Wouldyouwelcome a nativeofSouthCarolina, a graduateoftheUniversityofNebraska, PatrickKennedy.
Thankyou.
I, too, wouldliketothankeveryoneforcomingouttonightandwanttowelcomeyoutotheClintonSchool.
PublicService.
Thisis a treattoseeallofyouhere.
And I'm excitedtohaveyouallhereandmoreinthefuture.
I'd alsoliketogive a specialthankstoDrThomasBruce, ourassociatedean, whohasbeen a strongadvocateofholdingconversationsthatglobalhealthhereattheClintonSchoolandunderhisleadership, wewillcontinuetohavemoreofthesecalmdiscussingtheintersectionsbetweenglobalhealthandpublicservice.
I cansurethankyouforallyourhelpandguidanceinthisprocess.
Uh, muchoftheconversationsthatyouhaveseenasofrecentlyhasbeenabouttheavianinfluenzavirus, alsoknownasthe H five n onevirusthatcouldpotentiallytrigger a globalpandemicandcausemassivechaosanddisruptallaspectsoflifewiththeUnitedStatesandaroundtheworld.
Um, ourspeakertonightcontinuallyemphasize, isthatwhetherit's theavianinfluenzaoritisanemergingdiseasethatwehaveyetfoundanditdoesn't evenexistyet a globalpandemicwill, infact, cometheheequatesitfrequentlytothehurricanes.
Bruce, I wannagivemyacknowledgmentofsomeonewho's been a longtermfanofworkyou'vedoneformanyyears.
DeanRutherford.
Thankyou.
Also, it's a realhonortobehereinthethroesofClinton.
Here, giveitallthepresidentwhyhewasthereand I hadthefortunetospendsomeofthattimeworkinginsomeofthoseprograms.
And I thinkit's greatand I don't wanttodiminishthat.
But I havetotellyouthepersonthat I havethefondestingreatestloveforofallpublicpolicypeopleprobablyisSenatorDaleBumpersandBettyBumpers, whohavehad a chancetoworkwithintheareaoftheimmunizationsfor 20 years.
And I havetotellyouthatitisanexperiencetospendtimewithDalen, Bettyandworkthey'vedoneandtheytrulyarerealpublichealthhero.
But I alsotalkedaboutthefactthattheWorldTradeCentertowerintheAlQaedaoneyearbeforeithappened.
Ifyou'd askedmeinthatinterveningyearbetween 9 11 2000 and 2001 whatthelikelihoodthatthatattackwouldoccur?
I probablyhavetoldyougiven, youknow, mysciencebackgroundofrisk, I don't knowoneand 5001 in 10,000 orsomethinglike, Really, I amheretotellyoutonightandhopefullyprovidethesupportofinformation.
Andsotonight, what I wanttodois I cantellyourightnowattheoutset, andthismaybe a reasonfor a numberofyoutogetupandleave.
I knowlessaboutflewtodaythan I did 10 yearsagowhen I wasteachingmygraduatestudents 10 yearsago, I thought I knew a lotmoreaboutthistopicinthemorewe'velearnedmore, werealizedveryhumblyhowlittlewereallyknow, and I'lltrytosharethatwithyoutonight.
Whatwereallyknowdon't know.
Andwhat's a MaybenowtheWorldHealthOrganizationputout a documentlastOctoberabout 10 thingsyoumustknowaboutpandemicinfluenzaandletmejustsayattheoutset, atleastfromtheperspective I comefromandsomeoftheroommayhavesomeadditionalcomments.
Butthe W.
H O isreallyoftenconsideredtobeoneofthemostconservativeorganizationsweeverdealwith.
I mean, theytypicallyare, ifyouwanttohave a niceconservativebase, wherebytheconservativemeaning, youknow, theynevershytoofarawayintothefuture, etcetera.
A coupleofadditionalthingsyoumustknowaboutpandemicinfluenzavaccineandantiviraldrugsloveminimalimpactonthepandemic.
Itoccursthenextseveralyears.
Why?
Becausewewon't havevaccinesanddrugs.
I'llexplainwhythat's thecase.
Noquickfixesrightnow, oneofthethingsthat I havethehardesttimeaboutdoinginWashingtonwithisEverything's about a quickfixjustbeforeithappensorafterithappens.
Therearen't anyquicksecondball.
It's goingtoturnwaves.
Pandemicinfluenzais a situationthatoccurswhereonceitemergesinworld, ithashistoricallysweptthroughtheworldinwaves, meaningthatitwillgothrough a communityinthespringon a notireareaoftheworldandthensomewhereelsethroughouttheworldatthesametimeintheearlysummer.
Butwhatcouldwehavedoneifwehadknownjust a littlebitbefore?
We'vegottodothat.
BusinesscontinuityPlanningisnotabsolutely I meaninfections, Epidemiologistbytraining.
Whatthehellam I doing?
Talkaboutbusiness.
I willsubmittonightthat, asgoestheprivatesectorrugalourhealthbecauseifwedon't havefood, ifwedon't havemedicalsupplies, Ifwedon't have a lotofthingsthatwecountoneverydayinourlives, thehealthimpactwillbesubstantiallygreater.
Andfinally, Andthisis a messageyouhavetoecompletelybelieve, oryoumightaswellgohome.
Forexample, wedidn't knowthatcatswerereally a verygoodrecipientofthe H five n onevirusuntilwefeddead H fiveinfectedchickensto 46 BengaltigersattheBangkokZoo.
What's happeningrightnowinAsiawillshowyouthatin a momentwherebasicallyonlyrarelydoesthatvirusfinallyinfectedhumanandalmostneverdoesthatvirustransmittedonbyhumantoanotherhumannotyetsit.
