Here are some of our featured programs coming up this weekend. Saturday night at 8 00 eastern, the state of the black world conference. Include melanie campbell, director of the black civic participation. Brockett, mayor of new york, new jersey. Get together and we have an agenda, you have to understand we also have to unite with other people. To win, we dont want to struggle for struggles sake. There are hundreds of thousands of people in our community that are in jail, they have been beat, we are not activists and revolutionaries because it is fun. My mother and father did not participate in the movement for to be praised, they did it because it was necessary. Followed by nebraska senator ben sasse on american values. It turns out the meaning of america is persuasion. The meaning of america is love. The meaning of america is holding a better product or trading a Better Service or persuading someone to marry you or persuading someone to join your church or synagogue. And then newt gingrich, van jones and Patrick Kennedy discuss opioid addiction and treatment. People have to change their minds, they have to have some willpower, it also because of the way opioids work, they have to change their brains back. This is a biological thing. Oncebrain is an organ, and the doctors hand you these pills, for a lot of people, those hills damage that organ. Watch on cspan and cspan. Org and listen for free on our radio app. Tv,unday december 4 on book we are talking about the attack on pearl harbor. Stephen to me, the other of countdown to pearl harbor, and craig nelson with his book pearl harbor from infamy to greatness. Also, the other of all the gallant men. We are taking your phone calls, tweets and in no questions live. For theok tv. Org complete schedule. Where asking students to participate in this years bydentcam video competition telling us what is the most urgent issue for our next president , donald trump, and the Incoming Congress to address . The competition is open to all middle school and High School Students grades six through 12. You can work in a group to from 57 video minutes. 100,000 in cash prizes will be awarded in shared between 150 students and 53 teachers. 20,deadline is january 2017. That is inauguration day. Format information, go to studentcam. Org. Today, Michelle Obama welcome to the arrival of the White House Christmas ttree. This years tree is a balsam fir from wisconsin. What you think . It is great. Should we inspected . It . I think we are good. My replacement kids. This is what happens when you have teenagers. Guys. Ob, christmas begins, we are ready. Our last one and we are excited about it. Congratulations to our Award Winners here. Thank you, guys. Our work here is done. Are you ready . That was easy. Mrs. Obama it is the easiest part of the holiday season. Happy holidays and happy thanksgiving. We will see you around. Now, part of the wall street andnals meeting washington, d. C. In this meeting, the head of the centers for Disease Control and bill and Melinda Gates foundation discuss Infectious Diseases. As is 45 minutes. This is 45 minutes. Good morning. We are going to start with the worstcase scenario. I dont know if how many how many of you have seen contagion. I watched it recently and got scared at how close we are to Something Like that. How close we are to a biblical plague . Every year we identify one new pathogen. The contagion scenario is pandemic influenza and that is what worries us most. Bill gates said there is only two things second kill 10 Million People around the world, nuclear war and a biological event. What hasok back to happened, it has happened before. Even 1957 with the influenza pandemic, it cost 3 of the worlds gdp. A relatively small outbreak cost 3 billion. We dont know when the next one will come, where will come from or what it will be the we are certain there will be a next one. With the Gates Foundation interest in this, you have been involved with ebola specifically zika how was this that it disruptive . We need to be ready for the worstcase scenario. The world needs to be ready for pandemic flu. But what we learned from ebola is there are a couple of things underutilized and not fit for is in the world, and one government, and the Global Health security agenda has gotten more attention. The second thing is having the right tools. The focus on Global Health, research and development, the focus on tool development, those are aments of global r d big focus of the foundation. Somethinge talk about contagion, we saw this last summer house Something Like zika virus that was thought not to be a big threat spread by a mosquito, a particular threat for women who can get pregnant because it causes a catastrophic birth defect. Even from the business standpoint for those that would travel on business, or women who were completely concerned about their risk if they should they become pregnant or their partner become pregnant. Understanding these new pathogens and what we need to do from a governance standpoint and having the kind of tools starting with diagnostics is a focus for us here at focus for us at the foundation. In terms of Global Health security, i think a lot of people think of Homeland Security and economic security. I dont know how worried the general public is. That affectt things africa or pregnant women so how many of these are really able to control . What are the components . There are three things that need to be strengthened. And then stop them wherever possible with that Global Health protection. They are institutions that need to be strengthened and will hold genomes sequencing with handheld sequencer is in the field. The thing that everybody should have heard is if you want to start a business, you want to know what are the corruption risks. You want to know, is the country ready to deal with an emergency from the Health Sector and there is no way currently to do