Saint John’s University
September 29th, 2015
Richard Ice:
Good evening and welcome to the Dr. Norman
L. Ford Science Literacy Lectures Series.
I’m Richard Ice. I am the interim provost
of College of Saint Benedict and St. John’s
University. Let me give you a little background
on the creation of this lecture series. A
couple years ago, a St. John’s alumnus from
the 1970’s, who wishes to remain anonymous,
came to us with the desire to endow a lecture
series. He majored in the natural sciences
as an undergraduate. His goal for the lecture
series is to engage our students, our members
of our academic community, and the wider public
in cutting-edge science topics igniting their
curiosity and developing their overall science
literacy. We are deeply grateful to him for
this generous gift and creative concept. He
was unable to join us this evening, but has
conveyed to us that he is thrilled with the
selection of Dr. Michael Osterholm as the
lecture series inaugural speaker, having admired
Dr. Osterholm many years. At the donors request,
the lecture series is named in honor of one
of one of his favorite and most inspiring
professors; Professor Emeritus Dr. Norman
L. Ford. We are very fortunate to have Dr.
Ford in the audience tonight for this inaugural
lecture series, along with his family and
friends. Would you wave your hand here norm?
[Applause]. Dr. Ford taught biology at the
College of Saint Benedict and Saint John’s
University for 31 years, from 1967 until his
retirement in 1998. He was a specialist in
ornithology and was widely published in his
field. As important as his considerable, professional
accomplishments are, it was Dr. Ford the consummate
teacher who is warmly remembered and admired
by the hundreds of students he taught during
his years here. This skill was formally recognized
in 1998 when St. John’s presented Dr. Ford
with the Robert L. Spaeth Teacher of Distinction
Award. The citation that accompanied that
presentation really says it says it best.
He said “its 7:45 AM on a Wednesday morning
and Norm Ford and his class have already been
at work (Did you hear that students? They
had already been at work and its 7:45) Uh…
he came early to gather with his students
in a field and listen to the morning silence.
The silence and the bird songs that punctuated
it. He came early to help students tune their
ears, train their eyes to notice things, the
color of a feather, the tone of a mating call,
which the rest of us might pass by, leaving
them unnoticed and unknown.” For more than
30 years, Norm called his students to a more
perceptive understanding of their world because
of his fine crafted presentations, an emphasis
on critical thought. Many students consider
Dr. Norm Ford to be the finest professor at
their undergraduate careers. On a personal
note, 26 years ago, Dr. Ford welcomed me as
young first year professor on this campus
and I classify him as one of my mentors and
I thank you Norm for that. In many ways this
lecture series, in Dr. Ford’s honor, is
a continuation of Norm’s mission, as our
speakers call us to a more perceptive understanding
of our world. And now I’d like to welcome
to the stage Dr. Barbara May, Associate Professor
of Biology, to introduce our guest speaker
tonight.
[Applause].
Barbara May:
Thank you. It is an honor and a pleasure to
introduce Dr. Michael Osterholm as our an
inaugural speaker for the Norm Ford Science
Literacy Lecture. A graduate of Luther College
in Decorah, Iowa. Dr. Osterholm continued
his graduate work at the University of Minnesota
with the Masters in Science, a PhD, and a
Master's in Public Health. His list of accomplishments
are vast and I'm sure I could spend a long
time talking about all these and I'm just
going to mention a few. He’s authored over
300 papers, uh 21 book chapters, and has written
a book entitled Living Terrors: What America
Needs to Know to Survive the Coming Bioterrorist
Catastrophe. I read it a while ago and have
have um thought about Oster--Osterholm and
he has been a hero of mine as a microbiologist
for a long time. In all of his work, Dr. Osterholm
is known as an advocate for the development
of National Emergency Preparedness for Rising
Pandemics and Biological Weapon Attacks. Uh
His list of service is long, he served for
24 years in various roles at the Minnesota
Department of Health. The last 15, as the
State Epidemiologist and Chief of the Acute
Disease Epidemiology section. While at the
Department of Health in Minnesota, Osterholm
and his team were leaders in the area of Infectious
Disease Epidemiology. He led numerous investigations
of outbreaks of international importance including
food borne diseases, the association of tampons
and toxic shock syndrome, the transmission
of hepatitis B in healthcare settings, and
the human immuno--immunodeficiency virus infection
in healthcare workers. His role changed slightly
in the early 2000’s when he became the Director
of the Center for Infectious Disease Research
and Policy at the University of Minnesota.
From 2001 to 2005, he also served as a Special
Adviser to the U.S. Department of Health and
Human Services under secretary Tommy G. Thompson.
He advised the National Government on issues
related to bioterrorism and public health
preparedness. His--had additional leadership
in advisory roles with other agencies including
the Center for Disease Control and Prevention,
the National Science Advisory Board on Biosecurity,
and the World Economic Forum Working Group
on Pandemics. Currently, he's a Regents professor
at the University of Minnesota. He's also
the McKnight Presidential Endowed Chair in
Public Health and he remains the Director
of the Center of Infectious Disease Research
and Policy. He's also a distinguished teaching
professor in the Division of En--Environmental
Health Sciences which is part of the School
of Public Health, a Professor in the Techno--
Technological Leadership Institute in the
College of Science and Engineering, and an
Adjunct Professor in the Medical School. He
he has reached a vast audience. Finally, he
does have ties to the College of Saint Benedict
and St. John's University as his daughter,
Dr. Erin Osterholm who is fortunate to be
with us today, um is a Bennie graduate. [Applause].
So it-- I'll like-- I would like to give us--
like us all to give Dr. Osterholm home a warm
CSBSJU welcome as he presents his talk entitled
Infectious Diseases of the 21st Century: A
New World Order. Thanks.
[Applause].
Dr. Michael Osterholm:
Thank you and good evening uh, President Hemesath,
other distinguished guests in the room, professors,
students, and most of all, Norman, Billy,
and your family. Um I've had the good fortune
to give lectures in many locations, under
many circumstances, and I can't think of any
that honor me more than to be here tonight
with you, Norm, and to celebrate this inaugural
address. Norm and I go back a long long time.
I never will forget the first time you called
me and asked me to come lecture here in my
busy schedule and I realized why you are,
who you are because no one could say no. [Laughter].
But more importantly, as was described earlier,
Norm is the consummate professor. You invented
the term “pay it forward” long before
anybody else ever thought it up. Your legacy
is in this room tonight and it'll be here
forever, long after you and I are gone. In
addition to the fact that he's not just a
great professor, Norm defines for me, in a
new way, the word; class. I once was told
that class can be defined by someone who,
because of their accomplishments, could go
to the head of the line, but they never fail
to always go to the end of the line. Norm,
you are class, and for me to be here tonight
is just such an honor. Thank you. It means
more to me than I can ever say. On top of
that—[Applause]. As someone once famous
said “at least you do for my brother you
do for me”. Erin, my daughter, not only
was a Bennie, but she actually was Norm’s
graduate assistant TA in his last year of
teaching. Norm wrote a letter of support for
her application to medical school that today
as a father still makes me cry. Norm, thank
you. It is an honor to be here with you tonight.
With that, let me begin and I will have a
slide here shortly. To share with you, at
the outset, the reason why you're here and
I don't mean for this talk. Why you're here
at this campus or should be at this campus.
