Transcripts For CSPAN3 The Next Pandemic 20171128

I did want to hear some of his view. Some of you Vice President had a chance to hear it as we move into a new era. In this landscape the view of preparedness articulates a position where strategy implementation and evaluation of progress should be based on rather than a program base. They may be accidental or deliberate. We recognize the systems we put in place must be able to adapt to whatever type threats we are faced with. We develop health care we Response Strategies that hone in on federal resources ant support to state local stake holders as they identify risks and develop capabilities to address the known and immerging addresses. He aimed to do this through four key priority areas, first to provide strong leadership and situation awareness and secure adequate resources. Support the sustainment of reliable Public Health cape abilities including ability to detect and diagnose Infectious Diseases and other threats as well as ability to rapidly dispense in an emergency. And fourth to cultivate by capitalizing on science to develop and maintain a robust stockpile of vaccines, medicines and supplies to respond to immerging disease outbreaks, Chemical Biological incident and attacks. Our mission is to save lives, protect america from 21st Century Health security threats. The update was developed through a collaborative process and expands on concepts outlined in the original plan, knowledged the advances made in science and research and other outlines across key domains. You heard some of that from dan. These Areas Community mitigation measures, development of Health Care Systems and infrastructure preparedness. In 2017 the update highlights progress since the original plan. We made progress in addressing many needs and we are better prepared now than we were in 2005. Specifically state and local partners of their own plans. We worked to expand who can vaccinate and in what settles. Ten years ago you had to go to the doctor or hospital to be vaccinated. Now you can go to your local pharmacy. It is important to note with flexible nimble authorities and multiyear funding to facilitate partnerships with cutting edge expertise. Over the last decade if barta developed 34 fda licensed products. They are ready for emergency use and significantly expanded production capability. Bar with respect to the Health Care Systems preparedness the program in the past year released new guidance. The funding opportunity announcements for 2017, 22 and outlines Program Requirements for jointly with the cdc Health Emergency preparedness program. These Capabilities Build and improve particularly incorporating a better focus on health care. When the Health Care System planning is incredibly difficult it is an inclusive planning process including clinicians, legal and experts just to name a few. The National Training and Education Centers were created during the pandemic. They partnered to establish the ebola Training Center that will end in 2020. It is a consortium that safely and treated a confirmed patient with ebola during the 2014 outbreak. The care of patients with ebola and other special pathogens and established a phone line to provide emergency consultation with health care facilities. And lastly, they launched the pathogens network to create a platform. 2018 marks the anniversary aft pandemic. Theres an increasing milestone. It is important to recognize the advancements during that time. We will continue to develop new and better ways to prepare for and respond to and recover from not only pandemic influenza out its breaks and release of highly infectious whether intentional. Thank you. Okay. We have time far couple of questions. Can you say more about what we all learned in the experience of ebola . I this in some ways it caught us a little off guard. We deal with infectious patients every day. We have systems in place to monitor and track Infectious Diseases. It is putting a challenge on how is it transferable and what are the other levels of care when we dont really know the cause has really put a challenge and sort of wake up call to go back and read this. We had Continuous Education classes almost on a weekly basis. A lot of those programs had not been a place in hospitals where we were bringing people back together and reintegrating on certain things. There was fear involved and trying to do the right job. It really placed a new challenge on education and training for our staff. And for people who are unfamiliar with how hospitals are involved could you explain is it a Grant Program or requirement, how did the government interact . The Health Care Coalition program is the funding that comes. It informs and enhances the ability of communities to build coalitions amongst health care provider. It was a hospital preparedness program. Over the years we recognized it is a kplunty based focus. We need to draw in all of the other members trying to build a coalition of people in that community or in that region that when an incident comes in youll have to share resources to meet the Health Care Needs of that community. The program in fact rolls out to those around the country. Is that related to the program that sends Emergency Health care workers to hurricanes and to responses . How do they relate . It is a medical system. It is a separate program that is shortterm employees. They are health care administrato administrators who volunteer to be temporary employees. The