That was amazing, an incredible tour de force.

And really, as I said, nobody thinking

about how to protect our country and keep

it safe over the last 30 years than Tony Fauci--

so amazing way to begin.

What we're going to do next is I'm going

to bring the first panel up.

And we have a little video.

So let me line up the video while I ask

our first panelists to come up.

So if we could have Mike, Dennis, Hillary, and Mosoka

come on up, and join us.

And the first video--

so we had asked Larry Summers to come, and offer some remarks.

Larry is traveling.

For those of you who don't know, he's

the Eliot University Professor, a former president of Harvard,

former Treasury Secretary.

So then the question is, why Larry Summers?

He has been very deeply engaged in this,

and thinking about this, and cares a lot about this.

I was going say, I realize you guys

may not be able to see the video from sitting up there.

So it's up to you if you want to--

either way.

And so Larry was kind enough to record a video for us.

And it's about six minutes.

We're going to watch it.

And then I will introduce our panelists,

and we'll get started on our first panel.

[VIDEO PLAYBACK]

- I welcome the Harvard Global Health Initiative's review

of what happened a century ago with the flu pandemic

and its effort to look forward to mitigating the risks

and the consequences of future pandemics.

I am convinced that pandemic flu is the least focused on

of major global challenges.

Vast efforts and concern surround nuclear proliferation.

Vast efforts, appropriately, are directed to issues

around global climate change.

Taking the risks over time of pandemic,

I believe that the consequences are similar,

in terms of total economic impact,

in terms of lives lost, to the risks associated

with climate change and the risks associated

with nuclear proliferation.

And yet, pandemic risk is a obsession for specialists,

a preoccupation of those concerned with insurance

and reinsurance, but a much less-mainstream issue

than nuclear proliferation or global climate change.

And so, I believe that this initiative that reminds us

that more people died in the flu epidemic after World War I than

died as a consequence of World War I,

that reminds us of how profoundly society was changed

by a disease that took the strongest rather

than the weakest among us, those who

were young or of middle age, is something

that is very, very important.

We certainly have made immense progress

in the biomedical sciences over the last century.

And that is a positive development

with respect to pandemic risks.

On the other hand, we live in a much, much smaller and much,

much more interconnected world, which

means that disease vectors will be transmitted

that much more rapidly.

Full quarantines will be that much more difficult.

We live in a world that faces too much

superstition, propaganda--

dare I say it-- fake news, and confusion with respect

to vaccination, which has to be at the center of any effort

to control epidemics and pandemics.

And we live in a world where, too often, the preoccupation

is with the urgent rather than with the profoundly important.

And that diverts us, too, from preparing

for the next pandemic.

I believe that this is a central challenge

that deserves far more global attention than it is now

receiving.

And I am glad to see Harvard's Global Health Initiative do

its part to arouse concern, prompt study and reflection,

and drive preparation for the epidemics and pandemics that

are all too likely to come, albeit unpredictably,

at some point in the future.

[END PLAYBACK]

Great.

So as I said, most people in this room

have been thinking about and working on these issues.

But Larry Summers, who has thought broadly, has worked,

obviously, across a variety of sectors and is one

of the leading economists-- and I think, public intellectuals--

has glommed onto something that is really

a key issue, which is that this is not a specialized issue.

This is not a health care issue.

This is not an issue that specialists need to obsess on.

And the point he makes, that if you

think about the things that can cause catastrophic harm

to human society--

global climate change is more slow moving.

But if you think about things like a nuclear weapon going off

in a major city, terrorist threats,

we spend enormous amount of resources-- and rightly so--

on understanding those risks and mitigating those risks.

And then when we switch to something like pandemics,

it drops way down.

And we start thinking about, well,

do we really have the money to afford it?

Can we really make the investments?

So that's part of the challenge that we're dealing with.

And so our first panel for today is an extraordinary panel.

And I'm going to very quickly turn it over to them.

I'm going to do very quick introductions.

This is about understanding and mitigating risks.

And so the first panel--

for those of you who've been with us,

you've seen Mike Osterholm join us.

So thank you, again, for coming back, Mike.

He's the director of CIDRAP at the University of Minnesota.

And as I described him a couple of days

ago, when the country faces challenges

he's one on the shortlist of experts

we turn to, as he was after 2001.

