Outbreak Week: Preventing Epidemics: Ron Klain

Let me introduce you very briefly to, our lunchtime. Keynote, speaker. Okay. So. Ron Klain is our, keynote speaker for the lunchtime and Ron, is, executive. Vice president and general counsel for revolution. LLC. But what he really has been has, been somebody, who's been deeply involved in running. Of our federal, government for. A, long time he's, been chief of staff. For. Both, Vice President Biden as well as Vice President Gore and then. In, 2014. As, the Ebola, outbreak. In. West Africa was, raging as Ebola, was coming to Dallas, and. There. Was a sense that our government's, response was not as optimal. As it could be as it, should be and President Obama turned to Ron to, lead the government's response and what's. Remarkable to me and he has since then become a colleague. A mentor a friend and, it, has, been really, impressive, is is a guy who has spent his career working. And. Thinking about how to make the, federal government work better and more effectively, has, really taken on the cause of pandemics. And disease, outbreaks as. As, his own and has made it his own and has become an expert in a way that, most of us who've actually spent our lives thinking about this feel. Like we don't always understand, so it, is a pleasure and an honor Ron thank you so much for being here. Thank. You Ashish thanks for that introduction. We, live in strange times where. My. Leaving. Washington DC to come up to Cambridge to talk about the possibility, of 30 million people could die from an epidemic is like. An upbeat alternative, to. Being. Back in DC today so it's. Really a pleasure a real pleasure, to be here. I, also. Want to say that as, if she's mentioned in 2014, I took over as the Ebola. Response coordinator, I had no scientific. Background no medical background no expertise, in the field and, as. A result of that experience though I've had the opportunity to speak to groups. Like this a number of times over, the ensuing four, years it's always very intimidating, for me because I'm the least. Expert. Least credentialed, least. Well. Experienced. Person, in the room and I want to thank the organizers of outbreak week for, finally. My, four years of doing this for the first time holding. An event in the one building where, I haven't, I have a degree from I'm, actually more, credentialed, than, other people so it was very good to be at my alma mater here at the Harvard Law School to, talk about this topic you, know we gather in. Part to commemorate, the 100th, anniversary of, you, know one of the worst. Mortality. Events in world history and the, worst mortality, event in American history the, Spanish flu epidemic, which. Killed more people in the United States in World War one in World War two combined, and. When I talked to people who, are not experts in the field about this. They often assume.

That Because 1918. Was so long ago and, so, much has, happened in science and medicine since then that, were not at risk of a, similar, kind of pandemic, today and of. Course there are a lot of ways in which the, progress in science. And medicine have set have suggested, or it suggests. That if, we faced a similar kind of flu epidemic. Of the US today we'd have all kinds of tools we talked about all morning different, kinds of you. Know antivirals. And antibiotics, it would make it less. Serious, and indeed, if you think even about, the Ebola outbreak in 2014. And. The progress that's been made even in the four years since then we're seeing clinging out in the DRC now as scary, as it is as complicated, as it is as much as we're not worried about its possible spread to Uganda, and the, the, disease, playing out in the crisis zone all these things even so the progress in just four years and understanding, how, to how to manage the disease in particular in the, introduction of a vaccine and having 12,000, people vaccinated or more, in that area two, shows that we are making progress in the world is a safer, place in many respects, but. I want to talk today I want to focus today on the, ways in which the world is a less safe place than it was in 2014, and, even than it was in 1918. And I. Want to talk about how, the risk we face here, is, a real risk. Bill Gates his famous prediction, that it's not a nuclear war or a terrorist attack or any, other, threat but a pandemic that has the highest risk of a. Single event that could take 30 million more lives in the next few years certainly, chills. Us all, and. You know as I said the good news is the people in this room. And. Your, peers and colleagues around the world are, doing so much to lower that risk and to decrease that risk and we're making progress every day on vaccines. And therapeutics Diagnostics. Tools, data, analysis, all kinds of things to, make that risk decrease. But. There are ways, in which the risk of a pandemic, is increasing. Notwithstanding that progress and that, is my focus, here this afternoon. So. I. Want. To start and move past quickly, the, one obvious, way the one obvious change, in which our risk, of an epidemic spread is increasing, I'm going to pass it quickly because it's generally a benign thing and, that is the, massive increase in global connectedness, due. To development, in. Transportation. Infrastructure, the way back in 1918. There. Were parts even of this country, that never really saw a substantial Spanish.