It's because it's all about a liberal arts
education. Tonight, I'm going to talk about
why connecting the dots in a modern world
becomes more and more important every day.
I've been in this business for 40 years and
I can say with all honesty more has happened
in the last 5 to 7 years and happen in the
previous 33 to 35 years. The calculus of change
in this world is working against us to be
successful against many many issues. Not just
world politics or world economics, but also
public health and infectious diseases and
tonight that's my job is to share with you
that and why I am looking to you, many of
the students in this room, for the solutions.
Somebody in this room tonight could very well
be the person that provides the answers that
some of us old-timers haven't quite figured
out how to do yet. Last count I had about
55,000 slides in my repertoire of slides,
electronic slides. And… I have to tell you
if I had a slide fire tonight the one slide
I'd save is this one. This one tells me and
tells you about the world that we live in
today, probably better than the other slide.
While it's a bit old because it was published
in little over past 2000, if you look you
can see first… last hundred and fifty years,
it literally took us over a year to circumnavigate
the globe. Around the world with fast sailing
vessels and by the 1950’s with the advent
of jet engines we could do that a little over
a day. Well I can tell you that that flat
part of the line is actually maybe the most
dynamic part of the line tonight and I'll
show you why and what that's about. I think
about that last Tuesday afternoon I was in
a meeting in Seoul, Korea at 1 o'clock in
the afternoon and I was actually on a conference
call back here in Minneapolis at 5 o'clock
that afternoon. Think about how fast we now
travel and traverse the world. If you look
at world population, think about this. From
1850 when we were talking about 600,000 people
in the world and now we're talking about--600
million excuse me, now we're talking about
7.6 billion. And as some of you may know,
the U.N. just revised its estimates of the
world population increase to now 10.2 billion
people by 2050. We don't even need to wait
that long, a lot of every people has ever
lived as on the face of the earth right now
and guess where they're being born? They're
being born largely in the mega cities of the
developing world where if Charles Dickens
were alive today couldn't adequately describe
the lack of sanitation and the living conditions
that these people have to experience. If you
want to make infectious disease cauldrons,
you would invent the developing worlds of
the modern world and you'd create the cities
that are in those developing countries. That's
a big change. Now if you look at world population
in terms of life expectancy, we have really
had remarkable changes. Make no mistake about
that. In 1900, in Minnesota, the average life
expectancy was 48 years. It took us over eighty
thousand generations to get to that point
and since that time, literally, in places
like the United States, for every 3 days we've
lived in the last 110 years, we've gained
one day of life expectancy, that's amazing.
Now the rest of the world hasn't come along.
Now why is that? It has very little to do
with modern medicine. Modern medicines done
very little for that. It's about a guy named
Tesla, who all of you now think of the electric
car. Mr. Tesla actually gave us the alternating
current. He invented, in a sense, modern electricity.
With modern electricity, we could make water
pumps and create safe water supplies. With
water supplies, in pump water, we could create
sewer systems. With electricity, we can refrigerate
food. With electricity, we could make vaccines.
That's where all that changes come from…
and unfortunately some of us are very concerned,
we're about ready to tip that. That those
numbers are not going to continue to increase
and you'll see why in a minute. So don't think
that what we've experienced over the last
110 years necessarily dictates where we're
going, and I'll explain why tonight. And I’ll
let you be the judge. If you look at world
population, this is from a slide from our
World Economic Forum in Davos in February.
Where in fact, if you look at world population
increase the O.E.C.D.: the Organization Economic
Cooperation Development which is the United
States, the EU, Australia ,etc… the quote/unquote
developed countries. You can see world population
increase is really quite minimal. But if you
look at the BRIC countries: Brazil, Russia,
India, China, and South Africa, as well as
all the others. Look where the growth is at.
That's where the infrastructure is the least.
That's where we have major challenges and
I'll share that with you tonight why the diseases
that occur there are going to be very important
to you, here. Because you don't have to be
there to get those diseases anymore. And from
an infectious disease standpoint, if you get
nothing else out of this lecture just know
oceans, mountain ranges, canyons, and political
boundaries are irrelevant to microbes today
and that's one-- a very important point. This
is the world we live in today. Where the peri-urban
kind of slum is right there with the modern
world. Just in recent weeks, I've been involved
with several cases of high-level IT experts
from India on consultation basis here in the
United States who only found out after 4-6
weeks of coughing at their workplace that
they had multi drug-resistant T.B. and everyone
had been exposed to it. It's not just the
slums themselves, it's the spillover that's
occurring in the world. In 1968, when the
world decided that they would eradicate smallpox
from the world… of horrible disease. They
were able to do it for two reasons; one is
the disease lint itself that was only infection
in humans, we had a vaccine that would work.
But the second and most incredibly important
thing is the USSR and the United States of
America decided we will do it… and when
those two countries decided anything in the
60’s or the 70’s, it happened because
every domino behind it was a country and when--
as soon as one of the two superpowers pushed
a button, everybody fell in line. Today, nobody's
in charge. We don't have a world leader. We
don't have one. So we can't do the same things
we once did. How do you explain to people
in Pakistan trying to eliminate polio that
it’s good to go to work every day when 87
people have been assassinated in the last
2 years just trying to deliver polio vaccine
to the population? That would never have happened
30 years ago or 20 years ago or for that matter,
even 10 years ago. It is a new world order.
Today we have failed States, something we
wouldn't have ever thought of before. 34 countries
in this world today are considered in failed
state status. With the Ebola crisis we had
in West Africa, I ended up doing a number
of briefings on the hill, in Washington, for
Congress. Guess who wanted to hear about this?
Not the public health committees or the health
committees, it was the intelligence committees
and the military committees because they worried
that should Ebola move eastward across sub—across…
the central part of Africa, it would end up
in the countries where Boko Haram and Isis
is alive and well. Who would be in charge
then? Who would deal with that issue? How
would that further basically undermine the
status of the governments there? So today,
trying to deliver these services are very
difficult. How many of you are aware of the
fact that, as bad as the crisis is in Syria
right now… we have good data to show that
many more people have died from infectious
diseases than have died from the war itself?
Think about that. Lack of basic Public Health
vaccines, safe water and food, injury related
infections, you never hear about that part
but that's part of the real world. The World
Economic Forum, which is the International
Forum for Economic Issues, and as mentioned
in the introduction I shared the pandemic
preparedness Committee for that group, but
this report came out from another section
of the World Economic Forum this past year…
and it's a pretty important report. It interviewed
and followed up on it from the best minds
in the planning and preparedness world and
I don't have a pointer here but if you look
at the legend you can see on the bottom the
likelihood goes from lowest: left to right,
the impact goes from lowest: bottom to top.
The two red dots on the top are spread of
infectious diseases and water crisis’s.
