Thanks for this amazingly but. [inaudible conversations] will come. Clearly universities the virginia then i am delighted to be moderating this panel today. With two outstanding journalists and authors to both currently living in baltimore and share their stories with us. We will be on a tight schedule which i am responsible for keeping the will look forward to about 15 or 20 minute presentations from each author than ample time for questions please silence your cellphone i would also like to since i am so excited about this panel to remind everyone that virginia festival of the book is keeping most events free. Please consider a donation and my third request as the festival is always looking to improve offerings and then we have books for sale here in local bookstores throughout the of festival so now i would like to introduce our speaker to my far left. Sonya has written the book under discussion today as well as others a prizewinning author and a science journalist. Per work has appeared in the new york times, wall street journal, Foreign Affairs and the outstanding ted talks on eliminating malaria if you want to take a look at that. She focuses on the intersection to be discussing the book with us today. We also have Karen Masterson from the Houston Chronicle and to pursue that interest close to my heart and on microbiology and to study malaria at the u. S. Centers for Disease Control and prevention. She has a masters in journalism and also masters in science writing where she is now a teacher and a science in journalism and she lives in baltimore with her husband and twin daughters. So again, welcome. Please keep the self homes quiet we will have a fascinating discussion i will turn the microphone over to sonya. I want to look at how microbes which are the little microscopic things these highly deadly events that we call pantex so we have had 300 infectious pathogens better newly emerged or were they have never been seen before. From rodents we have lung disease, from monkeys and chimps we have hiv, malaria, probably zika virus and birds are getting west nile virus etc. So these pathogens are moving into human populations and then we are allowing these great opportunities to apple if i in our cities. Now the process of urbanization that first started in the 19th century is really reaching its peak now so by 2030 the majority of the human population will be urban and we are going to be living in giant cities. They are not going to be cities like lovely charlottesville. They will be cities like monrovia in freetown a lot of ad hoc development, a lot of slums and poor infrastructure. We have already scene these pathogens take advantage of this ebola is a great example where we have had Ebola Outbreak since at least the 1970s that they are always rather small and selflimited. One important reason why is because those viruses never infected places more than a few hundred thousand inhabitants. What happened at the end of 2013 is ebola virus emerged in guinea and within a few weeks was able to reach three Capitol Cities with a combined population of nearly 3 million. Thats an important reason why it became such a huge complication where we lost 11,000 or more people. More people died in that outbreak in all the previous Ebola Outbreaks combined. Similarly the zika virus, around since at least the night he 40s possibly before that, but it was in the equatorial forest of africa and asia carried by a mosquito that mostly dead animals so we didnt have a lot of infections in humans. But what has happened just recently is the zika virus has arrived in the americas where we have massively expanding urban populations in these tropical areas and that means we have massively expanding territories of this mosquito that thrives in cities. Its an urban mosquito. It lives in human garbage. He can breed in a drop of water in a bottle cap so all the garbage around a little rain did send them it allows them to breed in this mosquito is a very efficient carrier of diseases because it only bites people. But we are not only crowding our cities together, we are also crowding our animals together. Its not just about people its also about her livestock. Right now we have our animals under domestication that the last 10,000 years of domestication until 1960 combined. This is because our populations are getting more wealthy. They are Getting Better bigger and as we do that we demand more protein in our diet but a lot of these animals are living in the equivalent of slums. So we have 2 billion People Living in slums by the year 2030 and we already have millions and millions of animals living in slums and those are factory farms where we have a million or more animals crowded really close together exposed to each others fluids and excretions. This is one important reason why we have this increasing frequency of influenza. These Avian Influenza viruses are only live in wild waterfowl. Doesnt make animals sick at all but when those viruses are able to reach back tree farms full of captive chickens and birds, bacon wrapped locate really quickly, they can spread faster and they become more virulent and this is why we have seen an increasing frequency of the much more beer went forms of Avian Influenza emerging mostly in asia where most of the waterfowl live. The slides are advancing way too fast. We are about five slides ahead, im not sure why. Thank you. The last one, just last year we had in Avian Influenza hatched in the giant Poultry Farms in asia, reach north america for the first time caused the biggest outbreak of animal disease in u. S. History. So along with the crowding of our animals we are also getting getting thank you. Its that one that we want, number five. There we go. So we have a massive, we still have a sanitary crisis of human waste in our planet right now. We have 2. 