Flu Outbreak. Because, there are parts of this country that were so disconnected, from other, parts of the country let alone other parts of the world they, were largely insulated. From, the spread of the disease but. Today of course today it's very different than that it's not just that someone can, go from Beijing to Boston. 16 or 18 hours is that, someone, in the most remote, village. On the planet can get on a scooter and now ride a road to a regional capital, where they can get on a bus or a train and, get to a national, capital where they can get on a plane and get to Paris. Or London New, York Washington Beijing Riyadh in less, than 24 hours from any spot of the planet to almost any city, on the planet before, a warning, about an outbreak could even appear in the global media it, could be in our schools or workplaces our hospitals, Boston. May still be the hub of the universe but, it is an infinitely, smaller universe, than, when Oliver Wendell Holmes said that just, a few years before the Spanish flu epidemic, hit, our country so. Global connectedness, does raise our risk of a global epidemic but, has so many other benefits exchanges. In culture, and learning, commerce. Education, all, these movements. Of people and ideas that. We wouldn't, want to turn back to, tie it on that and we can't turn back the tide on that but. What about the changes, in trends, in the world today, that are making us less safe and that are not as positive as global connectedness and. That's my main focus and. My message today about these new threats as I, will discuss them in, a few minutes is that, it's a time the global health security and. The public health communities, must, get more, political. More active and public policy, than ever before now, might be clear not saying more partisan. I'm, not talking about a political party, thing here but I am saying that there are controversial. And divisive public, disputes, that, need this community, to speak out more, than ever the men and women of this community who risk life and limb offered to fight disease have, to stick their necks out a little farther not, to face down a virus, or a vector but, to face down the social and political trends. That. Are endangering, our ability, to prevent and respond, to future epidemics and there are three particular threats, I want, to talk to right now the. First is the rising tide of isolationism. And xenophobia. A turn, inward, and many of the world's developing, nations particularly, now in the United States in Europe and a turn away from global, engagement, now. I want to stay away from partisan. Politics here I am a partisan, there's no question about it but very active and vocal Democrat, but when it comes to the issue of pandemics. There, is no democratic. Or republican response there should be no you. Know red. Or blue answer, to this there should only be you. Know the right and wrong scientific, answer and. And. I'm, not here to really debate about what would really make America, great again but um. But, there is no question there is no getting around the fact that an, America, first mindset. Leaders. Who tell us that globalism, is bad, and that. Global engagement is not our path make. America, less safe when, it comes to pandemic, prevention, and response the. Belief that isolating, ourselves from the world can. Prevent the spread of diseases here, is foolhardy, there's. No wall we can build that's high enough to, keep infectious, diseases or, the vectors that spread them out we. Have to be part of a global community that's. Attacking a shared global threat. Now. We don't need to speculate about how much mindsets, have, made. Us less safe we've seen it already in 2014. As, the peak. Of the, fear of Ebola in the u.s. a fear. That, by itself risked cutting off public support in our country for fighting the disease in West Africa then. Citizen, donald, trump tweeted, that President Obama's decision to medevac back to the United States Ebola, fighters who, contract, the disease was. Quote stupid, and that, these people should be left in Africa to quote suffer the consequences. Of their, choices, now, had that been the policy of the United States at that time and not, just the tweeting zuv a provocateur, not. Only would some heroic, people have died as a result, but, getting doctors, and nurses, to go to the frontlines to fight this disease would.

Have Been infinitely more difficult and. Fewer. Responders, would have meant a greater, spread of Ebola in West Africa in 2014, touching, more countries killing, more people and ultimately even endangering, the United States in a variety of ways, fortunately. That sorts of isolationism, was not our policy in 2014. I've, had the honor of meeting dr. kent brantly and nancy writebol, two, people who were mended back back to this country for treatment and whose, lives were saved and I can assure you they're very much alive and still making the world a better place. Nor, is the impact of isolation, merely, a what-if, question. In, 2015. And 2016. Xenophobic. And isolationist. Sentiments, on Capitol, Hill played. A major role in Congress. Delaying funding, for the Zika response. Time. And again as I and, others and, urged Congress, to pass the emergency, response package, that, the administration, had sent to Capitol Hill months. Before the first outbreaks, of Zika in the continental United States and. Congress refused to act I heard, repeatedly, back to, this advocacy why. Should we pay for this Zika, is an immigrant's, disease or Zika. Isn't a public health problem it's an immigration, problem just, keep the foreigners, out as a. Result of the delay in Congress acting we had the first case of local transmission, of Zika in Florida and the, first instance ever of the, Centers for Disease Control, issuing. A travel advisory against, travel, to parts of the continental, United, States. America. Withdrawing from the world makes the world less safe risks, the spread of infectious diseases in all sorts of places and, will cost thousands, if not millions of lives so you manatorian catastrophe, and if for some reason that is in persuasive let me say this it, also makes America, less safe our. Failure to combat. Epidemics. Overseas just starts a ticking clock, to facing, those epidemics, here at home global. Health advocates, and public health professionals must be at the forefront of facing. Down this, mindset here, in the US and around the world, now. A second, threat is. The way in which taste today's communications, technology, and networks. Can transmit, an epidemic, of fear and doubt even, faster. Than the viruses, and vectors themselves. Can communicate, a disease, the. Speed of Twitter the, impact of Facebook the immediacy of cable television create.