That's their words, not us us public health
people, that is the world's experts in preparedness
said that's we have to be concerned about,
not all the other issues have come up. Last
February, James Clapper, the Director of National
Intelligence for the United States government,
issued his annual report, a report unlike
he had ever issued before. And I say that
because it was a whole section on the issue
of Infectious Diseases Continues to Threaten
Human Security Worldwide and they highlighted
this that this had the ability to undermine
whatever government's we had out there and
could create, literally, a colossal, global
calamity. Jim Kim, President of the World
Bank, gave a very important talk in January
of this year. In which, the headline says
it all the World is Dangerously Unprepared
for Future Pandemics. I've spent my whole
life trying to get ready for outbreaks or
large, global pandemics and I can tell you
we've never been less prepared… and I'll
give you the reasons why tonight and what
we have to do to turn that around. Why the
– yeah -- those students in this room, I'm
counting on you to help us get out of this
mess and frankly you don't have a choice because
you don't have a get out of jail card. We've
got to figure out how to deal with this. Bill
Gates, someone would say, knows a lot about
a lot of things. I personally appreciate what
he did at Microsoft, but I can tell you the
Bill and Melinda Gates Foundation has been
the bedrock of Public Health support and preparedness
for the last decade. But, for Bill Gates,
I don't know what we'd be doing right now
for support for Public Health around the world,
amazing. He wrote in the New England Journal
of Medicine, this past March, that in fact,
the thing that had the greatest likelihood
of disrupting the entire world order as we
knew it was an infectious disease pandemic,
not new martyr killer war. Think of that,
a pandemic, and he went through all the reasons
why. I think he's right. Now I'd like to share
with you why some of this is the case. And
what I'm going to do here… if I can successful
here… old men need the glasses… See if
our guy appears… I'm trying to get down
here… Well I may not be able to do this.
What I needed to try to do here was get the
pointer to take me down to the bottom there.
Is our baby guy still here? Okay, he's not.
Well I'm going to have to try to get us back
in here then. What? This isn't working. What?
Thank you. [Laughter]. This will give you
a sense. This was data from basically uh…
2014, but these are air flights every day
that are occurring around the world. This
is actually one 24-hour period. Every one
of those is an airplane full of people and
an underbody that may be full of mosquitoes
or any number of different things. Now watch
what happens globally as you follow a time.
They just keep coming and coming and coming
and coming and coming. You want to know if
we're mixing up germs around the world? Either
in people or animals or in cargo holds. It
is now around the world. That's the modern
world we live in today. Remember a hundred
years ago this didn't exist, for all of time.
So this gives you a sense, basically, of what
we're talking about today, just with airplane
travel. Who said you can't teach an old dog
new tricks? This is a slide taken from yesterday,
every hour on the hour, all the major shipping
vessels in the world report their location,
the weather conditions, we follow this every
hour, and you can see 62,000 different ships
up here, all big cargo ships. This is the
warehouse of the world, any of you are business
majors in here, do not ever suggest the word;
warehouse. That's enough to make you go to
confession daily. Because it's a just-in-time
delivery world. Things that we need right
now are on a ship somewhere sailing from China
to the United States, that we hope they get
here in time for tomorrow's need. All these
ships run [inaudible] or Liberian or Panamanian
flagship, nobody's really in charge. Anything
it would disrupt this, would be amazing. We
just did a study several years ago in which
we surveyed a group of Pharm D’s, doctorates
and pharmacy, they spanned all the areas of
Medicine, we said “What are those life-saving
drugs you have to have every day or people
die? Not not cancer drugs, not a lot of those
lifestyle drugs. What do you need that's on
the crash cart in the emergency room?” We
found 31 different drugs that we absolutely
have to have every day or people die right
now now, not tomorrow, not next week, now.
Of those 31 drugs, all of them were generic.
All them were made offshore. All of them are
just in time delivering, there's no stockpiles
anywhere. That's how vulnerable the world
is right now. So that's what we have to deal
with in terms of understanding the global
context of infectious disease in the modern
world. If you look at travelers, right now
uh, tourism is obviously a booming business.
Over 1.1 billion people tra—crossed the
international border last year just for purposes
of tourism. Next time you take that trip to
the Caribbean, bottle this talk later, and
I want to ask you about your mosquito exposure
and what that means to you, or what it might
mean to you. I don't want to dismiss a number
of important things like antibiotic resistance
and the availability of antibiotics. Just
think of this, every time a child is born,
we assume it takes from about 20 years to
hit a next generation level. It takes an E.coli
20 minutes. And now we're watching rape as
a weapon of war in Africa, be used repeatedly
and beginning to continue to alter the HIV
related transmission issues. These are not
done. The issues of even what to do in terms
of disease like polio, we're trying to eradicate
it from the world, we keep finding hotspots
where the virus finds those hotspots before
we do. In the Ukraine, right now, we're very
concerned about a major polio outbreak in
the Ukraine because less than 25 percent of
the population is vaccinated for polio given
all that's going on there and we now just
have cases introduced. Look at the issues
of something like measles, a disease that
we don't even really worry about in this country
because we've done such a good job of vaccinating
our kids. Yet, in the Congo, we're talking
about an outbreak there. Just in the last
several weeks, has killed 400 individuals.
Remember those people travel to somewhere
and maybe not to the United States, but they
travel to somewhere with somebody who is going
to travel the United States comes. And I can
guarantee you, if we don't keep our immunization
rates up we're going to find more and more
of these illness problems, like this. Then
we even have the issue with the refugees and
what's happening with worldwide migration.
Right now, what's happening in the Middle
East and Syria is a travesty of humankind.
But one of the issues I mentioned before,
the number of deaths from infectious diseases
as opposed to even just those related to war.
The risk of infection continues to increase
and we even see the fear that goes with that.
Which in some cases, is totally unjustified.
The--yes they're at risk for themselves but
not to others and already our dear colleagues
in Norway, who are well known for being some
of the most altruistic and socially conscious
people in the world, are seeing big increases
in public fear about taking refugees in. What
is that going to mean? Today, we also worry
about the issue of another disease called
monkey pox. Monkey pox is a virus very similar
to that which calls smallpox, but in this
case transmitted from some human primates
to humans, not from human to human. We never
used to see monkey pox problems in Africa.
Why? Because everybody was getting vaccinated
or they'd had smallpox and either one protected
you against monkey pox, but we have been vaccinating
for 30-some years in Africa. We've now created
a whole cohort of people who have been born
who have no immunity to either smallpox or
monkey pox. Now, monkey pox isn't at all like
his sister smallpox. Instead of killing 35
percent of the people who get it only kills
20 percent… still pretty good. We're worried
today, we have no plan in place whatsoever
for what to do about monkey pox. We never
thought we'd have to be vaccinating again.
We never thought about that. We thought “we're
done.” Then that brings me to smallpox and
I just want to mention this, this is an issue
that has been front and center for me. Probably
the most poignant moment in my public health
career that I will still never forget and
it haunts me to this day. I had the good fortune
of serving as a personal adviser to His Majesty
King Hussein of Jordan for a number of years
on the issues of bioterrorism before he died.
In January of 1999, I was still at the State
Health Department, I got a call from the Jordanian
embassy saying “his Majesty wanted to see
me right away. (which usually meant sometime
in the next few weeks we’d set something
up) No. Right away.” To make a long story
short, I was on a plane to London, where he
was at his estate Ascot outside of London,
within four hours and the same clothes I went
to work in. I landed at Heathrow early that
next morning, overnight flight. I was picked
up by the security detail, taken to the main
house (usually if I would come I would stay
at one of the outhouse areas, beautiful Lodge
areas, sleep for the day etc.) I went right
into his house (I hadn't showered since I
went to work, I'm still in the same clothes).
He comes down in his robe along with the head
of GID, the Jordanian CIA, and pumped me for
four and a half hours about smallpox. I knew
he knew something. Everyone knew King Hussein
was at the centerpiece of every major intelligence
information, good guys or bad guys. Ten weeks
later, he wrote a very famous letter that
dismissed his brother is the region or heir
apparent and appointed his son Prince Abdalla
to be the new King, which unfortunately, came
true just four weeks later when he died suddenly.