6 billion people around the world with no access to modern sanitation so they are still living in the equivalence of 19th century slums but what we also have now is a new kind of sanitary crisis and that is what their livestock excreta. Our livestock are producing 7 million tons of waste every year and this is far more than our continent could possibly absorb so what is happening is farmers are collecting them in things like manure look is essentially giant unlined pits of untreated animal waste so when it rains or when it storms all of this material can leak out into the empowerment and this is one reason why we have an increasing problem with virulent forms of e. Coli. There is an e. Coli strain, it doesnt make the cows sick but because cattle manure contaminates so much of our food and water we have about 70,000 people, americans coming down with this virulent form of e. Coli every year. So in all these ways we are driving these pathogens in term garment carrying them around in the most efficient way possible. We dont have just a few airports and a few towns but we have hundreds of airports in small towns and cities and hundreds of thousands of connections between them which means where when a pathogen breaks at one part of the world that can rapidly spread to the rest of the world and this is a simulation of a food pandemic on a geographic map and you can see how quick we disperse his. But if you plot that same pandemic on a map like this which is all the cities connected by direct flights you can see when it comes up it will resolve into a series of waste. You can actually predict where and when a city will get infected if you look at the number of direct flights between infected and uninfected cities. One of the things they did in my book is not only reporting to look at where emerging pathogens were coming from and i went to haiti and south china and new delhi and elsewhere but i also looked at the history of some of our most powerful pandemics in and the one i focused on was cholera because its one of our most successful pandemic pathogens. Its caused seven Global Pandemic since it immersed and merge the 1970s. We think of cholera is a disease of poverty and it is that today but when it first emerged, there we go. This is a map of an epidemic in 1832 in new york city. Thousands of people died and this happened again and again over the course of the 19th century. It wasnt just new york city was also london paris and new orleans in the number of cities were plagued by cholera epidemics in the 19th century. What i wanted to look at is how that happened and how we responded and how that could shed light on the challenges we face today as we face our own era of new pandemics. Back in 1832 doctors collected data. It shows a pretty clear picture. Cholera coming down the hudson river coming down the airy canal heading straight for new york city however nobody in the city of new york wanted to quarantine the reverse through the waterways because this is the engine of economic growth. This is the time of the robber barons, huge amounts of commerce coming of the waterways so they refuse to quarantine the river. My powerpoint wants to give the talk all by itself without me saying anything. Very annoying. They didnt want to cornstein in a the waterways and they didnt and doctors went along with it. They said well you know they looked at this map and they said it looks like cholera is contagious and coming down the waterways but in fact its not. Backed cholera is caused by these decomposing vegetable matter organic. This is based on a 2000yearold hippocratic theory so they said its not the water its just these bad smells and do you know who is to blame for these bad smells . Its the poor comets immigrants, its the drunks and so cholera came down the waterways and in fact did new york city again and again over the course of the 19th century. So there are companies that were making money selling cholera contaminated water to new yorkers in the 19th century. The epicenter of a lot of the epidemics of cholera in a which is pictured here, this is a slum that if anyone has seen the film gangs of new york, so its very crowded very dirty, very crowded place about 77,000 people, six times more crowded than tokyo today but this had been built on what was once a pond. That pond had been filled up with garbage and the slum had been built on top of that. There wasnt a sewer system in 19th century new york. There werent even rules you had to empty your cesspool so all the human waste was allowed to spill over into the streets into the alleys and into peoples Drinking Water into peoples wells and down to the groundwater. Of course in this area the groundwater underneath the slum would be extremely contaminated because the ground attorney that was lowlying and it wasnt bedrock like the rest of manhattan. Now the company that the state of new york chartered to deliver Drinking Water to the people of new york, rather than task up chain change sources of water which they knew at the time would be cleaner, fresher and would taste better, they tap that well right in the middle of that slum and they delivered out water to one third of the residents of new york city. They did this over the course of the century through repeated epidemics of cholera. The company that did this as an adjusting