A Mechanism for. Distributing. Information true. Or untrue at. That literally at the speed of light the. Impact and damage that this kind of communication can do if it's false or panic-inducing it's really hard to calculate but. It's painfully, ironic and, thoroughly, applicable, that we say that these kinds of communications, when, they are maximally, impactful, have quote-unquote gone viral, now. I know you devoted a day earlier, this week to the issue of communications, and epidemics, want to be repetitive of that and moreover. I think it is important to acknowledge that for large swathes, of the world's population, it is still a lack of communication, and not a plethora of messages, that poses risks during. The 2014 Ebola epidemic there, was a lack of cell phone coverage, in Sierra Leone, there was a real barrier to contact, tracing in parts of that country and a lack of broadcast, radio coverage in Guinea that slowed our ability to disseminate public, health messages there but. In the highly connected developing, world and increasingly. In a larger share of the world as a whole it. Is the ability of false information, to crowd out truthful, information of fear. To spread and paralyze of paranoia. And hatred and conspiracy, theories to capture, the minds of millions that, poses a great threat at, a time of crisis. Back. In 2014, whenever, these forces got strong, and we, risked being overwhelmed, by them my, office developed. A highly sophisticated and. Technical. Countermeasure. That, went by the initials, PT. Fo t, that. Stood for put, Tony Fauci on television. The. Ability, to have a national, icon like Tony as a messenger, of science. And information of truth that education. Was, an invaluable asset at critical moments during the Ebola outbreak, in 2014. But. Not every country, has a Tony Fauci and even. Tony cannot be everywhere at once, solving. The challenge of hyper connectedness, and hyper information, is absolutely critical, for dealing with the dangers of a future epidemic, once. Again the burden falls on this community to take on the false information that conspiracy. Theories, to. Tackle, the Twitter trolls and to, create a communications, environment, that, will permit and promote an effective, epidemic, response. Third. There. Is the growing tide of, anti-scientific. Thinking, of a. Rejection of expertise, and a resistance to evidence-based medicine that. Is now often associated with the rise of populism, in the US and Europe Tony. Talked earlier this morning about what we're seeing in Italy right now and it's, particularly manifesting, itself with the rise of the anti-vaccination, movement in developed, nations of. Course in large parts of the world it's, nothing new for people who. Adequate education, or background whose culture, lacks, a disposition, to this right framework, to be skeptical the validity of modern, medical measures. But. We're seeing now in large. Parts of the u.s. in Europe is something. Very different and very dangerous the. Growing refusal, of parents to vaccinate their children, well-educated. Parents. With no historical, or cultural barriers. To explain their resistance is dangerous. And, just the tip of an iceberg that could sink us all in the event of an, epidemic we're rapid vaccine, deployment, might be critical, to public health this. Is a political movement that does not uniquely belong to the left or, the right and includes left-wing populist, who doubt vaccines, because of the corporate status. Of vaccine makers and right-wing populist, who reach the same conclusions, despite, the educated, elites who, promote vaccination. During. The Ebola epidemic of 2014, I would often talk to policymakers, and, explain the challenge of persuading, communities, in West Africa, to, adjust their burial, practices, to, reduce the speed of the spread of the disease and time, again these policymakers, would say to me if only, those people, could put aside their irrational, beliefs and accept, science, and each. Time that happened, I would point out that at that very same moment in Southern. California, here in the US there. Was discussion of closing Disneyland, because, of a spreading buddy, because of a budding measles epidemic that. Was the product of parents in Orange County California, refusing. To vaccinate their, kids if, only. Those people would put aside their irrational beliefs and accept, science indeed, so. In the, face of these threats that, raised our danger and epidemics.

