are using. Both are being tested in randomized controlled trials. Questions . All the way in the back. Dr. Fauci, npr, do you have the capacity or scientific capability to not only address the current coronavirus outbreak but also anticipate others that come ahead, looking back at mers and sars. Could anything you have done now addressed prevention so that we are not just addressing what is here, but what emerges in five to 10 years, so that if it emerges, you are ahead of the curve. Is that tenable . Dr. Fauci it is tenable, there, but it is unpredictable. 75 of all of the new infections that afflict mankind come from an animal to a human, which is exactly what this coronavirus did. If you look at sars, it took a while, but we showed, definitively, that it went from they sacrifice them and eat them in certain religious circles, and that is how it transferred. Mares is the middle east respiratory syndrome. This virus, if you look at the evolutionary biology of viruses, coronavirus is really like bats. If you collect 1000 different bats, you will find coronavirus is in them. You are able to trace the evolution of the mutation until it reaches the point where it can combine to a human receptor. I dont want to get in the weeds with you, but the human respiratory tract has a wo. Eptive called ace t the spike protein of the coronavirus binds to that receptor, which allows it to infect the human. The ones that dont do not have the right confirmation or write me like killer confirmation molecular right molecular confirmation. If you have bats in animals, you get the right mutation in right circumstance, and it jumps species. Sometimes, it ends into the human, and you infect one or two humans, and it will stop. It infects one or two humans, you infect them, and it will stop. He transmitted from human, to human, the human. That is exactly what this coronavirus did. To that,w the route how you can prevent it to merely be able to have good surveillance, good diagnostics, and good response capabilities. Dr. Kadlec to your point about capacity, its relates to the bottom line, which you really need to take what tony said, because all of these platforms that allow you to rapidly respond, as well as there is another approach which, can you look for Broad Spectrum therapies, in this case antiviral, that would have activity against coronavirus is . There is a huge challenge year in terms of how do you do it . You cant do one approach or the other, but try multiple prongs to see what can give you the best coverage. , as tonylike to think said, get the indoor record but we will have to beat it again in terms of permission ourselves not only for this one but for the next one. And, what can we do . Platforms are significant advantages we can take as well because not only do they allow you to rapidly insert and test something but allows for the regulatory pathway if the fda is familiar with these things and the broad Science Behind it. Your data and the safety and efficacy of these products, it is complicated, for sure, but the answer is that that is what we need to do and we are doing it. We need to do it fast for this one. Dr. Fauci, you mentioned one of the keys is surveillance. His domestic is our domestic surveillance capability up to this challenge, and nationally, is the surveillance capability there that we need . Dr. Kadlec domestically, the cdc has a good system that partners with state and local health authorities. That is the great strength of the cdc because not only are they a Great Organization but they are connected to the state and local health priorities. Globally, it is spotty. Areughout the world, there some places that have very good surveillance, and the Global Health surveillance that we have right now, i think, is much better than 15 to 20 years ago. Yes, sir . John andrus, George Washington university and university of colorado. My point is related to what was just mentioned. I convened i chair the Panamerican HealthOrganization Regional commission for measles rebel elimination. Last week, we heard presentations from colombia and venezuela. Venezuela lost its measles free status, but the two countries would not talk to each other. I think the role of the Panamerican Health organization , in tackling the international relatedness of Infectious Diseases, is crucial. My point is partnerships. Could you comment on the partnerships required . In our own backyard, there are opportunities to at least maintain the current level of collaboration. Dr. Fauci i think you hit the nail on the head. If you dont have partnerships and collaboration, you have essentially destroyed a continuity of the system, which is what happens in south america, unfortunately. It is tragic that it happened, but it did. Yes, sir . Andy weber, council and strategic risks. Thanks for a great talk. How do we conduct Clinical Trials in china of these candidates, antivirals, and vaccines you mentioned . Thank you for the question. It is happening. The chinese have agreed to do a randomized controlled trial of standard of care versus standard care loan. Scientists, you will likely do one with kaletra, which is retentive here presley 10 of your plus live 10 of your. Rugs. Exchanging emails last night and this morning about trying to get that trial, which is a master protocol for the people in the United States who are infected and have been shipped to nebraska. Hopefully we will get that going. That concludes our meeting. Thank you for taking time out of your busy day. Service. For your [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2020] the discussion on the coronavirus Available Online at cspan. Org. The council on Foreign Relations in the search box. Some news on the coronavirus. Senator tom cotton suggested over the weekend that coronavirus could have been created in a laboratory in china, despite pushback from experts and officials. During an appearance on fox news sundays sunday morning future, he commented on the rapid spread of the virus, saying, we dont know where it originated. We have to get to the bottom of that. According to the washington post, he is referring to the ahn bio safety wu narrative that has picked up some rightwing websites in recent weeks. You can read all of that at thehill. Com. More Live Programming coming up in just over half an hour. A look at the political situation in venezuela live it 2 05 eastern on cspan. Former government officials discuss Lessons Learned from the war in afghanistan in response to the latest development in the peace process. That is life from the institute of peace on cspan. Wgbh tv in boston hosting a debate between senator ed markey and his challenger in the 2020 Massachusetts Democratic Senate primary, commerce been joe kennedy. Watch that congressman joe kennedy. Watch that live on cspan, on cspan. Org, or listen live on the free cspan radio app. Senator Bernie Sanders speaks at a get up the vote early rally at the university of nevada las vegas. Early voting for the nevada caucus ends today with a caucus on saturday, february 22. Watch senator sanders at 5 30 eastern on cspan2. During this election season the candidates beyond the talking points are only revealed over time. Since you cant be everywhere there is cspan. Our campaign 2020 programming differs from all over political coverage for one simple reason. It is cspan. We brought you your unfiltered view of government every day since 1979. This year we are bringing an unfiltered view of the candidates who are trying to steer that coverage this november. In other words, your future. This election season go deep, direct and unfiltered. See the biggest picture for yourself and make up your own mind with cspan campaign 2020, brought to you as a Public Service by your television provider. Uch money. Up next, the second stop in a weeklong American History tv series focusing on d. C. Area museums, highlighting collections that explore the american story today on the stoy