aside they did this because they wanted to save money sort of like what happened in flint michigan. The reason they wanted to save money was because they wanted to start a bank and the Companies Call the Manhattan Company in and the bank is called the bank of the Manhattan Company predicts anyone here know what the bank of the Manhattan Company is called today . Jpmorgan chase, yes, thank you. So i will lend the story by telling you how colorado in new york city because i think its instructive. Eventually new yorkers move the well from there too out there on the crimson river but they didnt do it he cut his they wanted to uplift the Public Health. They didnt do because the people of new york were screaming for better water which they knew would make the more healthy. They did it because the local brewers wanted better tasting water for their beer. They felt like the water was putting their beer at a disadvantage especially 12 brewers in philadelphia so finally cholera vanish from new york city. A century of cholera pandemic links ended in the spread throughout the country and throughout europe as well. So the question i have is of course we can do a lot better today in our era of emerging pathogens but as the story to me says its not necessarily about our technology. Its really about whether we have the political will to do it thank you so much for listening. [applause] now we are going to welcome kessler the author of capture and im going to switch with you so i can see. I came to Global Health issues and might grow by accident or as a political reporter. I was an environmental reporter before that but i was at the National Archives looking for something completely different and i stumbled upon some records that talk about how our researchers during world war ii infected patients with malaria so they could test new drugs on them and this was shocking to me and i couldnt find a whole lot in the treatment of this and as i kept pulling threads in the archives i realized i was in uncharted territory and i had to tell the story. Didnt know much about world war ii or malaria and didnt know much about bioethics but i got up to speed because this was a fascinating story that i wanted to tell. I actually wanted these slides to be the leadin but i will whip through them as fast as i can. Her records were stamped top secret. The world is at war and nobody had the good malaria drug and before normandy most of the fighting happened in highly malarias area so if you had a weapon against this disease you had a leg up on all the battles so our government, the Roosevelt Administration opened the spigot for this project. 50 universities, most of the American Drug companies came together to find a bomb. It was the same Umbrella Organization of all the wartime science projects including the manhattan project. The reports were written by the lead investigators and sent to a central clearinghouse at Johns Hopkins university and there they met every month, scientists and they could compare notes. I figured out how to not be totally judgmental of the science the scientist he did this work. I was taught by this man bill collins. I got to sit next to this man and listen to his stories and dissect mosquitoes. He had been around long enough to study the disease and test drugs on their induced infections. The problem back then was you couldnt throw malaria and a petri dish. You had to have life infections and asthma lariat dried up in Northern Europe and the northern states of the united states, it was hard to come by so to infect people you could to study it and he called those the good old days. I said you were talking to reporter, right . Im going to write this and he was in fear. Those were the good old days. Now you have to infect monkeys and they were difficult and expensive than they tried to bite him and monkey malaria student extrapolate all that well and they had to write all the new vaccines on these monkeys so he did call them the good old days. A roomful of archives that no one had seen before from world war ii and the years immediately following world war ii and he used the data and that was collected from these infected patients to inform todays vaccine researchers. The data they had have on life infections remained valuable to this day. He and one of his colleagues. So we actually got me thinking like a malariologists and i came to the story with a little bit more objectivity and not as much judgment and i tried to let the story speak for itself. This is a blood slide taken from an american soldier during world war ii. This is the blood stage of malaria. With the parasite does is in sundays talk she called them a shapeshifting parasite. Immediately gets into your liver and i thank you baits and hides from your immune system until its ready to launch an attack on your red cells. When it does that your red cells end up looking like this. You have truly is the parasites in your body sicker than youve ever been. Its a terrible weeklong infection. At some point during this time when you are feeling the most sick for some of these parasites mature and they become distinct and migrate as it cannot collect tracks mosquitoes. The mosquitoes drink demand and the mosquitoes week or two later depending on temperature they burst into microbes to get get into the saliva and they migrate again. I tell the story about the world war ii project for several reasons. For one ive really liked them and i didnt want to spend my whole book on one of the scientists who i felt that there biological linking dialed up a little bit too much without