And-- but what was more telling, was most
the letter was about a man saying that the
thing he worried the most was not about war,
he worried about terrorism because of what
that would do to ripple effect through the
population. The thing he worried about most,
was smallpox and he wrote it all in this letter.
To this day, the intelligence communities
don't know what he knew. But I had no doubt
at that time that smallpox was not just securely
in two labs at the Centers for Disease Control
and Prevention and at the Russian research
station at Novaya, Siberia. I just still don't
believe it's true. But we don't even need
to worry about that anymore because here's
a disease, while even though it was only here
in part of the 20th century and only part
of the world, it killed 200 million people.
But smallpox is something you can't ever forget.
Day 3 and a young child, day 5, days 9, day
13 and knowing that up to 30 percent of these
people will die. A large number will be left
blind and other health problems, not a good
disease. There's a young girl from Pakistan
who had hemorrhagic smallpox which is very
common in pregnant women uh and select individuals
where you can see the bleeding in her eyes
and mouth. These people typically die within
about 24 hours, almost 100 percent case fatality
rate, not a good disease. Well why do I tell
you this? Because you know what? Even if somebody
doesn't have it out there, even if a terrorist
is not going to use it. Back in the 1980’s,
we had made a decision in this country “we
maybe we should destroy the smallpox virus
as we had left”. But there was a big debate,
well we should keep them because we may need
to do research on them. No, we should destroy
them, but everybody agreed we'd publish the
sequences. So back then, before we could sequence
agents like we can today, major projects were
undertaken to sequence orthodox viruses i.e.
smallpox. Well this is like sequencing the
Grand Canyon. These are huge huge viruses
and nobody ever thought second of it, of publishing
all the data. So you can go, right now online,
and find the entire genetic sequence for several
small pox strains. Well you know what? Technology
changed. Just like back in 1980, I still got
in a hard line phone, asked an operator to
connect me to a certain long-distance number
and that was it. Today, my iPhone does FaceTime
with me when I'm in Korea with my grandkids…
very different. Well guess what happened?
We now got good at taking these genetic sequences
and making real bugs. In 1990—or in 2001,
research group at Stony Brook in New York,
reconstructed a polio virus de novo from just
taking the published sequences, buying amino
acids, now putting them together like tinker
toys, and they made a virus that was lethal.
Well we never thought we could make smallpox
virus because it was a 1,600 story genetic
building. Which is too big, nobody could make
a 1,600 story genetically, just as this article
says we can today. I have no doubt it's going
to be just a matter of time before somebody
makes smallpox virus. I don't even know think
it's necessary for nefarious purposes, but
if it gets out, we're screwed. That's part
of the modern world we live in that I would
never have imagined myself 15 or 20 years
ago. Influenza remains, also a lion king of
infectious diseases. Again, for those and
and Norm this is your bird centric world.
Where in fact [laughter]. influenza viruses
took up residence the wild aquatic birds many
millions of years ago. Many millions years
before chickens even showed up. They virtually
live in the gut of the bird. They don't have
very good receptor sites for getting into
lungs, whether bird lungs or even human lungs,
particularly. But guess what? Over time, those
viruses do fly out of there and they do get
into poultry and they can cause severe disease.
They still have a hard time getting to people
but they can because again, the receptor sites,
the lock and key, just doesn't work very well.
But pig has become the universal recipient
and donor. Pig lung cells actually have receptor
sites for bird viruses and human flu viruses.
And when the viruses get together in the same
pig cell just by accident they're the most
promiscuous virus you could ever imagine.
They swap out gene material left and right
and they create new strains that are now human
adapted but have a lot of the bird characteristics.
That's when we get pandemics. That's when
suddenly influenza wipes through like it did
in 1918, killing 50 million people in this
world. Well we did worry in 2004, when H5N1,
a type of influenza virus showed up a lot
in birds and Asia, caused us some real concerns.
Well it kind of-- you can see from the data
on the left there we had cases in humans but
we never saw sustained human to human transmission
and I don't think anybody haven't heard about
this in the media. Look what's happened in
Egypt over the last year, it's exploded and
we can't explain why. It could be more exposure
but as the virus changed and what we're worried
about is over time this virus is like it's
like a drip phenomenon boop, boop, boop, and
pretty soon, there's enough water in that
barrel to put out a fire or to drown someone.
And what we're worried about is we are seeing
these changes now with H5N1 after having everybody
get upset in 2004 and then by 2013 they said
“oh don't bother me with that again”.
Is Egypt a harbinger of things to come? Well
I don't know, but this is the one that even
scares me more. H7N9, another type of flu
virus out of birds that we had never even
thought of as being a potential risk factor
for humans, and it turned out that in 2013,
suddenly started seeing these cases. By the
way, a third of the people who get this died.
And it was not very good person-to-person
transmission, was coming out of somewhere
though and we turned out that with high path
flu viruses, like H5N1, they do kill domestic
poultry. Where there's smoke, there's fire.
You know you got a problem if your birds start
dying. These birds were all fine. We went
in and sampled these birds and guess what?
They were loaded with H7N9 and they weren't
sick at all, not even a slight fever. We did
the studies as part of our Center at Minnesota
in which we actually took the viruses from
China and put him into quail, chickens, turkeys,
etc. And guess what we found? Instead of mostly
pooping it out the south end, which is what
birds do with flu viruses. They were blowing
it out the north end and they weren't getting
sick and initially the Chinese went in and
tried to basically take out these flocks but
there was such an uprising by the population
of killing healthy birds, that they stopped
doing it. Right now, there's no control rods
in the reaction in China. What's this going
to do over time? I don't know. The case fatality
rate remains at 30-some percent. Is this going
to be the next flu virus? I don't know. It
could be. It's primarily located in eastern
China. Get a sense of this, the average time
period from a chicken being hatched until
that chicken breast is on your plate is about
35 days, 35 days. It's the fastest any-- anything
we have in the food supply for converting
energy to protein. In the peri-urban region
of Shanghai alone, just one town, one city
in China, 100 million chickens are born every
month, just to feed Shanghai for that month.
Every one of those is a virus vessel. Every
one of those is another test tube. That's
just one city in China. The WHO put out a
rather strong statement in February this year,
basically saying “warning signals from the
volatile world of influenza virus is the current
global influenza situation characterized by
a number of trends that must be closely monitor
these include an increase on and on and on…”
The summary statement here “the diversity
and geographic distribution influenza virus
is currently circulated in wild and domestic
birds run president since the advent of modern
tools for virus detection characterization.
The world needs to be concerned.” Well we've
been following it since 1940’s, with virus
detection, but even if you go back to chicken
flock health studies dating back into the
turn of the century, nobody's ever seen this
before. Something is happening in nature and
it's-- I don't know what's going to keep these
viruses from spilling out and causing a pandemic.
Look no further than what happened right here,
don't go very far from here. This past summer,
we in the U.S. were kind of smug about our
quote-unquote poultry production capability
and our biosecurity to keep viruses out. And
I say this with kindness because I--it's not
that anybody isn’t doing anything wrong
if we didn't know better. But it's kind of
like the people that buy a submarine put a
screen door on it and never taken it underwater
for 10 years and tell everybody how well the
screen door works and the first time they
take it under, didn't work so well. Well suddenly,
with the high path virus, we had 223 different
outbreaks of H5N2, in poultry, in Minnesota,
Iowa, and to a couple of joining states and
small numbers. Almost 50 million birds died
or were put down. This is unprecedented .This
is incredible. We've never had that happen
before. We had one small outbreak of a high
path flu virus an American poultry back in
1983 and six farms in Pennsylvania, all next
to each other, and we put it down. We don't
know if this is going to come back or not.