medical system, we have teams that are activated during the response. They go in for a twoweek period of time to provide care when they are needed and do a rotating system. The last three hurricanes challenged our ability. All of the teams were activated and many did another tour if not more in order to meet the Health Care Needs in a community. They come in to supplement and support the medical care needs during those events. Maybe one last question on counter medical development. Uhhuh. We heard about influenza vaccine development. What is it in terms of fda and cdc . Barta is the later term entry into this process. They take the work and roll that into advanced Research Development and bringing it to final manufacturing. So in those last days they are a partner from end to end strategy in medical Counter Measure developments. Thank you very much. Let me invite the next panel up to the stage. On my right, she directs the programs, operations, administrations, strategy for the departments Emergency Preparedness and response work including oversight for Public Health emergencies related to the Health Care System. She is basically responsible for directing pandemic preparedness. You can tell me if im wrong about that. To her right is jamie who is the Program Officer for pandemic preparedness. It is an organization dedicated to making in many areas. She has been leading for the past 18 months. She has been giving grants around the country and the world to diminish risks and those from other biological threats. She worked at the department of defense and on the global Health Security agenda and with federation of american scientists among other constitutions. I will turn to them in a moment with questions. I will start with a couple of observations. The first just to kind of place the pandemic in a local context is worth looking back at what happened in 1918 in baltimore. There were 600,000 residents of baltimore. Over the course of one month one in four people became ill with influenza. 2 of those people died. In one month more than 3,000 people in baltimore died from influen influenza. Every sector of the work force was effected. Communications was impaired. Trade with other parts of the country was impaired. It was devastating to the Health Care System. Overall it was a major event in the life of baltimore. So its tempting to think today we would be able to escape that. My last point is that no matter how you slice it how the people respond to a pandemic will have enormous consequences. We have to talk about the federal issues. They are so important. We also have to focus on the state and local systems, doctors, nurses, Public Health agencies that are working to prepare the country. What i want to ask marissa about is maybe you want to take us through the pandemic efforts, just explain how they work. I think its worth starting by saying based on we conducted health and Public Health hazard vulnerability and pandemic ranked number two only after coastal storm was on the heels of sandy. I think it is a threat we take very seriously and we feel certainty this is something we are going to see in our lifetime. I think the point was made earlier about the Health Department or sort of Health Taking the pandemic. Thats case in new york city. It is a collaborative effort. We cant respond alone. This is a city wide response. While we take the lead and drive the planning it is very much in partnership with the fire department, police department, Emergency Department as well as the Health Care System. We do plan for both mild to moderate as well as to a severe scenario. Our goal is to limit impact. We dont assume we are going to prevent it from entering into new york city. It is about how do we limit the spread. We break it down into seven key objectives. Mental health and last but certainly not least kplun ca communication and outrieach. So really learning from previous events we started writing the initial plan with federal funding in 2006. A lot has changed since then. We also have learned a lot from ebola, zika. It goes into that pan flew response. And the final point on this question is this is very much dependent on Public Health funding as well as hpp funding. Without this funding we wouldnt have the dedicated resources to fe kus on this type of planning. Great. You spent the last 18 months or so and time before that kind of wandering the country and the world looking for the most impactful ways to prepare for other risks. You talked to people in laboratories, governments, what have you learned about that and what do you think is the least appreciated about that . Sure. Thank you. So not much surprises me in this space except for one thing and that is that we find ourselves in a cycle of panic and negligent. It is not a phrase i developed. What that means is while there is an acute response in reaction to pandemics like h1n1 and ebola as soon as the acute phase passes it doesnt continue to be a sustained priority and so i think the thing thats surprising is how it phased away. We have seen a number of warning shots in recent years. We sought to outbrak that infected more than 25 of the population. We saw the 2014 Ebola Outbreak and now we are dealing with a zika outbreak. I would consider all of these warning shots. I think it is in when i talk to my colleagues a number of them say we are in the negligent stage. It is surprising to me we are finding ourselves in this place. This is not the first