really having enough empathy for their patience. I identified with him. After the war he was 18 of the university of Chicago Medical School and Vice President there and he advised the eisenhower frustration on medical education. He said we are teaching our medical students to specialize to focus on body parts and that is unsafe for us we should be focusing on the whole body. We as medical professionals and he was called a communist ford in the 1950s. Before the war he was a malaria expert. He started out as a Large Network of american researchers trying to get a handle on the u. S. And pandemic will area. In leesburg georgia the infection reached 80 . He worked in places that look like this where the cypress trees were being ripped out to keep up with the Development Going on and they were left with these gaping holes of larger producing swamps that filled the skies with mosquitoes that carry malaria. Throughout the course of the 1920s and 30s he worked with , this was samuel darling. He was the brain behind the effort to build the panama can tell. Samuel darling was responsible for which the americans attempt to build the panama canal and next him as paul russell. He is one of malarias most favorite sons. Through the new deal and tie Poverty Program building dams in a way that eliminated mosquito larva instead of producing mosquito mosquito larva bringing electricity to communities in the south and fans and airconditioning and attracted industry which brought jobs and people could get out of shaxson get into homes with tight deeds. By 1940 most of americas malaria had been completely dried up. While we were working on malaria julias youre a good one and nobel prize. He figured out how to give malaria to neurocefl addicts and cure them of insanity. In 1927 he won a nobel prize because syphilis was rampant. The late stage of syphilis is an infection of the brain that causes erratic pay for your, in same behavior and most and up and asylums and hospitals and they would die. Malaria fever, he controlled them with quinine which increase the bodys immune system to a point where he could fight off that difficult stage of syphilis because you cant grow parasites in a petri dish he got the strains of malaria going by taking blood from infected patients and giving them to new patients so this became the new way of treatment. State hospitals all over the world picked up this. It costs money because she needed lab work but if you are lucky you could kick malaria if you have neurosyphilis and you could be potentially cured or if this was a major breakthrough. He is one of two psychiatrists to win a nobel prize in medicine in history. The germans were very clever, the chemists who were trying to come up with synthetic drugs for malaria. We dont need to do our studies in africa and in places where malaria is a pandemic. We will run drug studies on patients who are going through malaria. They came up with two potential drugs and the drug made from the yellow dye. The dye attaches to the parasite and they add a side chain asleep parasite and carries the drug to the target and wipes out the infection. The only problem is they are pretty toxic drugs so they never broke into the market. Quinine was he only drug made from the bark of a tree that grew on plantations that the dutch have the monopoly on. The world just kept using quinine. This is a german, one of the leading malariologists in germany who ran some of these studies for bayer and he said why stop there . Why not run the studies on prisoners. We have wars coming and we need to find a drug soaked he wrote a proposal to do studies on prisoners. He said lets give malaria to prisoners and we can test our drugs on them and Heinrich Himmler thought that was a great idea and gave them the dachau prison camp where he infected 1000 prisoners. Some were russians. His prisons got an extra ration of food and they slept on clean sheets and they were given their fever so he could test this drug and then given quinine and cured and sent back to the barracks where they died, a lot of them because of ifas in colorado. This is him trying to explain to american lawyers who liberated the camp that hugh was just doing malaria therapy that this was the standard. He wasnt doing anything wrong and they didnt understand malaria therapy and he hanged. Meanwhile back before the war now and he knows another leading malariologists they are testing their drugs on State Hospital patients in making progress in building drugs and he nationalizes a plan for the americans to do the same thing. He temporarily is sidetracked to africa because an air route that we had created to supply the british in egypt and the russians with guns and planes were completely shut down because of malaria and west africa so the supplies were flown out of i am the to the elbow of brazil to the of african boom they are stopped to kiss the airfields there, the workers are all completely injected with malaria. So the usair command asked if they would go over there and clean it up. He got there and found airfields there were being carved out of the jungle and creating massive mosquito production, massive mosquito breeding and this was the reason why the pilots and the mechanics and the construction people were all getting a malaria. He had quinine but he realized under these conditions it didnt work. He had a jog under these conditions that didnt work so they were going to screen you guys are going to roll down your sleeves and where netting over your helmets and to the best of your ability youre going to wear bug spray. He had