Dennis Carroll, next to him, is the director of the USAID

Global Health Security and Development Unit

and has been deeply involved in these issues.

USAID-- when we talk about the importance of global health

security, we often talk about CDC,

and NIH, and the Global Health Security Agenda.

USAID has been a very central part of this.

And it's really been from Dennis' leadership.

Hillary Carter, next to him, is the director

for counterbiological threats at the National Security Council--

has been working on global issues--

not just global health issues, but global issues--

for quite a long time--

is a PhD from Georgetown.

And then next to her is Mosoka Fallah, whose official title

is deputy director of general and technical services

at the National Public Health Institute in Liberia.

What he really is--

he's been a close friend of the Institute for many years--

is one of the people who was central to turning around

the Ebola outbreak in Liberia.

And he did it through a combination

of both incredible intellect, but also personal integrity,

and trust, and working with the community quite directly

and has been a colleague, friend, and a hero of mine.

So I was thrilled to have Mosoka join us.

So why don't I turn it over to Mike.

I think everybody is just going to make some reflections--

up to you.

Do you want to come up here?

You tell me.

Why don't you come up?

I think people can see a little bit better if you're up there.

I'll sit.

And then we'll have a discussion.

Good morning, and thank you again for the invitation

to be here this week.

It has been really, truly a remarkable experience

over the course of the last four days.

And I just want to thank the organizers

for the vision to put this kind of a meeting on.

Let me begin by saying that I, as usual,

want to kind of send this meeting into a topsy-turvy

moment.

I would like to challenge the notion

of what we talk about when we talk

about pandemics and epidemics.

And there's a very real reason why.

It's not a semantic issue.

It's a actual response issue in a key way.

We often throw around the term pandemics and epidemics.

And we intermix them.

And I think that's at our own peril.

To my mind-- and I tried to discuss this in some length,

the justification and the background for it, in my book,

Deadliest Enemy, Our War Against Killer Germs, last year--

I believe that there really are only

two disease categories that rank in the category of pandemic.

Remember, a pandemic is a worldwide epidemic,

meaning every country, every region,

every continent has the chance to have the same problem happen

as does any other one.

Obviously, first and foremost is influenza.

Just to remind people-- and Tony showed a nice slide up here--

but our group went back and looked at this carefully.

And by the time that the first isolate of H1N1

was identified in California in April of 2009--

we now recognize that that virus was

in at least 27 countries for certain and maybe

as many as 43 countries.

It had moved that quickly around the world.

That's a pandemic.

The second category, I would say,

is an unusual one, in that it's not a disease in and of itself.

We are facing truly a pandemic of antimicrobial resistance,

which is a pan pandemic in the sense

that, on a worldwide basis, it's happening every day everywhere.

Some organisms may be more prominent in some areas

of the world.

But it's just a matter of time.

Beyond that, all these diseases we're talking about

are really what I call diseases of

critical regional importance.

Ebola is absolutely critical to Sub-Saharan Africa.

But will Ebola become a major disease problem

in the Americas?

No, not likely.

Now could we have cases--

as we talked about and I mentioned

in my previous presentation the other day--

that what kills us, versus what hurts us,

versus what concerns us, versus what scares

us can all be very different.

And we saw that with Ebola in the United States.

But from an impact statement that's very, very important

to distinguish.

Let me give you an example.

We live today in a global economy

that we are so dependent on others

out there to supply to us what we need every day.

As of this morning, pre-hospital drug shortages in this country,

meaning what's on the emergency room cart, what's

on the ambulance cart right now--

we have 189 drugs that are either absolutely not available

or in critical short supply.

Many of them are absolutely lifesaving drugs.

Why is that?

In part, because almost all of them are generic.

Almost all are made in China.

And the business model has been set up to cover the mode,

cover the mean.

Don't try to cover shortages, et cetera.

It's too much money to have that much [? pan ?] capacity.

If you wanted, today, to go to war with China--

and for anyone who's in the room from China,

I hope that never happens.

They wouldn't need to fire one bullet

to put their drug supply hands around our neck

and strangle us.

Our military is totally dependent on these same drug

shortage drugs that we, as the public, are dependent on.

When the situation happened with the poor Hurricane Maria

in Puerto Rico, everybody seemed so surprised

that we had this big shortage of IV bags all of the sudden.

I gave a talk four years ago in which I predicted the next F4