time we have gone around this merry go round. We were also focused on the threat after the 2001 anthrax attacks. As time went by we are repeating that. Im hoping we can learn from the warning shots. Certainly it is productive to have a lot of on Public Health but also important to remember they tl will be effects if youre dealing with it. It will strain our Hospital Systems chls. It might strain electric power. It could lead to conflict depending on what are the critical vulnerabilities and how can we be resilient to the disease itself and also from a Critical Infrastructure perspective. Great. Let me ask you a couple of questions together. What do you think are most likely to go wrong . I think the population size and density. We anticipate that this is something that will hit us early and that it will have dramatic spread. Relatedly as one of the major strategies being social distancing i think that will be very challenging especially with the public that is so dependent on mass transit. 5 Million People ride the subway every day. I think the other big challenge is really getting back to the resource issue. Again, i mentioned that i dont know if people are aware, the fact that the award has been cut it has been a 37 cut and then on the hpp side a 38 cut since its peak in 2004. I think it is very concerning to us. This is the funding that we really depend onto really get the planning done. As someone mentioned, its training, exercises and also as i mentioned, its not the Health Department alone, its bringing together our colleagues and a lot of what we invest in is personnel. When funding gets cut thats what we jeopardize. Finally in terms of a general challenge it has been issues of equity and health disparities. It is something you certainly see in emergencies as well. When you Start Talking about resources how will the resources be allocated when chunks may be having daytoday access. In terms of how we plan to get medication to the people, again, it is a mullprong strategy. It is so we can take kir of our first responders. Relationships with providers and mechanisms to get to school. We did a school based vaccination. In 2014 we did a no notice exercise where we were able to open 30 pods in less than eight hours which we were excited to see the culmination of a planning and to show we were able to carry it off. We have really belt relationships. We have been working to getting Contact Information and thinking through how we can utilize them in other scenarios as well. In terms of challenges, you know, it is very challenging to staff pods when its a vaccination scenario. Not everyone can vaccinate. It limits our personnel. Also we found during h1n1 it can be not really surmountable. And then the issue of maintaining adequate supply levels. As was mentioned earlier, concerns of people doing what we need them to do. As someone said it so eloquently, you need to have those relationships built in advance. Great. So jamie, in your view, what do you think the community is doing well and what do you think are the biggest unmet challenges of the organizations you have been working with . So i think the number one thing that i would point to in terms of where the community is doing well is global Health Security agenda. I think it was an international initiative. It is continued under this pandemic. And there are a number of thing that is are exciting. One of them is that it was really a focused effort to develop a shared set of goals across countries and across different sectors to prevent, detect and respond to these threats and that a number of actionable steps were highlighted and funding was committed by the u. S. Government and other governments to take on those tas ks. The intention has always been for it to constitute where governments can be held accountable for results. And then i think another aspect of it is the able to respond is largely the same irrespective of whether it is a caused outbreak. They brought together the National Security community to Work Together to build one system. So those are both really productive aspects. It is disheartening to see there has been a renewed commitment to this and the open question is whether or not it will continue to be there in the next five years. Great. On the health care side how do you think or how do you think any city Health Care System could respond to an event like a pandemic. . What kind of bed and dwimt do we have on hand . Ventilation from National Stockpile and how would they work . I think thats true. Our Emergency Fund 8 is the lynch pin of all health organizations. We have been our hpp funds to build up the way we look at it, the funds are youed to address systemwide gaps. It is ools to provide facilities. We provide support to pry pair care sector. This is one that we work with the various sectors on. We feel it has applicability to a panflu scenario. You know, we have a total number of 22,000 licensed hospital beds and 57 hospitals and right now 2,000 bedside ventilators that could be used for adults and a thousand for papediatrics patie. We bring in a faux patient we check to see if they made changes. We find it could be strengthened especially around hand hygiene and when they are getting a mask there is a delay when they are getting a mask. It needs to become more testing given staff turn over to make sure it is really to maintain individual levigilanc vigilance. In terms of the work that youre doing, can you give us a sense of