Weknow a conceptcalledreassortment, whereitcangetintopigs, pigsor a universalrecipient, wheretheycouldbeinfectedbybirdvirusesandhumanviruses.
Andsometimestheygettogether.
Theymixupthereandcreate 1/3 violence, called a reassortthatcouldcause a pandemicorwhatwe'reworriedaboutnowandwhatweknowaboutthe 1918 viruses.
Itcanalsooccurwhenthere's justenoughchangesthatsamevirus, soitessentiallyisstill a birdvirusbutjusthasenoughchangesthatfinally, itcantransmittohumansbyhumans.
Thepointbeingisweonlygrewthisvirusoutrecentlybecauseof C S.
I likescience, actuallynowextractedgeneticmaterialoutoftissuefrompeoplewhodiedin 1918 foundallthegenes, wentbackandrecreated a virus, whichis a wholeinterestingstoryinitself.
Wethinkitoccurredin a pigwedon't know, butthisisalmostthedumbeddownversion.
It's not a newvirusinthesensethatit's allnew, butyetit's got a lotofhuman, andinthispenand 60 to 70,000 peopleinusdiealongcomes 1968 69.
Homeflu H three n two, whichisnowtheremnants, strangelystilldealwithandwhenever, whatever, thenextpandemicstrangerswilllikelybecomeourseasonalflutillthenextpandemicafterthatoccurstoGene's McDuckReservoir 16 fromhumanvirus.
Approximately 40,000 peoplediedthere.
Well, letmejusttake a stepbackbecause I thinkthatthecurrentfiveinonesituationshouldinfactbeviewedthroughthelensof 1980.
Thesetwovirusesarekissingcousinsbiologically, weseeclinicallyandexplain a bitmoreaboutthat, and I wouldurgeallofyouifyouhave.
Ifyoureallywant, understand, readthisbook.
GreatinfluenzaJohnBarrierreallyis a masterpieceofhelpingtodescribewhatreallyhappenedin 1918.
Letmejustpaint a pictureforyou.
Thisis a letterfromDrRoyGripswasoneofthephysiciansatoneofthemilitarytrainingcampsoutsideofBoston.
Andwhat I believethatreflectsistheamountofviruspressureinthebirdpopulationandlargedomesticbirdsinage, andwilldistinguishdomesticbirdsinAsiafromthoseofdomesticbirdsindevelopingcountriesin a moment.
Intheearly 19 sixties, H threeandeight, anothernameforanotherfluvirus, jumpedfrombirdstohorses.
Anybodywho's a horselover, nohorsesagainstinfluenzavirus, wedon't knowwhyorhowitjumpedappearedtobe a directjumpedfrombirdstohorsesandhasbeen a realproblemSuddenly, threeyearsago, thisvirusstillprettymuch a birdvirusinhorses, jumpeddogs.
Andtodaywehave a majorproblemwith K ninewinsouttheremakestreeandate.
Andwedon't knowwhy I didn't take 30 yearsforthatvirustojumpfromhorsestodogs.
Wedon't have a clue.
Thepointbeing h five n 1 maynotdoitthisyear, nextyear, nextyear, but I wouldn't wanttobetthat's notgonnadoit.
Whydo I saythat?
Lookatthese.
Youknowyou'regoingtohearmoreaboutpoultryinthiscountryagain, I comebacksaidoverandoveragain.
Poultryinthiscountrywillneverbe a significantpartofthe H five n onerisktohumansever.
Ifit's thecurrentagefive, whenCaseycounterfrom 1.6 billion, does I gottatellyounoneofusreallybelievetheywouldneverstayatthathighmortalityratebecausepoortoadapthumanswouldbetransmitted.
Itwouldreducethecasemortalityrate.
But, youknow, reducing a virusof 60% to 30% ofthebigdrop.
TheseairTheofficialNumbersdepartmentHealthServiceisplanningdocumentlookingat a moderatepandemicsevere.
Whydo I thinkhealthcarewillnotbethatofmodernhealthcare?
Ofthe 1918 likehealthcare?
Well, here's anexample.
Ifyoulookatthesenumbers, evenfor a moderate, we'restilltalkingaboutfourorfivemillionpeopleneedinghelppatientcare 855,000 hospitalizations.
YouawareoftheIowaInstituteofMedicinereportcameouttwoweeksagoshowingthatwehavediverted 500 or 500,000 peoplelastyearinthiscountryweredivertedfrom a emergencyroomat a time, buttheyneededone, meaningthattheyhavebeenreallywerefull.
Thecurrentresearchon H five n onehasbeenoftenmisunderstood.
Wenow I'm awareofatleast 31 candidate H five n onevaccinesarebeingtestedWecantaketheoldspringthestrainofsixmonthsagoinhumansbirdsandmake a vaccineforhumans.
Howwellthehumansrespondtobe h five n oneandallthestudiesshowweneedatleast 6 to 12 timesasmuch.
I meanmorethanwecurrentlyused.
Andwecan't growthisviruswith a dimechicken, whichiswherewegrowonly 10 to 15 yieldoffcomparedtowhatwecurrentlygirlforfluvirusvaccine.
Bottomlineisourbestguess.
Meninthefirstyearof a pandemicwillhaveenoughvaccine.
Actually, 20 to 30 millionpeopleworldwideandthevastmajorityofpeoplebeoutsidetheUnitedStates.
That's wheretheproductioncapacityis.
Sodon't comeinvaccineinthefirstyearof a pandemictodoanythingforyou.
Secondofall, lookattheoppositionwithalsoTammyyourtreatmentofTamiflu, whichagainhasbecomeseparatethefluworld H 51 1918 h one n onecausedverydifferentdiseasein a storyintothecurrentseasonalflu.