that. Over the past be years, we are gotten a global consensus on an objective, transparent public rating of all countries agree to do it come a and if a country does not agree, they can be considered problematic. It looks at whether they are ready. That is important because it holds them accountable. It also holds all of us accountable. We want to close those gaps. Yes, diseases from anywhere can end up here from a plane ride away. , orher it is drug resistant the next hiv. In terms of the Gates Foundation to put together publicprivate partnerships, how can that be done in a way that gives the Rapid Response . What you have a structure in place, can you deployed rapidly . Enough thatis there is applicable to the influence the pandemic . We know that each pandemic has its own characteristics. The first thing is to partner with organizations like the cdc and others who help us understand the global infrastructure. Their borders and country sovereignties. Figuring out that piece is essential for us. On the publicprivate side, that is one of the parts of the Gates Foundation that maybe is not as wellknown, that we encourage companies, Multinational Companies that have the power and capability to move quickly in the face of an epidemic. That would be you. Everyone in the audience. Invest in these, not only because they can affect your business. One of the pools we like to use is for market failures. Left less than 3000 cases in the first 30 years. In the case of market failure, we are willing to make investments to make sure the Multinational Companies can work in the areas subject to mold market failure. Working on ebola vaccines, working on vaccinations for any of these pathogens is something we invested as a foundation and collaborate not just with academia but also Multinational Companies and small companies. From the cdc perspective, about 25 years ago, congress created the Cdc Foundation to help the cdc do more faster. When ebola hit, the Gates Foundation was first to give us resources so that we can act very quickly and in a more flexible way than would be possible within usual government systems. So we encourage that collaboration. You also able to provide those individuals and companies will time information realtime information, whether it is flu or ebola or zika. The other thing we should mention is the investment in data. One of the Biggest Challenges over the last couple of years would be last couple of years, is really getting good, global data that is believable and on time. And using things like the ubiquity of smartphones, we have invested, and again, collaborating whether it is with the cdc or foundations or others, we have invested in more accurate and quicker data so that everybody in the world knows what is going on. Technology plays a big role. Were talking about one of the battleground scenes for zika is in florida, where people are said because they dont want their neighborhood sprayed. You are picking your poison. Ori want the risk of poison vigor . Zika . We have what we call vector control. Think not just trying to of a vaccine for humans, but we are trying to control mosquitoes. Carry many different things. Withannot just protected bed nets. Vector control can be challenging with this particular mosquito. There are two different novel ways of digging about controlling these mosquitoes. One is further in time, and that is a genetic modification, that is that the research stage. There is a nongenetic modifying approach, something called will theius, it is like microbiotm. The bacteria that is naturally found in half of the insects on earth and not in this mosquito. Weve been investing since 2005 in an australian inventor who has invented a new way to infect this mosquito, which prevents the mosquito from transmitting zika. It was originally done for dengue fever. That is now being used in brazil and colombia through a recently announced grant to try to release these mosquitoes that cannot transmit the virus. A great example of Global Health research and development, some thing that seemed risky and far out, that is being done with the communities. It was very thoughtfully studied and it is important for us to realize when you think about hader change intervention, the communities are driving this intervention. We had a lot of opportunity. We do not know how big it will scale. It has just gotten the populations that are 2. 5 million. When youre faced with these vectors and are concerned about things like insecticide, a very novel, based on biology and research attack on mosquitoes. There is our problem with the Public Health perception. I know that in puerto rico, they had a problem with people getting sprayed. Quite mosquitoes are difficult to control. They can hatch in a bottle cap of water. Theyre an urban pest like a cockroach. We need to do two things. Mix and match our current tools to control them as good as possible and are several approaches that none of us like to use. New tools that may in the future be very effective. And you try them if community shoes to. What we would recommend in miami is to use an aerial insecticide and killing the larva. The result was quite impressive. We saw almost all the mosquitoes killed overnight. Counts went to zero in the traps. As the next batch bred, they applied it again. After four more times, no more mosquitoes and the spread of disease stopped. It shows in that environment, it was possible to stop an operating an outbreak. Once it started, it is too late to do that. Have one fundamental approach in Public Health get the data and use it to improve performance. We dont like to do something because somebody told us to do it. Continuously improve our program. Dr. Desmondhellmann there is one other innovation on the zika front which is modern family planning. One of the early grants weperfo. Made was to the cdc organization to get the right communication so that women who