sessions every day. He made education most important part of what he did. He told them if youre going to go the dash you have to go during the day exists the malaria carrying mosquito bites at night. In the course of six months the infection rates in liberia were 100 and it was brought down to 1 . It was completely successful. The quinine used as a backup to save them from this african form of malaria called service are promalaria can kill you in a day. He brought that back to the u. S. Military and said the War Department said its not just drugs you need a multipronged approach and they said we dont have time for you. We will talk to you later. After the japanese attacked pearl harbor they attacked the philippines. Macarthurs chirps were forced out of manila and down the peninsula and within a month and their quinine ran out they started falling with malaria. 80 of them have malaria the time of surrender and commander said we had rifles and bullets and plenty of ammunition but everybody was sick with malaria and we had no quinine. That woke up the War Department. A lot of other scientists came together to argue. While 10,000 marines were landing on guadalcanal they were recruiting scientists, top scientists and airfields. Many of these men had never learned about lariat that they were needed for this project. This is the number one priority of the War Department and they started working on drugs as the marines on guadalcanal bricked up the landscape. The waters cooled, the mosquito spread in the camps turn into mud holes. At one point a battle commander said we have got to do something about all of the mosquitoes that are breeding and creating turbo malaria. They are screening drugs they are doing toxicity tests on dogs which it did not translate very well for humans. The War Department said stop just make this drug so they did. The American Drug companies started to make it and we were overdosing the troops they were soiling their payments in the middle of battle because of uncontrollable diarrhea and vomiting and crashing is psychological episodes it is say neurotropic drug so the men refused to take it. The War Department turned on the propagandist machine so and dr. Seuss drew cartoons, made posters and, of the troops the posters were so ubiquitous that they understood and they started to get it if they listen to the commanders had would roll down there pants protecting themselves that day would not get this disease malaria. They had or the dose that they could use it as up prophylactic clearly they thought sexual intercourse would get the message out. [laughter] they treat 10,000 men in new orleans to form malaria units so instead of using rifles they could catch the larva in the waters to study the mosquito larva. Was there were attached to the combat you did they hire thousands of local men to clear though bader ways Running Water kills larva stagnant water produces mosquitos. They sprayed tire tracks and dumps and kerosene to kill the larvae up. They studied the problem in their tents where they would take blood from local people to figure out how seated they were and how large of a malaria problem they would have had to go to malarias school the one that you can control quite easily and it is a deadly force is the kind you get in africa that is quite deadly you have to know the difference between day relapse and macarthur even had to go to School Everybody up the chain was educated on malaria and how it worked. Into sprayed those flooded areas in italy after the germans destroyed to flood the landscape and to slow the army down with malaria. It was about this time to have the major breakthrough. To make almost 7,000 compounds. Nothing that was produced was worth anything. And it up with their report on their desk it was a report that shows results from studies of the adobe villages of tunisia to use this drug from bear. It was the most advanced to come up from the synthetic quite nine say and the study showed hidden only work as a prophylactic but it was a cure in to nearly 100 . Sova malaria project is it used the State Hospital patients to have clinical material including James Shannon who was the head of the nih. They decided they should go into prisons to of plenty of men to do their research in the present so in goldwater oriole hospital in the men coming home from the war ended the boston psychopathic hospital so the blood from them but then they were said to this man. So try to figure how to use this drug and a need to go into the State Hospitals. So he grew malaria in tested his drug habit and then even used prisoners as technicians among the most famous and though he remember the leopold murder case the crime of the century . He saved him from hanging in then to pick up a neighbor because they thought they were so smart that they could. And was brilliant in the lab to help turn this drug at after the war was used like aspirin in the tropics. With that approach to eliminating malaria it was hard and it cost money and a restaurant of ddt a allegis use these projects ended did you leizhou use them in a global effort to eradicate malaria. In the resistance developed in by 1978 and spread from africa. And replace the drug in the same route would hold true them also for the same fate in the last remaining drugs the only drug that we use a was a created to police that parent molecule during the wartime project also ghost town the same route resistance to developing nations and it is spreading. The reason why i find this story so important because it is instructive. We have these schools will halt