A Growing. Tide of isolationism. The. Rapid pace of modern miscommunication. And the, swelling anti-science. Populism, what, can we do, what. Can those of us concerned about global health security do, and, as they said before I think the answer is that, this community has to get even more political, even more into the policy, arena and as, I said I'm not talking about more partisan, in fact I thought, Heather's, presentation, this morning but what the Trump administration is doing on trying. To combat, some of these dangers was, was great, and I think there are good steps happening, there but. And, this is not about one political party or the other but. We do need to match our investments. And our, focus on research, and development on things, like sappy on vaccines, and therapeutics with. An equal focus on changing, heads and hearts and, creating the political and social and policy framework where. We can improve our efforts to prevent future epidemics and. Make any future response, more effective, and rapid. We, have to match risk-taking. In progress, in treatment, units and on the lab bench with. The same sort of instincts, in the public arena and in, Town Square and so, let me close with three specific suggestions, about my, call, for more politically active Global Health movement in the, United States first. We, need to continue to work with policy makers to, get in place the legislative, and the budgetary, measures we, need to make sure the u.s. is prepared to, respond, to, future epidemics this. Includes, a much larger, and fully, scaled public health emergency, fund a reversal. Of the, recent chipping away of the investments, we made in 2014, and 2015 and domestic. Epidemic preparedness. Making, sure we have well-funded. Well-trained, well staffed infectious, disease treatment centers and first, responders, it, means changes in the Stafford, act to allow the President to declare a natural disaster arising. From an infectious disease outbreak most. Of all it means a continued us investment, in global health security and, assistance. To other countries, that are trying to improve their own response capacities, we. Must recognize emphasize. That these commitments of these investments, must, be consistent, in long term not, episodic. And crisis, driven in the, end the best way to combat the dangers of essa' isolationism. And xenophobia. Is, to lock in place policies that, can overcome the consequences, of these ills by. Institutionalizing. And extending. The US commitment to, combating health security threats around the world and. While advocates, like myself can play some role in winning these battles it's the voices and ideas of true experts, like the people here they're, absolutely, critical, second. Beyond. This work here in the US which will have positive, impact here and around the world we, must be the vanguard, of building. Out and improving, our global, response, system, right. Now as everyone in this room knows all too well when. An outbreak occurs in a country that has a weak national, Health System the global, response relies, upon the you w-h-o, and a. Network of courageous an, amazing. But. Nonetheless private. And voluntary NGOs. This. Exceeds, the capacity of the former and leans. Far too heavily on the latter had. His past, government's. Throwing some money it. Is chaotic it is ad-hoc and if, the crisis, were truly substantial, imposed a global risk it is in substantial in inadequate. Yes. The w-h-o is doing a better job today with new leadership and more, transparency. But. As we're seeing in the DRC right, now when, it encounters, security. And political obstacles. It, often must cease operations, we. Need a robust, white helmet battalion, and responders, who can operate globally and, power an epidemic, response, in any country, under, any set of circumstances we. Need better international, cooperation, and information sharing so, that all nations have visibility and to what vaccines or therapeutics, are being administered in outbreak response. Unhear. Deeply. Flawed woefully, ineffective, at many points still. May provide a basis, on which we could build or, perhaps it's some other structural organization, which, would be the price right platform for a fully equipped fully resourced Global.