were pregnant or could become pregnant knew what was going on, knew how to prevent zika and we continue to Fund Research and development to make better, more widely available, more affordable modern contraception that can be used by anyone in in the world when faced by a health threat. Laura you mentioned earlier about the idea of hospital infections. A big crusade has been antibiotic stewardship. The idea that we are using too many antibiotics. It was really a virus and not a bacterial infection. I have probably done that. The question is are you seeing progress towards this call to stop overusing antibiotics to prevent the number of people taking them that do not need them in hospitals and the community . Dr. Frieden this is a really big problem. Ive cared for patients who have infections that cannot be treated with any antibiotics. We talk about a preantibiotic era, if we are not careful, we will be in a post antibiotic era. The Economic Impact is enormous. It is not just about infections you think of like pneumonia and uti, it is about modern medical care. Treatment of arthritis, organ transplants, dialysis, chemotherapy. In all of those situations, we expect there to be severe and we expect to be able to treat them. We can risk undermining much of our medicine. We have estimated based on careful analysis of data that between one third and one half of all the antibiotics used in the country are either completely unnecessary or too broad. We do need to do some things in Getting Better tools for diagnosis. It would be easier to tell if it is a bacteria or a virus. We dont have that yet. To be do a lot more better stewards of the antibiotics we have. We have not had new antibiotics anytime soon but we will not invent ourselves out of this. We have to outsmart the microbes. One of the things we have done working with the center for medicare and Medicaid Services is to require that every hospital have a Stewardship Program as part of the health care agenda. We are expanding our knowledge of what is out there in terms of drug resistance. It is a broader issue. We over treat symptoms and under treat silent conditions. If you look at things like the flu or common cold or pain or adhd, we may be overusing medication. If you look on the other hand like hypertension, where we are under using medication. Globally, we have not even scratched the surface of what is needed to understand. A few years ago, i was back in the indiai was at institute of medical sciences which is a high quality institution. This is soon after a new delhi strain of a very resistant organism was defined. The headset i am not sure why you are and we expect to be able to treat them. This. Every patient has untreatable organisms. Ned about dr. Desmondhellmann from a Global Health standpoint, two things to add forganisms. Irst, many of the people we serve in the poorest areas of the world do not have access to antibiotics. We want effective antibiotics to get to where they are needed if irst, many ofntibiotic thethat includes any microbial sensitive things like aids, malaria, which are also global threats. One of the things that is a best approach to Antimicrobial Resistance that should not go unmentioned is vaccinations. Vaccine preventable diseases do not get to the stage where you have a fever and worry about antibiotics or resistance. Nearnsider vaccines as miracles because they are so profoundly making a dent already in childhood mortality globally. Any child that can get a vaccine , that is somebody that will not be subjected to antibiotics. Again, you have to use Public Health channels. You have intelligent people in places like southern and Northern California and seattle. Its sort of a real problem of resistance based on junk science and personal belief like this is not natural. How do you overcome that . Dr. Frieden first, we believe sun life is an open disinfection. We put it all on the web so people can see them. There is never been, to my knowledge, a Vaccination Campaign anywhere where there hasnt been some conspiracy theory. One of the things that the Gates Foundation, and we have worked very closely on this, is polio eradication. It is still a challenge. Dr. Desmondhellmann increasingly, we are making a big dent in polio prevention. 250,000den in 1988, children were disabled by polio. This year, it has been less than 30. Of progress. With vaccinations, these are one tothe greatest gifts humanity that there is ever been. Theyre in some ways victims of the rohn success. To people see people die from measles. Here, it has gotten rare enough that people wonder maybe i can get away without getting vaccinated. Part of this has to do with our rebuilding economy. We are all in this together. Policy iere a know certain schools will not allow you to have your child in the school unless they are vaccinated. We see more people doing homeschooling. Is it more of a global concern than the United States where we still have the ability to educate people and get beyond the antivaxxers. Dr. Frieden if you look at it, well over 90 of American Kids are vaccinated and on time. There is a small local group we will never convince, maybe 1 . We answer the concerns. We listen. Some parents who decided not to have their kids vaccinated for flu and their kids. Have gone on tv to tell that story. Each year, we lose at least 100 kids from influenza and 90 of them are usually not vaccinated. These are not just theoretical risks. It can happen and only by working together and taking those preventative measures that we can protect ourselves and our neighbors. Laura you did a Public Health piece in the american journal of medicine where you listed all the challenges of Infectious Disease and chronic diseases. The largest cause of underlying disease in the world is tobacco. Dr. Frieden tobacco use continues to kill globally millions of people. More than Infectious Diseases combined. And, it can