programs that focus on drugs, we need vaccines but we need to do harder work. [applause] with that pink and green map with that develop into resistance so in your book you talk about the development of resistance to multiple pathogens with the paradigm shift necessary to move and between the dominant paradigm of searching for a magic bullet as wading into the complex intersection of commerce and politics anwr and the environment that leave it to the emergence of these pathogens to their spread and to their success. How should we be thinking about that . It is a great question. There is an elephant in the room that we never get to this if we aim of the biomedical interventions that does match with the economic interest and those that benefit from that and Drug Companies and others. Talking about Public Health interventions they are often in conflict and what i have been writing about now and that is partially because they have been underfinanced with the publicprivate partnerships that generally is a good idea but when companies tell the ctc of a earmark the money to say looking into this or that this is now we sell more products or divert research away the whole interview with the economic interest now the who gets twothirds or more of the budget from private donors and we really need to address that course we do the more industry friendly Public Health interventions as it is such as huge influence on Public Health. They didnt know keep water would make us that much healthier. Their theories were all wrong but the thoughts for clean water and better housing in the face of a lot of scientific uncertainty may need to reform Public Health it doesnt matter if it disrupts commerce and we will demand that. Steel that is the missing factor. But then to come up with a magic pill. If it is a matter of perception we have a perception of how to handle anything that has to do with diseased. Is bugging me and i go to the doctor to save weber cited san tendinitis he should get a cortisone shot this is my first time anyone to give me a shot . What about my acupuncture he said i just need to loosen your muscle and stick a needle in your arm after a couple of weeks you will have to get that but that medical and media solution to a problem that needles will take longer believe longer or more permanent with no side effects. And to have Global Health with these matters of pandemic said the only thing we can do is come up with a drug or vaccine but think of poverty and surveillance and Health Systems and if they will be protected from the things across our borders we need to care about how well the Surveillance Systems are with the percentage of the money that we spend much of that comes back to western labs. And decided we should spend a son different ways to create a better surveillance system. They will last longer and work better. So i our perception is off it is always medicalized the germ theory of the best there. We came to understand terms as the devices that cause elvis in the stuff out of chemistry labs but it is more than that we need to take a broader view. And would like to open up for questions. I will repeat the question. They give for the presentation. I have noticed every time there is an outbreak or zika virus there seems to be a fringe group of a conspiracy theorist. It is caused by gm no so we have a public is it taking the threat seriously and to say any vaccine that might be prevented is out of the question so what are they trying to combat that even though it is a fringe group so it is spreading almost like the virus why isnt there is so little trust that even if we have good evidence to be carried by mosquitoes, we have good evidence. Why is it there are groups of people who believe otherwise to come up with the alternative theories . But our traditional response is to save day are ignorant the same with people who do vaccines. So that is a real mistake. What if we trace that back . Where does that mistrust come from . So it does come from Something Real that people are mistrustful of the corporate influence of madison but what is happening all over the world and contempt chemical contaminant contaminants in my opinion that is a real concern that needs to be addressed in an honest way. With conspiracies coming from the of mind that comes from somewhere real and leads to be addressed a real way and we have not done that yet. I agree it is the other side of the clean where a majority would have a medical response to a Health Problem but it is the most appropriate when there is a push back because the pharmaceutical industrys has so much influence as they pushed back so why should i trust you if it is not in line with my personal interest . I view that as the extremes that are coming from with the public is too trusting that is to our own health. Between the public and private interest of if you find that the gag laws are based on the way animals are treated but the same laws are hindering getting Accurate Information on these factory farms or how big in from the in a rights perspective i never put that together. I am not familiar of those laws of disclosure so i really dont know but there is a great deal of proprietary secrecy. So my Research Method is looking into the gray literature. In the unlikely places to find this data. We see doctors over prescribing but also in the middle east when you combine antibiotics he does go to the drug store but a Public Health official is omans said sometimes the problem is not what the doctor does it is the patient who travels a hundred miles to get their guests a prescription