It could. Again, we're in total uncharted
territories. What was really interesting is
we had this mindset, this is this closed mindset
that we own today. This is where our liberal
arts students challenge us on everything.
We thought “well this has to be kind of
a farm gets infected I feel like a concentric
circle exposure like a bomb, so you know you're
this far out this far out” Well we now know
that's not the case. We actually did virus
sampling outside of these barns and we look
at the spread. And guess what? It was a wind
rose, meaning it was a long plume. You could
have been one mile on either side of that
farm but if you weren't in the wind plume,
you were fine. But, if you were 20 miles downwind
you might have got hit. Totally rewriting
the world of flu viruses. So suddenly, what
do we do to create poultry production in this
country? We concentrated them in places like
Kandiyohi County because the ease of production,
delivering, supplies, harvesting. You know
where we put our pig operations? In the same
counties. Talk about a mixing vessel, and
remember pigs don't get sick with this virus,
so we don't really know what's happened with
virus infection in pigs. Again, if I had told
you this story last winter, any of you would
have looked at me and said “you know what's
he been drinking?” and now it's right before
us. Back in the old days, you'd have to worry
about vectors i.e. mosquitoes or anything
else surviving an airplane flight, so you
actually didn't always know you were going
to survive. [laughter]. You know DDT between
the DDT and the smoke you could cover everything.
[laughter]. That's-- times have changed. Today,
Aedes albopictus, which is the worst of the
worst of the worst of the worst mosquitoes.
And I say that because they're mosquitoes--
basically are a nuisance until they can carry
a disease and only a very limited number mesquite
species carry diseases. The ones that carry
diseases are the ones that, to get infected
themselves, so when that guy takes a blood
meal there-- woman actually, only female mosquitoes
feed, that's a whole other story. Basically,
what's happening, is they take blood up into
their proboscis. They then take the virus
from or whatever else is in that blood and
if they are susceptible to that virus or that
parasite they then become infected and it
goes basically into their salivary glands.
So the next thing, they take a blood meal,
they don't die from the infection. When they
inject that saliva down that proboscis to
keep the blood flowing and anticoagulant,
that's how you get your mosquito bite, you're
reacting to that material but that's where
the virus or the parasite is. That causes
you to get infected. Well thank God most mosquitoes
don't carry any diseases at all. Aedes albopictus
is the universal donor. It can get infected
by darn near everything. Look what happened.
The green areas of the world where aedes albopictus
was historically found, through the 1980’s.
And then we had a major run on used tires
for large vehicles because of the world economics
around tire and rubber production. And suddenly,
we started shipping tires from Asia, Southeast
Asia in particular, that inside of were all
these aedes albopictus eggs and they landed
in ports all around the world and look what
happened overnight. Aedes albopictus spread
around the world including right here in Minnesota
and it does fine thank you. So we've suddenly
created-- we put this huge howitzer right
in the public square and just said-- dared
anybody, just you know put a bullet in, go
ahead. So we already had the underpinnings
of a potential for a problem before any viruses
or bacteria or parasite first showed up. Aedes
aegypti, again another famous mosquito, the
reason why it took so long to finish the Panama
Canal because in fact it kept causing to all
the people to die from yellow fever, work
there. This slide is one we're actually working
on right now, but in the 1930’s, this is
where aedes--aedes aegypti was found in the
Americas. By the 1970’s, when I got an infectious
disease and everybody said “why are you
getting into horse and buggy making?” You
know, it's old, it's done, it's over with.
They had every reason to say that, not only
was it only in lesser areas of the Americas
but in much lower numbers. This is 2000 and
we're now in the process of making the 2015
slide and I can tell you it is spread even
much more through the Americas and the numbers
of populations have gone dramatically higher.
1930, 2015, you tell me, which will be better
prepared to deal with mosquitoes with? So
again, this isn't just just trying to tell
you that things are worse because I want you
to be worse. We have the data to show we are
living in a very different world order today.
This slide, which was meant not to be read
because it's meant to scramble your brain
to think about something, and that is; chikungunya.
And you say “what the heck is that?” It's
a mosquito-borne virus that basically, like
another disease called dengue fever, causes
people to really get kind of sick, but not
that many people die. Fortunately, probably
1, 2, or 3 percent at most. But we're now
realizing that 40 to 50 percent of people
that get chikungunya, actually end up having
some very serious neurologic and muscular
skeletal issues for months and months and
months. Up to 40 percent or more. Well guess
what? In December of 2013, somebody brought
chikungunya infected mosquitoes to St. Martin
in the Caribbean. Since then, all these millions
of cases have occurred. We now know it's millions
and millions and this is what's happened.
It has spread not only through the entire
Caribbean, it's into all the Americas, and
even in the United States we now have indigenous
transmission in Florida including pretty widespread
transmission in Dade County and the keys.
38 states have reported people with chikungunya.
Most of them traveling to the Caribbean for
vacation. So when you think about your vacation
spot this winter, I always thought the cold
of St. Cloud and St. John's was not so bad.
[laughter]. This is-- this river, this hadn't
existed in the end of 2013 early in 2014 and
look where it's at today. Millions of cases
have occurred. Other new scans, you can see
here, this is from our CIDRAP website where
we have in very active new site. Bajo today
just announced 12,000 new chikungunya cases
and in studies being done looking at actual
cases versus reported. We think the underreporting
is about somewhere in the neighborhood of
50 to 80 fold of the actual cases. So when
we report a million cases, you can read and
assume that's 50 to 80 million of these cases.
That's pretty significant. This is a paper
that I published in Lancet uh Major Medical
Journal a few years ago, 2011. It's the worst
paper I've ever published in my life for a
heartache. We had been very involved the 2009
influenza pandemic at our group. And we took
onto a study to look at just how well the
flu vaccines work after that and we thought
it would take us a couple of months and how
prepared we’ll be for the future. Well the
more we peeled back the onion, the more we
peeled back the onion, and the more we found
wasn't the case. In this paper, we found that
we had been grossly overselling how well flu
vaccines work in the public and that at best
59 percent was the average, particularly for
younger people, and that we had a real absence
of data for older people and yet we've been
pushing this. Last year, this was really brought
home. Where in fact, originally it was 23
percent. In the end, and the bottom slide
you can see here, overall flu vaccine was
just 19 percent effective. No evidence of
protection of those over 65 and yet I bet
most of you didn't know that. Now we hope
we're going to do better this year because
we've actually put two strain changes in but
it's still not going to be optimal. Well what's
going on here? We need flu vaccines seasonally,
but more importantly eat them for pandemics.
We looked at the issue of the pandemic in
2009 that we had which was a quite mild one
by all standards and if you look here what
you see that blue line actually is the number
of percent of visits for influenza like illness
on this right bar. Basically, really detailing
the second wave of the 2009 pandemic which
really peaked in mid to late October. Vaccine
didn't arrive until October. Most of didn't
get here until November, December and if you
look at the numbers we're still talking about
16-80 million doses. But most of these doses
went in kids, which was a two dose regimen.