be stopped. If you look at countries and communities that have taken tobacco prevention seriously, they have been able to drastically reduce tobacco. The Gates Foundation we are working together to come up with a concrete set of policies that can really drive smoking rates down. In new york city, we helped people stopped smoking in a few years and extending Life Expectancy for a few years. This is something we can make a huge difference in and companies have gone people stopped smoking in a few smokefree. Companies have been supportive of this. Sometimes you can say you are probusiness. Businesses have different interests. If your business is to sell tobacco, you want that. The Health Care Costs are much higher. Dr. Desmondhellmann profoundly positive intervention that we have been thrilled to partner with a Bloomberg Foundation in supporting what our proven remedies for tobacco control. It has an Economic Impact. It is a profoundly positive intervention. The other intervention we have invested in is nutrition. Globally, we see over nutrition and undernutrition and poor nutrition. Very simple things like exclusive breastfeeding for six months. Making sure mom has access to Good Nutrition when she is pregnant. Understanding micronutrients. The kinds of things on nutrition and tobacco we could do as Public Health interventions are incredibly costeffective. Because thatomic magic time of your first 1000 days from conception is not just body, but foryour your cognitive development. Businesses are working in those countries are extremely interested in this because that is their future workforce and future consumers. Dr. Frieden this is very relevant to the issue of Health Care Costs. A nonsmoker costs drastically less to care for than a smoker. At least 1000 less each year for an exsmoker. There are 10 million fewer smokers than 2009 in the u. S. It is quite substantial. In Public Health, we often have a wrong pocket problem. We spent the money here and save the money there. It makes it important there are groups throughout society, whether it is vaccinations, tobacco control, research, that there are groups that are advocating for that which is good for the society as a whole. Laura the idea of wellness and prevention, a lot of Companies Look at their health plans and wonder if we have to offer this and that. I think you said the idea of making wellness a priority, to get ahead of disease before you have to spend the money to prevent it, is that a good investment for ceos to make . Dr. Desmondhellmann i think it is a great investment. I was speaking to a ceo, there is Nothing Better than a group of committed, passionate employees who are not so passionate about the mission, but passionate about their own ability to make an impact. Always felt it has not changed over time. That is the best investment any institution can make. Laura any other major Public Health issues before we turn it over to a couple of questions . I know uncontrolled Blood Pressure is another thing that people call a ticking time bomb. Dr. Frieden we could keep going for hours. Hypertension is called the silent killer. In this country, 70 of people over the age of 65 have hybrid high blood have pressure. 30 of the total population have high Blood Pressure. A few years ago, i put in the Electronic Health record system in new york city and if you want to save the most lives through health care, what should you do . There was no analysis anywhere in american literature. The answer was clear control Blood Pressure. Nothing else can save as many lives. Globally, it is the only thing that kills more people than tobacco. Controlling it is not hard. Once a day medications, simple monitoring. In the u. S. For 3 trillion a year, we get that question right 46 of the time. They dont have it under control. As a result, heart attacks, kidney failure, more cognitive decline. These are problems we can prevent by better treatment and better prevention. Dr. Desmondhellmann all of this is possible if there is a functioning Health System. Globally, and we learn this with the ebola epidemic, a functioning Health System is everything from Blood Pressure prevention, Good Nutrition, vaccination and Rapid Response to a pandemic. Increasingly, our foundation with many partners and governments worldwide are focused on having a functioning, healthy Health System for those citizens. Laura i would like to throw it open for questions if anybody any about threats. Yes. You elaborate more on the prevention side . Were very interested in prevention, but can you elaborate on a policy standpoint . Advocacy, anything you would talk about on a policy standpoint . Dr. Frieden prevention is really underfunded. Hospitalsplenty of that have units named after someone who was cared for in their icu. There is no Health Department that has a floor named after a person who prevented many heart attacks. A lot of it is policy and some of it is clinical. Several different venues where human have prevention. On the policy side, smokefree workplaces, high tobacco taxes deter use. They make a big difference and change the context. In the clinical environment, different measures. Prevention could include increasing physical activity which is the closest thing we have to weigh wonder drug. Fromproves everything resistance to cancer infections and decreases everything you want to decrease including diabetes even if you dont lose any weight. We think often about what is scalable because there are very limited or no examples of whole communities becoming much more physically active with people changing things. We are working on that to try to see where that happens. Use the stairs instead of the elevator. There are many ways we can tweak the environment to make the healthy choice the default choice. There are other things in the clinical sector whether it is immunizations or control of Blood Pressure we know if we got Blood