Response Program, but I can tell you this if. Science fiction ever became science reality and the, earth was facing, an interplanetary. Threat. That. Might kill tens of millions of people we, would not go into battle with a global regulatory, body and a handful of volunteer, groups as our frontline of Defense, so. However it is structured, however it is assembled we, cannot, square the knowledge that we face agloe pandemic, threat of that significance. And then. When that threat arrives, intended. To be met by, the whio in a series of ngos. Third. And perhaps most fundamentally, scientists. And doctors and academics, have to be willing to step into the public arena even more and take, on the unpleasant, and contentious political issues, like, the public trends towards isolationism. Xenophobia. And demagogic populism. I know, that many in the scientific community try to avoid tangling with divisive, issues and I understand why but. Your voices are needed more than ever to confront these, problems. More. Of you than ever before needed to speak outside of academic, conferences, and journals and step, into the mainstream press and publications, more. Of you even need to be on Twitter the. Virus that may kill millions may. Not be one that can be stopped in a lab and may be the one that we confront as it Scrolls past on a smartphone. Four. Years ago as the Chiefs mentioned I was a lawyer and a layperson I was put in charge of coordinating policy, and execution, of the, Ebola response, lacking. Any background in the field I was ridiculed I was dismissed I was belittled the, week I was named to the job the. Opening sketch on Saturday, Night Live featured, Taran Killam playing. Me providing. Hugely. Uninformed. Hackish, and horrible answers to questions about the Ebola epidemic, it, was pretty humiliating, but. Fantastic, leaders from this community Tony and Tom, Frieden Nikki Lurie Raj, Shah and others took me aside and told me to hang in there and do my job which really was largely just to help them do theirs, now. Today, I'm telling, you that everyone in this room needs, to face the criticism. In the controversy, the unpleasantness, of public, life to step into the halls of Congress the, offices, of the executive, branch and, the many dimensions, of public. Arena to win passage, of the policies, we need to confront. The social and political trends, that, are making global health less secure, once, again the men and women in this room and in this community must. Go to the frontlines confront. The danger and help, make us all safer thank, you very much. Was. Awesome thank you Ron so let's, some questions. For Ron people. Want to come up and if it's okay while people are coming up I'm asked you a question please. So. One, community. That you, would think would get the. Harm. That comes from isolationism, the, risks that comes from disease outbreaks is the business community yeah and, they've. Been big, beneficiaries, of globalization. Interconnectedness. All, of this and yet. When we've seen this political, tide change in the last year. And a half two years there. Hasn't been at least in my mind it's mumbling, so. The question is where. Is the business community in the broader issue and then to what extent do they recognize, that. When, there is a disease outbreak that is made worse by isolationism, it's their bottom line that's gonna be heard as their workforce as can be disrupted, their supply chain that's gonna get messed up yep any thoughts or sense on where that community, is in all of this I'm. So. Attempted to say two words tax cuts but, but. But, look I think that I, think, that we are starting to see a little more awareness on the business community Ryan is here from wef and I'm working with them and and really. Impressive. Cadre, of business. Leaders from around the world who do recognize, this. Problem, I think that look. I think when you talk to business leaders it's, not that they don't agree it's that they have a lot of other things that are pressing and this risk seems a little, remote a little problem a little probabilistic. You, know what are the odds that's going to happen what are the odds that's really gonna affect my supply chain my, countries where I operate.

So. On so forth so I think it's, a question of in. A lot of free riding right a lot of like well someone else to worry about it well let someone else like solve this problem I'm busy like working on my bottom line I understand that but. I do think it's important that global. Business groups step, up and play a part it obviously starts particularly. With the travel and tourism industry which is usually the industry that's most immediately hit by these, issues but needs to get broader than that and. So, hopefully, we will get more engagement more involvement I do want to say I have to record I think I absolutely. With everything else she said on the other hand I do think we have to recognize the, enormous. Pouring. Of resource, and help, that came during the Ebola response from the private sector whether, those were technology. Leaders in California who wrote large checks, to the CDC Foundation which made a key, difference empowering the early days of the response to, the, shipping industry which, brought tremendous, amounts of personnel. And material, to West Africa to make this happen, to all sorts of other sectors including, the, industries. In West, Africa themselves, that largely, shut down operations, and still paid their workers, to get people to go home and not aggregate, in a, concentrated, area so I think the business community can do the right thing I think it often does the right thing but I do think we need more engagement on this on these but on these broader issues great. I'd. Love to hear what you think about the national bio defense strategy, and the White House's support, of it yeah so. I'm. Trying. Really hard to be bipartisan, today. Look. Ah you, know. Kudos. For putting it out okay, and so kudos, for that. It's. Nine, pages long. The annex. Is 20 pages long. You. Know I mean look I think it's progress that it's out there I think all the right things are, there the really issue is is the commitment they're like I mean in the end that. The thing could be nine pages long or 90 pages long or 900, pages long the, question is is the, budget there you know the reality is a factual. A political statement every. Budgetary, proposal from this administration has. Included huge, cuts in the NIH huge, cuts in the CDC huge. Roll backs of these critical investments, fortunately. Congress and again credit to Republicans, on Capitol Hill Republicans. On Capitol Hill have stepped up and rejected, those cuts and so, you, know we're, not in bad shape and. Again again. I'll give the cup administration, credit though, they were a little late in, responding, to the first outbreak of Ebola. In the DRC. Last. Year they did indeed ultimately be the became the world's largest donor, to that response and very, quietly they are doing a number of very helpful things for what's, going on with a bowl and DRC right now so you, know I think it's, just a question of trying to the. Strategy, is great, but in the end the resources, really matter and. Congress. Has been great on this the, administration, less so hopefully, if the strategy leads, the administration, to change direction and propose, a budget this, coming year for FY 19 that, really funds these priorities, then I'll be the first person to give them credit for that and to stand up and to applaud that, move.