opportunities from improvements . On presengs in particular because of thinking about deliberate misuse i think there is on dual use bioscience. I think we have a long way to go and theres a lot of work to be done there. On detection we have an opportunity to improve our systems for Early Detection of outbreaks. In particular the technology that is rapidly immerging could be sequencing technology. If there are innovative ways to identify unanticipated outbreaks in clinical settings and to apply that technology. We are not sure where the next pandemic will come from. The technologies that are most useful are ones that are very disease agnostic. It is not only against flu but other viruses that could immerge. Great. I think we have time for one more question ooech. What i would like to ask you is how do you think other cities are doing . We always hear about new york city because it is such a high performer. Do you think other cities are doing as well as you described . I think i actually wasnt nationally fall into the Emergency Management realm. Something that i learned along the way is whats valuable about the planning is the process, not to document. You should have tools people with reference but its really about the process. Thats lot of policy issues that come up. So yes, it does require resources. And so it has been challenging. You know, there was dedicated planning way back when and, you know, oftentimes as jamie mentioned you sort of have a focus on a particular scenario and then it kind of goes away. It is really about building all hazard capabilities, Building Systems you can leverage for many types of events. It does require continue investment. For the capabilities that we have built they have to be maintained with continued investments for the gaps that we identify, that needs assessment. It has become very challenges for other jurisdictions and new york city as well. We do have more resources than a lot of other places and we do try to share what we develop. I talked to my colleagues across the country. They struggling to deliver on baseline capabilities. You asked what it is that we need from the federal government. You know, i think continuing to really try to preserve the funding which is so critical for this kind of work is sort of at the top of the list. Understanding what the roles are. We did something really interesting of ebola. We got our federal and state and local partners all together in a room and talked about what had gone well, what would be improved with coordination. I think thats important to do. Si some times guidance is coming fast and furious. I think it will be really important. It could be done in advance and also at the time. Some of the guidance one not really in sync with urban settings. It created problems for us. Beyond pandemic influenza the organization has a what are you worried about what should we be thinking about . We think about manmade pathogens that could immerge. It is something that we think about because we feel that that could pose a severe pandemic risk. It is highly relevant to high kwons kwe consequence events. Thank you both for being with us. [ applause ] we appreciate it. Okay. Okay. Good afternoon. My name is rachel. We have the wonderful mission of understanding the Natural World and the place of humans within it. One of the great privileges of being a scientist in this museum is our connection, our service to the public. At the smithsonian it is to diffuse it. So with our exhibits we reach millions of people are year. I am the lead that serves critical function of public communication about pandemic threats. It is called outbreaks. It opens in may of next year. Outbreak places influenza and other viruses, ebola, zika, and hiv in an ecological context. We present human health, animal elt and Environmental Health as one health and show how pandemics can result from a failure to recognize and respect that connectedness. So we do this with stories that demonstrate the principals of one health where human impacts on Animal Health or envir Environmental Health such as virus spilling over from wildlife or livestock and causing an outbreak. We explain the human drivers, the activities that spread disease such as Global Travel and trade and how they can cause an outbreak and threaten the health of people everywhere. We show the effects on society and the kinds of efforts needed to fight back by science and health care and policy and last but not least we explain to our visitors the fundamental role of research and vaccines in preparing us for the next pandemic. So outbreak is a new kind of exhibit for us. Thats because Public Health is a new space for us as a museum, a space for us to be. You know, its part of our work that is motivating our exhibits in most cases. While it is true that our collections do have value for Infectious Disease research, thats not the only strength we are actually using in this situation, in this place. We have convening power at this museum which i think is demonstrated today. It is also shown by many free public events. And so we want to motivate behavior change and we want to cat liez conversations about pandemic risks in the public. And because pandemics are global we are try to go convene a global audience outside this city. Outbreak will not only be a new subject for our exhibits but it will be a new model. Thats because we designed a second version that will be able to pop up in a community in where in the