Pressure control in from 54 to 70 , we would prevent hundreds of thousands of heart attacks. At a minimum, we would change our expenditures from taking care of people in Nursing Homes or rehab, to paying for Blood Pressure and monitoring and medications. Dr. Desmondhellmann we are investing in understanding behavior change, particularly in what creates sustainable behavior change in a community and compliance. When you make a big investment, and Companies Find this all the time, you can shortterm change things. People wear their device and then stopped. Increasingly, what is sticking, what is sustained and how it community can drive its own wellness. Part of it is incentives. I think there is a big economic argument and making that more visible as a community is something that you will see more of overtime. Other questions. We also have a poll. Poll question so lets bring that up. You can be answering this while we get the next question. Do you have potential business interests that could be impacted by Infectious Disease threats like zika . Yes or no . How international are you. Yes. I will go back to the question about pandemics. Thetalk about the jee, assessment of individual countries. How do you think about incentives for preventative expenditures for those countries who come out with an amber yellow or red outcome from a jae . Haveo we convince them to preventative expenditures. Dr. Frieden this is something the World Community has to Work Together on. It has to be important to them. Business have to say we are concerned about this. Globally, we have to worry about filling those gaps. They have been honest enough to say this is a problem whether it is a world bank or bilateral donors. Ok, we are going to try to fill this area knowing that something will come back and objectively measure it again and say yes, the investment has paid off. It has gone from yellow to green. I think the key is we move from a world before ebola that was nonaccountable and nonassistance to a world with accountability. Dr. Desmondhellmann i would only add that having been in a number of advocacy discussions with now heads of state or their cabinets, one of the really costsant things is what the bucket goes in. If they go into economic progress versus a health bucket, that could be a net positive. Making the argument this is a financially positive economic engine argument could be a much more effective argument. Other questions. You both talked about the Global Readiness for the pandemic. Jim kim was playing a large role. How much of that has been hardwired . Dr. Frieden we have a lot more work to do within the u. S. We have done a lot to enhance our preparedness. We needed who more functional than it was today. Many new tools. We dont have yet a vaccine that can work against the flu overnight. We have been tweaking our methods. We have been cutting days, weeks, sometimes months off the production process and increasing the ability to do things that are rapidly deployable. Talking about Global Readiness in terms of the rollback and all of that. Dr. Frieden i think there is a lot more collaboration. That is what the global agenda is all about. We had more than 70 countries involved. We have had over 70 countries process. Or the by this time next year, probably 70 to 80 would have these evaluations. We are having a common vision of what is needed and where we are now, but we need people from outside government pushing to make progress. Dr. Desmondhellmann who is in a transition now on the leadership front so i think we more from who. There is some pushing, but more pushing is helpful. On the science side, many more investments. More from who. I think both on the science and monitoring sides, we are seeing a lot of progress and many investments. Any questions . Thank you. During the election campaign, we heard a lot of soundbites about opiates and heroin usage. Dr. Frieden this is a horrible problem. We are an outlier. We have in the u. S. , we use more than 80 of the global prescription opiates. What has happened over the past 20 years is the number of opiates prescribed has increased by 300 and that has been directly correlated with an increase of overdoses and overdose deaths. Over the past couple of years, drug cartels have recognized a new market and have lowercost heroin and illicitly produced fentanyl. It is a leading cause of death. More than 10 million americans have used opiates. More than 2 million are addicted. We need to address this with a really comprehensive approach that looks at two different populations. Are people that are currently dependent or addicted. They need better treatment and management of pain. The cdc this year released guidelines on management of chronic pain. Opiates are dangerous drugs. You take just a few too many and you stop breathing. You may be addicted for life after just a few pills. There are better ways to treat chronic pain. Second, for everyone else who has not yet had an opiate, we need to protect them from it because it may be a few doses until you are addicted. That means greatly improving prescription patterns. This is a very serious problem. There are communities in parts of the u. S. Where new businesses cannot start because not enough people can pass a drug screening. Dr. Desmondhellmann the prescribing habits are a very big part of that. My husband had a shoulder replaced, he walked out with a prescription of 90 onto gotten oxycontin. Dr. Frieden this is a huge problem. When i went to medical school, they taught us you can get a patient with rain in opiate and they will not get addicted. Completely wrong. Laura lying through the mouth. Dr. Desmondhellmann there has to be a complete rebooting of pain prescribing and it has to be done with a sense of urgency that is not consistent with typical continuing medical education. Background,ogist by so there are times when you need pain medicine. However, what we havgo