Thanks. Ron for being a champion on. These issues much appreciated, I'm Monique Mansoor The MITRE corporation formerly, with HHS, and, Novartis, and want to talk specifically, about I, know as she, said that's a great question about business, continuity I want to talk about, a particular sector that we're enormous ly dependent on in these responses, we had mark here last night, a representative. Saying, that they're not sure they could do what they did in, the Imola response again so, when we think about the industrial, base the complex, it's going to be sort of the first responders, or the suppliers if you will of critical assets, and and, what your perceptions, are of the, biopharmaceutical, base, as a, key responder, asset, capability. In. Biological. Threats, and pandemic response so what are your perceptions, about where we are well. Look if someone, from Merck said they weren't sure if they would do what they did in a bowl again. That's. An improvement from last time I've heard them when they said they absolutely positively would not do what they did on a bowl again so it seems like they're softening up finally it's good to look. I understand, the look, I understand. The attitudes, of the. Pharmaceutical. Industry about this and a. Lot. Of people poured a lot of money into developing an Ebola vaccine, and. Virtually. None of them got. That money back and maybe and maybe in fact in the end none of them will have gotten that money back and. And. It's hard to know what went wrong there that is to say I. Can. Assure you no one in the government called every, single vaccine, maker and said all of you must, drop everything, and all, of you must now all try, to develop an Ebola, vaccine right now. But. Yet that happened right and as a result if you just thought about logically it stopped the clock and stepped out of time for moment and said wait, everyone's, doing this like, a bunch of people could be unhappy when this is over, it. Was kind of an obvious observation. Time yen nonetheless, this, unfolded. To. Me the bottom line is we. Need better coordination, between the government and the private sector on this and we, need you. Know I thought the questions, from the floor this morning are. Shishas point about missiles and the government is a procurer, and this whole thing you know is an interesting, perspective because definitely not our perspective about the way we do vaccine. It's notwithstanding Barda, and some, role there it's something certainly not like the way the, folks at the Pentagon at work in any way shape or form but. I do think, I. Think. Sepi is a step in the right direction I think there's a lot of focus around that I think, that having our government, leaders though really. Understand, that. They. Need a better dialogue with the with the with the industry on this to, deal with future crises, to make sure we. Don't have the kind of thing that happen with a bullet where a bunch of people I mean companies spend a lot of money that they were never ever gonna get back that, wasn't right that didn't work we. Need, a process to confront these kinds of crisis events not was saying obviously, we need what we're doing now to kind of plan. And move forward but there will never be these crises and we, can't, have. What happened with Ebola happen again. I'm. Inspired, by your call for policy, changes for for us to advocate vocally. In politics. For policy changes on issues related to pandemic, preparedness do, you have any suggestions, for how we, might do so without ending up in the same sort of political quagmire as, climate, change for instance yeah. I mean look I think it's, a great question because, there is a lot about perfectly, what we're seeing now with the anti-vaccine. Movement that. Parallels, what happened, with climate, change right there was a time 20 years ago where climate change really wasn't a, partisan, issue it wasn't really a divisive, issue people some.