goes home after three days feels better so throws away the rest even though it is a than a regiment or doesnt feel better so no matter what happens deviances back to resistance. Ill take that one has the position. [laughter] the questions of monitoring prescription importances because it is tons and tons of antibiotics there in even greater threats even as a growth enhancer for animals and in order to preserve those that we do have against our most dangerous pathogens. Isnt just of those patients compliance directly as it informs our approach to tuberculosis for example,. And regarding the specific disease in this is something this new use a genetically modified mosquitos and then if you could just talk about that with new Disease Control approach. River just talking about that as the entomologist have Wonderful Technology and it is exciting to modify a mosquito but then they stop their end of everyone else extrapolates the modified mosquitos to displace national mosquitos in the entomologist all raised their hands. That is pretty hard were pretty sure they can but we have the technology in their working with it. It is interesting in the varieties mosquitos and with zika virus viet is a delicate thing to account malaria is only female in effectiveness mosquitos 60 by one person and get infected then wait five to seven days before they in fact, anothers. Those of the 22 lled. Bill the way we approach cannot Mosquito Control is we dont need to kill all the mosquitos. And if you get down to 99 to reduce transmission and . Who knows maybe they are very resilient because were not studying this and the ecological way at all. There is a big push to use the latest technology but huge questions all thus been Mosquito Control they have been doing so there is an effort that is set number of villages use that properly so as to live in the villages is the intense effort because if you know, anything if theyre not used properly in many parts of africa all types of bad outcomes have developed using an excellent cleaner article but in the of villages the entomologists found with the most winter percent coverage the mosquitos change by being habits and they would bite to earlier. They find a way in are adaptable. They can change chaplet have its pretty quickly so the main malaria carrier is the mosquito but says africa urbanizes there are projections that malaria will not be as large of the problem by india has an urban mosquitos miskito they will adapt. As africa urbanized is there is no reason to believe the mosquito wont adapt and become an urban mosquito. The frustrating part of reading the news is seeing a simplistic representation of how these insects operate in nature. I know this is a lot harder said than done because if it were easy we would have done it. Plenty of other diseases came before zika that screamed for mosquito elimination and it is not doable. What we can do is work on conditions people live in so they are not exposed to mosquitoes. But that is politically difficult so we try to eliminate mosquitoes as an species. In addition to mosquito transmission how many emerging viruses are sexuallytransmitted . The question was how many of these emerging viruses are sexuallytransmitted in addition to transmission through vectors . Zika is an interesting example, the only mosquito borne virus that is also transmitted sexually. That allows it to spread beyond where the mosquitoes are present so that is going to be an Interesting Development in how the disease flows but as far as i know that is the only one able to do that that we know of. You know ebola also and there is an interesting project in south africa right now looking at the viral population of the prostate so i will be interested to see because it is a clever place for a virus to hide. We may learn more. Thank you, this has really been fascinating, thank you but my question is we keep running from one part of the world to another, everyone is running to work on ebola, everyone in brazil. When you look at the world and where you think we are going next with our next run to the barn after the barn door is left open, what do you think is coming up . That is what the book is about. Maybe i should just end it there. But you are right, that is the milliondollar question, can we track this back so we can look at the drivers of where these pathogens are coming rather than waiting until they erupt, until we have exponentially growing outbreaks of untreatable disease and scaring to come up with vaccines to throw at it and that has been the model and maybe that would work okay if we didnt have so many new pathogens emerging but the way we live today we do. I think we are going to have to go backward and look at access to healthcare in poor communities, restoring wildlife habitats, addressing intensification of agriculture and livestock waste and all these things we know our drivers, we dont know which pathogen will cause the next pandemic but we can predict where it is most likely to happen and emerging to these experts came up with maps of hotspots where pathogens are most likely to emerge. We cant track every single micro but in those places we can do active surveillance to see where are the microbes changing, where they getting new opportunities, lets analyze them and try to detect these things before they start to cause disease. That is a technological approach but by doing that we will learn so much more about the underlying conditions that lead to these that then we get this huge opportunity to address
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