world using resources that will provide digitally including a guide to develop educational programming, template files to customize exhibits because that is the important part of allowing communities that are vulnerable to academics to have those tools it is the most effective messages and the most appropriate way. Outbreak would not be possible without the generous support of so many partners. We have been really really fortunate. Our donor partners are listed here. A few of our content partners are shown in that photo and some of our partners are here today in this room. I want to say thank you so much to them and really to all of the rest of you for the good work that you do. Thank you for your attention. So now im going to introduce our final speaker of this program. She is a bloomberg distinguished professor in the Department Bio statisti statistics. In addition to hundreds of publication and numerous honors she was named by the cdc as one of the 20 leaders and visionaries who have had an effect in the past 20 years. [ applause ] thanks very much. I will confess that i got here a little bit early today and i took to opportunity to Wander Around the museum and was reminded how wonderful a place it is. It brought back a lot of great child hood memories and memories of taking my son here. It sounds like youre taking it to the next level. Its really wonderful to see. I would also like to thank your sponsors for this event. And a special thanks to you all for being here in this room and for those of you watching online over the internet. As we have heard today, Public Health scientists have made remarkable progress towards characterizing influenza virus strains that could skauz a pandemic. It could also help identify other immerging viruses that pose a threat that are still of great concern. Our methods of global surveillance have also improved as has our capacity to manufacture. Our speakers reminded us of several other advances and pointed to disparities and our ability to respond to from a pandemic. Clearly more is needed to safeguard the population. We heard loud and clear from the very beginning that the push to develop a universal vaccine that protects against a wide range must be at the top of our priority list especially given that the seasonal vak teens have limited efficacy. We may need to go back to the very basics of understanding immunity if we are to get closer to that ultimate goal of creating a universal vaccine. We heard of the need for more effective global dsurveillance,a decrease and faster and more equable distribution. More research on anti viral drugs and the use of innovative and new technologies for rapid detection and finally, the improvement in capacity and readiness of Health Care Systems around the world to respond to a pandemic, with a focus on an allhazards approach. Ongoing, Continuous Improvement of our local Public Health infrastructure with an emphasis on forging multisectoral links is critical as we heard, in our level of preparedness. We also heard, again, loud and clear, that Effective Communication is critical. Health officials at all levels need to communicate Health Threats to the community in a manner that can be understood and acted on in a reasonable way. And as john barry admonishes, our officials must always tell the truth, all the time. And they must get out front and stay out front. So thats a broad summary of what we heard today. I thought i would like to end the symposium today as we began it, with some history. Although i will not pretend to be as great a historian as john barry is, but i would like to reflect on the ways that the influenza pandemic influenced the development of our own Johns Hopkins Bloomberg School of Public Health. As a new dean, i am only six or seven weeks into the job, i am particularly interested in our history, and i would be remiss if i did not acknowledge the input from our own historian, karen thomas, in reminding me of this rich history especially as it relates to pandemics. In october of 1918 what was then known as the school of hygiene and Public Health held its first classes just as the great influenza pandemic began to intensify. Founded by William Henry welch and the Rockefeller Foundation the school made the pandemic the urgent launch point for its work. Influenza and as worldwide aftermath jumpstarted the schools growth as a leading center of research and training in epidemic disease. Wade hampton faust, the first chair of the department of epidemiology at Johns Hopkins was a noted influenza expert when the pandemic hit. At that time data were very they were extremely difficult to collect, much less interpret, but as the head of the Public Health Services Office of field investigation, frost worked with colleagues to conduct house tohouse surveys nationwide. They revealed one of the defining characteristics of the 1918 outbreak, which is that the highest mortality was with young adults under 40. He published a chronology which became the model for all subsequent efforts to track global pandemics. Today frosts methods are still used to predict and measure epidemics. The pol pioneered the tactic the teaching of shoeleather epidemiology to confirm cases of a disease in a defined area. The pandemic became a primer for Johns Hopkins students. The schools leadership intensified after a former faculty member founded the Epidemic Intelligence Service at the centers for Disease Control in 1951. Many graduates of the school