People Were more or less interested. In it or whatever but, this strong. Kind. Of partisan, ization of the debate about climate change is a relatively, new phenomenon and you can see scarily, vaccines, kind, of creeping, along that, same trend line the, same sort of thing as. I said before did you don't only refer to what's going on in Italy with you, know the populist, party they are really making resistance. To vaccines like a major political issue in the country and, and. You know you'd only have to open up Twitter or read the Internet to see a lot of the same thing happening here in this country so. I thought I thought Tony foul cheese point, this morning that. You, know we need to confront this in a way that that, isn't. Accusatory. Or or. Or, uh or or. Further. Isolating. These communities, and really, try to make the, case to them directly about what's. Going wrong with their approach and why they're, looking at this the wrong way and so on and so forth I thought was great wisdom, as always from Tony and a great guide I think in terms of more. Broadly you, know that what, people have to do is talk. To their. Elected officials both. Democrats, and Republicans and, again, well as I said I'm a partisan, everyone, knows where I stand you know it is what it is but. I will say during the Ebola epidemic. One. Of our most helpful, allies, on Capitol, Hill in, terms of funding. The response, we needed was congressman Jack Kingston who's. Like what it was what he's no longer in Congress was one of the most conservative, Republican. Congress. Was that she national chair of the Trump for president campaign, and yet. Came through with the resources, we needed to, fight Ebola, both here at home and overseas. And, so I think you. Know it's mostly about educating. Elected, officials about this threat it's, mostly about trying. To make, plain, the consequences. Of some of these popular, movements towards, isolationism, and xenophobia, and anti, scientific. Thinking. And. And really bringing that forward to the public arena what. You'll be surprised at how much elected. Officials and political figures listen. To scientists, there's, still an on there's still a level, of respect, and. And. Expertise. Accorded, to this community and I think if you use, those voices, to engage in the public arena you. Will find an. Open. Hearing at least and I hope progress, on these issues -. Thanks. Ron. Thank you very much for speaking today and, for your leadership on sort of issues of global health security over, the last few years you. Know the US has been a leader, on global health security Paula, see and. It, was sort of fitting actually the u.s. was one of the first countries to undergo. Joint external evaluation, um, the. U.s. is owned je is this assessment of our preparedness. Capability. Identified. That coordination. Between the federal, the state and the local levels of government remained. A challenge so, given. The context that you've said today about that increasing, polarization we're. Seeing how. Do we get a politics, of this right in particular. That, relationship between the federal government and coordination, at the state level for public health security, yeah. So, you know as she's mentioned, I kind, of I was, the White House a bola response, coordinator, and for some crazy reason people said I was the Ebola czar and I, could tell you I never felt, as. Unsure. Ish as when. I was trying to deal with state and local officials on, matters. Of the Ebola response I. Would. Sit in my office in the White House and I would often call a state, public health officials, and they would assure me that I had absolutely no influence or control over what they were doing no. Matter what office, I was sitting in and no matter how close I was to President, Obama and look. We have a highly, diffuse. Highly. Diverse. Healthcare, system in the United States we have regulation, at all levels of government we, have a public in a private system we, have for-profit. And nonprofit players. And that. Makes. Dealing. With something like an epidemic response really really.

Really, Hard, right. You, just can't even it I'm telling you me working less you can't pick up a phone push a button and make things happen that's not the way the American system works. However. It. Also makes our system really, really, resilient, because, it means if something bad happens, with one place and one set of actors it doesn't affect other so let, me illustrate the point this way in the, fall and winter of 2014. As we were trying to ramp up the response in West Africa and get more doctors and nurses and health care workers to go and. Fight this, was a very difficult thing because there. Was no, one I could call and say hey you need to go right, I mean the, federal government we have some people in u.s. PHS, we sent over there but, by large this is about kind, of taking, a and calling. Healthcare, systems, calling. Different. Kinds of groups and saying hey could you please get a few people to go over and, every week during the response I do this status, call with, my counterpart, in the United Kingdom and he'd, say well how's it going and I would say well you know I made 52 calls I got like three doctors from Kansas, that I got two nurses from st. Louis and, I'd say how's it going for you is what I called it the National Health Service they're sending 50 more people over Wow. You. Have a much easier job than I have and, and, it went this way right like the, entire fall and winter right, and. And. I was like whoa there are systems, horrible compared to that this is this is a disaster, and then sadly, one, of those NHS nurses, came home with Ebola and, the entire NHS, shut, the Union for the NHS to shut down the response they sent no one else and, at. That moment the. Beauty of our diverse. Diffuse. Non. Command and control system, kicked, in and we were able to step up and send people from. All kinds of other places to because, there was no one person that, could say yes but there's also no one person that could say no so. Our system is our system and it's, not gonna change and. That. Means they're gonna be Democrats. Or Republicans in, the White House and Democrats Republicans. The state public health commissioners, and as welcome, public health pushers and so on so forth you have the craziness that you had in Dallas when, mr., Duncan got there and got sick and the person in charge of the response, but. Under Texas, law. Was. A judge, who was essentially the public health commissioner of the county in Texas judge, clay Jenkins, okay who. Was a fantastic. Person and did an amazing job it, would be hard to explain why. A state, court judge like if we drew a chart up here like how about a pathetic response works in America I was like Oh state court judge he's the person who decides whether. Or not. Neena, fams dog needs to be put to sleep because. It, was exposed to her potentially, having Ebola does the dog have Ebola does, the dog bone have Ebola does the dog food have Ebola like a state court judge in Texas is making these decisions, it's a crazy system, but, it is our system and we, need to work in it and I do think there are ways in which we can cooperate more levels. Coordinate, more between the levels and make, it effective. Okay. So. One of the topics that has come a lot over, the course of outbreak week especially. Some of the earlier programming, has been the idea of governance, and good governance, which is a very, broad amorphous. Term, but. One particular, did. I think falls, under the rubric of good governance is trust, in government and. One. Of the things we've, seen in public opinion and, not, just recently but actually over decades in the United States and many, other countries around the world is declining, trust in all. Or, nearly all social, institutions. So. It's, kind of a two-part question what. Do you think is the relationship, between. Trust. And government in particular I guess Trust in the executive branch and, the in the u.s. context. This is also an international phenomenon and. People's. Willingness to. Comply. With, public. Health guidance, and. Then. Secondary. To that if you think this is an issue are. There steps, that can be taken to, reverse. Trends. In trust and governance related. Acknowledging. That a long, term process is not just something that happened overnight yeah. It's a great question and, it's a very very hard problem and you, know you kind of jokingly said that during the Ebola response our. Secret, strategy was PT oft put Tony Fauci on television, but. Having. Someone having one person, who had this kind of history, and expertise, widely. Recognized served Republican, presidents, and Democratic presidents, you. Know really made, him a trusted figure and a trusted voice and was, a you, know really critical aspect, of communicating.