So there you have to cut it in half of people
that really had vaccinated. The whole world
experienced this. Most world had no vaccine
at all. Even the new modern cell culture vaccines
used in the old technology of the 1940’s,
which is what the current flu vaccine is,
didn't get out any sooner than the egg-based
cultures. We got problems. We went back and
looked at ‘68 and ’57, the two previous
pandemics. Each time the vaccine arrived too
little, too late. Well we then did this quite
exhaustive study starting in 2009 called the
CIDRAP Comprehensive Influenza Vaccine Initiative
Study: The Compelling Need for Game-Changing
Influenza Vaccines and, you may not be able
to see all this, but each of these chapters
reflects a very different part of the flu
vaccine world. We went through over 15,000
papers. We even had the old department of
war studies brought out of the archives to
look at the original flu vaccine licensure
studies of the 1940’s and to understand
what they did. We interviewed over 120 world
experts in all aspects of vaccine, some of
them many times. Finance, business if you
look in chapters… down here at 12, 10, 11,
12 we looked at the entire business model.
And guess what? We've been telling people
for so long this vaccine is so good… the
vaccine industry said “well why are we going
to invest any money in a new vaccine? You've
been telling me it's really good.” We were
shooting ourselves in the foot. Paper after
paper has come out recently showing new potential
vaccines that are very different than the
ones we have today. Very different but could
work very differently and much more protective.
Idea of a universal flu vaccine, which I'm
not sure it can ever be universal, but when
you sure get one that could work a lot longer,
a lot better. What's the problem? This is
a figure from our report. This thing called
the valley of death. What happens when you
start working in discovery in phase 1, phase
2, phase 3, we invest all this money in this,
when I say all its you know 20 million 50
million here but not big money relative to
what vaccines are going to take, and then
we suddenly get it and it stalls out when
it gets to phase 3 which is actually putting
it into people and doing a big study. We estimate
today it'll probably cost us a billion dollars
to bring one flu vaccine through and nobody
in the private sector has an appetite for
that. They'd have to charge $120 a dose for
flu vaccine, even think about recouping any
other investment. How is that going to compete
against the ones we have now? Because public
health has not been clear and compelling its
message we knew-- need new and better flu
vaccines and they should be government supported.
In other words, we're not going to get them.
So we can sit here and argue about this but
one day we're going to wake up with a flu
pandemic on our hands and saying “why in
the hell didn't we do better?” Even recently,
BARDA, the organization and U.S. government
is supposed to be funding these kinds of things,
basically said “we can't fund what's out
there right now.” and they blamed it basically
on the inadequacy of the vaccines candidates
which really was-- the truth of this matter
was you can't go in and buy a new Lexus for
10 cents and they just didn't have the resources
to do what it's going to take. So meanwhile
you and I are all sitting here. My kids, my
grandkids are sitting potentially on top of
a future flu pandemic with the vaccine that's
grossly inadequate and a vaccine it'll be
way too little, too late and we know it now.
We don't have to wait for the hurricane to
hit shore to know what's going to happen.
It's all about public policy and leadership.
We waste a billion dollars every day in our
government. Wouldn't it be great if we had
something that actually protected us and worked?
Ebola, let me just briefly say this is another
example the same thing. I mean all of you
are probably Ebola’d out by now but the
bottom line is this outbreak started in Africa…
in the Western countries of Africa a little
over two years ago and basically rewrote the
history of Ebola. We've had more cases, 20-some
thousand cases, 11,000 deaths, more than all
the cases combined in the previous 40 years,
2,400 cases, about 600 deaths. Well, what
happened? This is a piece that I wrote in
the Washington Post a year ago, last July,
not not last July but the month before anybody
even cared about Ebola in this country when
the first American physicians came home with
Ebola from Africa. And it was my attempt to
get the world to wake up and said in this
article I said “you know what? Wake up guys
this has the risk of destabilize the entire
Western African area.” and people yawned.
But the one thing I made clear was there was
no evidence this virus had changed, Africa
had changed. Africa is no longer a continent
of rural villages. Kinshasa Zaya-- Kinshasa
Congo today, a country in a city with 11 million
people living in one concentrated area, 4
million living in the worst slums you could
imagine. May well be Kenya. I've been in Kabara,
the slum of Nairobi where it took me days
to get the odor out of my nose. A million
people living in the most squalor conditions.
This is going to happen again. If this virus
gets into those settings from rural Africa,
there's nothing's going to stop it again.
We're going to have a Deja vu all over again
and we've had great success in West Africa
at a great cost but it's not over. We are
cau--cautiously optimistic, we've done a successful
job of getting the cases to stay low. We keep--
one week we report Ebola free, Sierra Leone
has some cases the next week. This recent
article from this week here. Now we have some
cases in Guinea. Brand-new surprises, we had
no idea when you recover from the Ebola virus
infection you may have the virus and your
seminal fluid for six months or more. So if
you go back home and start having sex again,
you're going to more Ebola cases. We never
knew that. We didn't know that it's in your
eyeballs. Seen your ocular fluid. If you have
anybody look at your eyes because a serious
eye problems if we see a lot of with Ebola.
Doctors and nurses are at risk by touching
your eyes, even though you've been recovered
for months. So we're rewriting the book but
there's optimism. But what did we really learn?
Well we learned at one time, basically, we
could respond but it took us months and months
to do. We now know is that we really haven't
learned the lessons because nothing is in
place after Ebola. WHO hasn't changed. There's
nothing in the works right now to really change
WHO at all. We did find a vaccine was effective
using this unique ring vaccination approach
where we vaccinated around cases and looked
at whether or not people got infected or not.
This is a vaccine, it needs to be kept at
minus 60 degrees in Africa, that's not easy
to do. It's a vaccine that we don't really
understand how reactionary it is in terms
of people who have HIV infection. We need
more vaccines. Our group at CIDRAP, the Center
for Infectious Disease Research and Policy,
along with the Welcome Trust, the largest
foundation in the world supporting infectious
diseases (slightly larger than the Gates).
Jeremy Farah, the Director that I chair this
group of 28 international experts that have
been staying on top of this vaccine. Because
guess what? It's the yawn factor again. Once
it went away, everybody's walking away. At
least three companies have put over 250 million
dollars into research for Ebola vaccines,
they're all going to lose it. The same thing
happened with SARS in 2004. Are they ever
going to come back to the table again? Not
likely. We've shot ourselves in the foot and
we may not in the end get even a licensed
Ebola vaccine out of this situation. We hope
you'll get at least one, but we don't know
what's going to happen. We've got to change
that. Again, thinking for the future, I don't
want to see Kinshasa go up in Ebola flames
one day. A vaccine would sure help. Which
gives me to my last topic here just talking
about the issue of another mediate and urgent
health crisis. SARS came upon us back in 2003-4.