have become eis officers and many eis officers in turn have since joined the faculty of the school. One of the officers, d. A. Henderson, directed the whos Successful Campaign to eradicate smallpox and he then came to the school as its eight dean. Henderson was pre henderson went on to establish the center for Health Security you heard about earlier which is now approaching its 20th anniversary. Alfred summer and henry moseley, two other notable eis officers, were sent to assess the 1970 cyclone and tidal bore that decimated east bengal, now part of bangladesh. Their goal was to guide longterm relief and recovery planning. Their eis experience as epidemic fighters was a springboard for outstanding achievements in research, training and administration at the Bloomberg School. Dr. Summer became our ninth dean and dr. Moseley chaired the department of Population Dynamics for over 20 years. The schools experience in fighting influenza built the foundation for its rise to International Prominence in vaccine development, evaluation and policy. The faculty have and continue to work on advancing the issues and development, testing and policy for vaccines against cholera, influenza, hpv, measles. Malaria, dengue as well as other devastating diseases. Theyve established the power of micronutrients to prevent nutritional deficiencies and Infectious Diseases. Using the Public Health tools of laboratory investigation, biostatistics. Epidemiology and policy, the school has emerged in the 21st century as a thought leader, a convener and first line collaborator for tackling epidemics. During our century of existence we are proud to have broadened the scope of Public Health, strengthened its Scientific Evidence base and trained a Global Network of Public Health leaders. If together in this room we are unrelenting in our pursuit of new knowledge and application of timetested Public Health methods and not neglect the lessons we have learned, we will one day, hopefully, measure death from Infectious Diseases as a one in million occurrence. Again, let me extend my thanks to all of you for coming and to those of you who are joining us online. Lets continue the conversation on our social media channels, online at the Smithsonian Magazine hub, via the schools Global Health now website and here at the reception to follow this event. Again, thanks so much for coming and good evening. [ applause ] some live coverage to tell you about here on cspan3. Secretary of state Rex Tillerson talks about the state of u. S. Europe orelations at the Wilson Center at 11 00 a. M. Eastern. At 2 30 the Senate Budget Committee Meets to consider tax reform legislation that includes an added provision for expanding oil and gas drilling in the arctic. If passed by the committee, the measure would then head to the senate floor for debate and a vote requiring only a simple majority. Sunday, on cspan q a, john kogen on u. S. Federal entitlement programs. Entitlement programs stem from a basic human desire to help someone who is in need of assistance. Its common. All of us have it in us. For politicians its a little bit easier to do it with somebody elses money but they still have the same basic desire that you and i do. They also have this desire to be reelected. So once that entitlement is put in place, then the game has changed. Interest groups form around protecting that entitlement, pressing for more assistance. Money starts flowing to politicians who protect those benefits. And the game changes. Its that desire for reelection. John kogen on u. S. Federal entitlement programs on cspans q a. The cspan bus is traveling across the country on our 50 capitals tour. We recently stopped in baton rouge, louisiana, asking folks what the number one issue is in their state. The number one issue continues to be flood recovery. In baton rouge we had a historic flood and my district was heavily impacted. My citizens in my district are forced to deal with issues regarding sba loans. The federal government considers the loans to be a duplication of benefits and right now we are having trouble getting those families the necessary dollars to recover because, with our staterun program, they have to deduct the amount that they were received through the sba loan. So right now our recovery has been stalled because of this issue. We are working with our congressional delegation, but again, its a tough issue in our community. The most important state issue to me is coastal restoration. Our coastline is eroding at a very quick rate. We are losing a football field wort of land per hour, and i would like for our state to focus on restoring and replenishing our coastline. So future generations can see it. I think the most pressing issue that well face and one that we are already working on and have been since the conclusion of our sessions this past year has been our fiscal budget situation here in louisiana. Not uncommon to a lot of other states. I think ours is a little unique that a good bit of what we face in 2018 as the rolloff of some temporary revenue in the form of taxes that will expire in june of 2018. So the ability to be able to find the solutions for that, both on the revenue side and the expense side, are what well be working on and hoping to come up with solutions before we arrive in 2018. Voices from the states, on cspan. World Bank President Jim Young Kim talks about recent friends in the Global Economy and what the world bank is doing to establish fci