With The public but, that's, not really a system. That's not really a plan. Right, and so, you. Need to address that now what are the challenges well one challenge, really is our media culture. So. If you watched TV, during, the, Ebola. Fear. In the United States while there was an actual epidemic, in West Africa a lot of fear here, the, media culture really, fed this fear right because. I'd. Watched, some expert, go on TV and and, and. You. Know we had this thing with. Um dr.. Spencer Craig Spencer who had been fighting Ebola in Africa came, home. Wasn't. Sick, immediately when he came home you, know found out he had a bowl of 9 or 10 days later the night before he. Found out he had a bola he had ridden the subway in New York and, and. So. The experts would go on TV and they would say well can, you get a bowl on the subway and, someone. Said you know it's like, incredibly. Improbable. Extremely. Unlikely and the, announcer say so you're saying you can't get a bowl on the subway no, no no I just said it's it's like. Unbelievably. Unlikely but. You're saying it's possible you. Know as well yeah. I mean like if, if, like, dr. Spencer like maybe like was, bleeding, he rubbed up against you on the subway and so. You're saying there might have been a bullet transmission, on the subway last night in New York right and so, you know that, is kind of our media, culture now right which is you know a lot of hype a lot of whatever now. What's. The antidote for that and, something, someone referred to earlier this morning which I really think is a lot, of community based communications. Yes, it's awesome if there's a national figure like Tony Fowler you can go on national television and reassure. People fantastic. But, the, reality, is the. Most trusted, communicators. On these, issues are, local. Community, leaders community. Scientific, leaders community, political, leaders community cultural leaders in West, African 2014, it was often community, religious, leaders we had a huge program of trying to persuade, Imams, to, go to different remote communities, and talk, to their their. Followers, about, burial, practices, and the need to change burial practices, in an, effort to prevent the spread of the disease but. I do think, that the the, best antidote. To, this kind of, rejection. Of expertise. And, rejection. Of authority is. Community. Leaders people may. Not trust the folks in Washington anymore. They, do tend, to trust their, local leaders their, local clergy, their, local elected officials, their, local community, icons, whatever, and so, they have to really be the. Key communicators. On a lot of this stuff they, play such a key role in this. So. I have to say I was I was one of those. Public. Health people who I got that, exact thing on the subway right after and ultimately. The, tactic, I switched to was not talking, about probability, because I don't know how to talk about probability, but, talking about my kids and saying, I would be fine with my kids writing the New York City subways today and trying. To like make this much more personal, as opposed to because, literally somebody cornered. Me into would, you be on would you be comfortable on a plane and I said sure I'll be on a plane and, they said is there no chance I, said no. Change yes and then. As soon as I said that I was done yeah, because I essentially I was saying was everybody. Was exposed on the plane and they're all gonna get Ebola yeah so. It's an incredible. Communication, challenge that like those, of us in the public health world have not been trained in how to deal with we talk in probabilities, like this, is low likelihood there's a one in a million chance well that sounds I to some people yeah.

Thank. You for this thank you for coming thank. You for all of your leadership over the last four years and thank. You for your call for us to get more engaged this was awesome great thank you.

2018-10-11 16:01

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