It was a severe acute respiratory distress
syndrome disease. It started in the Guangdong
Province of China. We realized this virus
called the corona virus was actually in badger
dogs and civet cats in the market, both rodents,
not dogs and cats actually. They were a food
supply. Once we recognized they were the source,
they were exterminated from the food source,
food chain, all the human cases. New ones
from that source stopped. We basically shut
the faucet off but we had to just lap up then
the human to human transmission. This is what
happened. We took this around the world was
a physician in the red box up there from the
Guangdong province stayed in room 911 at the
Metropolitan in Hong Kong. All those people
in that yellow box stayed at the Metropolitan
too. None of them had face-to-face contact
with him, was either in the elevator or living
on the same floor and then it spread around
the world. 9,000 cases, thousands of deaths,
literally shut down Toronto General Hospital,
it was a disaster. One of things we learned
is some people don't spread the virus at all
but a couple of people become super spreaders
where they shut it very effectively. Well
then along comes… this situation. A pathologist
in Saudi Arabia two years ago recognized a
very serious illness, looked like SARS, did
the testing on it, turned out to be a new
corona virus we now call MERS: Middle Eastern
Respiratory Syndrome virus. Same kind of family
of viruses, corona virus. Well since that
time, we have seen this epidemic activity
going on in Saudi Arabia. Initially, it's
seasoned around the early spring when camels
were birthing their camels, young camels there.
But more recently it's been constant and the
red boxes actually reflect an outbreak in
South Korea. It's all about the camels. We
now realize that dromedary camels in the Middle
East are likely source. And that, in fact,
what we see happening here is these animals
were previously infected with corona viruses
but not what was called MERS. Something happened
about three years ago. Genetically, those
virus changed and suddenly started transmitting
to people causing severe illness. If you look
at the whole schematic of how it happens,
we believe bats are the ultimate source of
this but it got into the camels then got into
the people and either spread in the community--we're
more likely a spread in the hospital setting.
Where a super spreader might come in and actually
be located. Well dromedary camels are kind
of important. Liberal arts educated people
should know that. There are… approximately
12 million dromedary camels in the world.
Of those, only 1.5 billion live on the Arabian
peninsula. 10.5 million live in East Africa,
North Africa. The country with the largest
population of dromedary camels in the world
is Somalia. Well it turns out, so far that
virus hasn't crossed the Red Sea, but it's
just a matter of time. And what this has been
doing to the Arabian Peninsula, particularly
KSA: the Kingdom of Saudi Arabia, will dwarf
be dwarfed by whatever might happen in Africa
because there's no resources to respond in
Africa. This is just a function of time. But
more specifically, we've had these continued
outbreaks and hospitals in KSA. Three outbreaks
going on right now, a large one in Riyadh.
The Saudis have responded very poorly. They
have not followed the direction that Public
Health Officials either from the WHO or elsewhere
have given them. I have been in the Middle
East. I've worked up outbreaks and Abu Dhabi
in the United Arab Emirates. They're doing
more about it but it's very frustrating. So
this source continues and one of the issues
about this is the camels. It turns out that
camels in the Middle East are more sacred
than the service dogs could ever be in our
country. Why? Because for 4000 years that's
how they survive, with their camels. Camel
milk in the desert. The camel meat that they
did sacrifice from some camels. The beasts
of burden, even the shade protection in the
desert. So if you go and tell one of them
their camels killing people, you might as
well say something about my sister. [laughter].
Because that's how its interpreted and we're
having major social cultural challenges there.
If you look at this issue, we keep having
these outbreaks and hospitals, the virus is
coming from the camels. It's not stopping.
It's in people and then these super spreaders
come along. We have new clusters of cases
as the Hajj disk was completed yesterday.
We run bated breath with an incubation period
of 7 to 10 days to see if any of these people
take it back to the countries they came from.
Over two million people arrived in Saudi Arabia
from around the world. If you look here again,
more problems with the Hajj. We don't know
what's going to happen here but we're very
concerned. Recently, the data shows that this
virus may be changing and becoming even more
amenable to human to human transmission. We
think that's surely what happened in part
in South Korea. What happened though is a
reflection of this, people who become infected
in the Arabian Peninsula and then fly elsewhere.
Either knowing they're infected in seeking
medical care elsewhere or not knowing like
two physicians who were treating patients
in Saudi Arabia when they came back to the
U.S., had no idea they were infected, and
in both instances neither hospital did any
kind of major infection control for the first
24 hours. The only thing was, thank God they
were not super spreaders. To give you an idea
what a super spreader can do. One of the outbreaks,
I worked up at a hospital in Abu Dhabi was
one where in fact, 7 different patients came
into that hospital over a period of a year
with MERS, didn't transmit to anybody. They
felt very comfortable what they were doing.
The 8th patient came in, transmitted to 28
health care workers, 2 of them died. Again,
the super spreader versus the none super spreader.
Well to give you an idea why that's important,
this was a paper published in the MMWR, the
CDC weekly publication, after the 2 cases
in the U.S., detailing the fact that every
month about 70,000 people fly directly from
the Arabian Peninsula to the North America,
either Canada to the United States and others
take indirect flights through Amsterdam or
London. Every month these people are dropping
in on us. Every month there's a risk there,
but I even worried even more today. 75 percent
of all the health care in Saudi Arabia is
provided by Indian or Filipino health care
workers and every day there's a 747 that leaves
Riyadh to Manila or Mumbai. One day they're
going to take back one of these infected health
care workers and there. So what happens when
this occurs? This. This is an outbreak that
I've been very involved with in South Korea
at Samsung Medical Center. One of the most
modern 2,300 bed hospitals in the world, not
some developing world hospital. They would
rival whatever we see at the Mayo Clinic.
Somebody came in with MERS, ended up having
an outbreak where they found infection control
lapses, this person had been in the Middle
East. No one recognized him with having MERS,
but the infection control lapses they saw
were no different we see in every hospital
around the country. Do you have any idea what
happened here? Patient 1 came into Korea from
the Arabian Peninsula, infected patient 14,
who infected 80 people in the emergency room
of the Samsung medical center and has spread
from there. They shut down this modern, 2300
bed hospital, for seven weeks. This new season
could be St. Mary's, University of Minnesota
hospitals, or Mount Sinai. You see a Medical
Center, could be any of them. We're not ready
at all. Here the President replaced the Health
Minister, just give you an idea the impact
that this has in a country. South Korean hospitals
in the center of this, I've actually been,
that's where I was last week was at Samsung
Medical Center again, and again I can tell
you over and over again my worst nightmares
it's just as it could happen in St. Cloud
or Minneapolis or St.-- Rochester. It's just
a matter of bad luck of getting the wrong
patient to fly in and present with respiratory
illness and we're not ready. What do we need?
We need a vaccine for camels. We've been working
hard to get that. Guess what? Nobody wants
to fund it. Pennywise and pound-foolish. Could
this happen anywhere? Absolutely it could.
That's the modern world of infectious diseases.
Mark my word, it's going to. So let me just
conclude by saying, one of our very famous
American authors Lewis Carroll said it so
well once “if you don't know where you're
going any road will get you there” I feel
desperately that's what we're at today. I
challenge the students in this room… to
challenge us who are in positions of supposed
authority and responsibility. What in the
hell are we actually doing? How are we going
to make this world so that when you grow up
in 2050, you're not dying more frequently
from antibiotic infections than you are from
cancer and right now we have no roadmap. My
most famous philosopher of all time however,
Mr. Ebenezer Scrooge once said “are these
the shadows of things will be the shadows
of things that may be only” and I can tell
you I need no… convincing of why I do my
job today. I think I'd do it if I didn't get
paid. It's not about anymore honors or publications.
It's because of that lady sitting right here
in this room and my three grandchildren and
my other son, that's why I do it and for all
of you and all of us in this room. We're older
ought to be asking ourselves the same question
“what legacy are we leaving our kids?”
I can't think of a worse one right now than
the infectious disease legacy. And if Norm
Ford taught us anything, he taught us about
the issue of being educated and acting on
that education and that's why I'm so honored
to be here in front of you tonight, Norm.
Trying to do my best. Thank you very much.
[Applause]. I think they like you Norm. [Laughter].
Barbara May:
At this point we’ll take a few questions
if there are any. If you can’t speak as
loud as I am, I do have a microphone. That
I can pass around.
Dr. Michael Osterholm:
And I'm the other Mike. [laughter]. Yes?
Audience Member:
[Inaudible].
Dr. Michael Osterholm:
Yes... well let's put it this-- thank you.
If all of you didn't hear it, it’s about
the viruses that are coming out of the permafrost.
Well first of all, what they're coming out
of is bodies that were basically long-term
secured bodies in the permafrost and yes we
are concerned about that. We we can't say
that it's a big issue. Um surely smallpox,
other viruses could be there that could still
be alive. Flu viruses. We have had some experience
with basically looking at bodies out of permafrost
for flu viruses and we couldn't ever find
whole viruses but it's a problem. But what
you probably didn't hear this week, in terms
of infectious diseases ,is one that has me
just as long with the number of my colleagues
chilled and that is Mars. We have no idea--
we now have confirmed that there's water on
Mars and we have no clue what an extraterrestrial
microbe might look like or what it might do
in a different world order. And originally
one of my mentors, Josh Lederberg Nobel Prize
laureate, got involved with the whole issue
of biosecurity infectious diseases because
of the original space flights. I can't tell
you that it's going to be a problem. I would
not want to find that there's a microbe on
Mars we bring back that under the conditions
of the Earth's atmosphere and the kinds of
conditions here could spread and be a real
problem. And so one of the things I know NASA,
and there's a group of us that have been communicating
about this, is very concerned if we do take
any missions to Mars now that we know that
there's likely water there. Which likely means
there are microbes there. That in fact, what
does that mean? So again another twist in
the modern world of infectious diseases. Yes
sir?
Audience Member:
[Inaudible].
Dr. Michael Osterholm:
Yes well let me just say, right at the outset,
you're one of the solutions. I can tell that
because you're asking the right question.
And we need a we need a global plan. One of
the things we've been working on is trying
to get a global plan that says “this is
as important as buying bullets and guns”
because if you stop these problems look at
all the things else you stopped. The best
estimate right now in Ebola in West Africa
puts it somewhere in the neighborhood of probably
a 100 billion dollars in cost. Do you know
how many healthcare systems we could have
funded in West Africa for dimes in the dollar
with that? That would have helped us stop
this much earlier. At the same time, by the
way, save people from measles. Save them from
T.B. Save them from a number of other infections.
So one of things we have to get our head around
is what is the cost of investment and what's
the cost of not investing. So your question
is right on the mark. You know, we shouldn't
be just talking about sealing our borders
from infectious diseases. Go to the disease
and put it out where it's at. Figure out what
we need to do with these kinds of issues.
What are we going to do about mosquitoes?
Don't tell me we can't do anything. I won't
accept that. So I think there's a number of
us trying to move and we're we’re trying
to move the philanthropic community. Where
the largest transfer of wealth is going to
occur in the next few years, to understand
why this is a good investment in their world.
Why it's a good investment in governments
and not get bogged down into the politics
of foreign aid but get bogged down in “how
are we going to do all this issue to save
all of us, not just somebody in a foreign
country?” So thank you for that question.
Very good. Yes?
Audience Member:
[Inaudible].
Dr. Michael Osterholm:
Um… I think, by far, the biggest impact
climate change is going to have, this is going
to change the vector control borne disease
picture a lot. Because temperatures are going
to warm up we're going to see mosquitoes and
other ticks surviving in areas they haven't
survived… before. In addition to that though,
part of that it's not just surviving but there's
basically a a situation where every winter
mosquitoes go into a condition called diapause.
Diapause is a sunlight length related change
where right around Labor Day to middle September,
mosquitoes in Minnesota stop taking blood
meals. Why? Because, genetically, they've
been programmed if they take them later than
that they may have an early frost like we
just had up in northern Minnesota and they're
dead meat because that blood will swell up,
freeze, and they'll explode and die. That's
why it could be 55 degrees in January and
mosquitoes could actually be out but they
won't take a blood meal. Well we've already
seen an Alaska data to support that diapause
has been extended almost two more weeks in
some areas now. Where genetically those that
would have in the past die, are actually making
it. And so, with mosquitoes, in a summertime
basis we look at a concept called amplification.
So if you have 2 mosquitoes, basically infected,
then it gets to 4, then it gets to 8, then
it gets to 16, and it gets to 32, then it
basically 64, and by the late summer is when
you get most transmission of these diseases
because you have so many infected. If we add
on 1 or more 2 cycles at the end of the season,
we could be in big trouble. We know that right
here with encephalitis in Minnesota. So I
think that that's going to be the highest
impact issue. The 2nd thing is going to be
water and sanitation. Water is going to change
completely. You know I was recently in Hyderabad,
India, where I stood from where I stood 15
years before in a well. At that time the water
was basically coming from 110 feet down. They
were now at 700 feet down, they ran out of
water. Climate change is going to finally
change the distribution of precipitation and
it's going to… open up all these errors
we've made and how we've allocated water.
We've mined groundwater as if it somehow its
limitless. We now realize that there will
be big changes where in fact rainfall falls
or then how fast it does fall. We're going
to see more flooding. So all of those, with
sanitation, are going to be huge and they're
also going to affect the food supply. Right
now, I worry desperately, where we have really
good growing conditions for produce in California,
they can't do it anymore. They're running
out of capability to do it. We're going to
ship those offshore to countries where the
hygienic san--sanitation conditions are much
less satisfactory but that's isn’t going
to be the same produce you're going to be
eating. I can tell you we've seen more and
more produce outbreaks. So I think there's
a number of things, but I clearly think that
the vector control issues are going to be
the huge ones. Make no mistake climate change
is real. It's real. And every day we postpone
doing something we're doing it, not at our
expense, you and me, we're going to be gone,
but our kids and grandkids are going to suffer
miserably. And if we don't care about anything
else, just keep thinking about your kids and
grandkids. You know, ask yourself “what
does it mean to their world”
Barbara May:
One more question.
Dr. Michael Osterholm:
Yes?
Audience Member:
[Inaudible].
Dr. Michael Osterholm:
[Laughter]. You know I get that question a
lot. And actually I do pretty well. But I…
um you know I think I actually have a I have
a belief that we can make a difference. I
wouldn't be doing this. I mean we wouldn't
be fighting on the Ebola vaccine front right
now. We wouldn't be doing a lot of these things.
So it's just a matter of organizing society
to understand this. And I hate to learn from
lessons like Ebola or MERS to help advance
it, but that's what you have to do. And so
you know, I have a fundamental belief in the
future. Maybe I'm naive but I have to because
I have three grandkids that I can't accept
the fact that the world's going to be such
a not much better place. So that's how. I
do sleep at night. I'm careful what I eat,
you know. I do things like that, you know.
But beyond that, I um…I just I don't we
don't we don't have a choice. We don't have
a choice. We have to we have to do this. Thank
you all very much. Norm, again, thank you.
It's my honor. Thank you.
[Applause].
