>> WELCOME TO THE 21st YEAR OF THE NIH COURSE IN DEMYSTIFING MEDICINE. THE GOAL OF THIS COURSE IS TO BRIDGE EXCITING DEVELOPMENTS IN BIOLOGIC AND ENGINEERING SCIENCES AND BRIDGE THAT WITH MEDICINE. THE LOGO IS THE BROOKLYN BRIDGE AND WE'RE LIKE THE TWO INDIVIDUALS ON THE BRIDGE TO COMMUNICATE. TODAY WE'RE GOING TO DISCUSS THE MAJOR HEALTH PROBLEM CONFRONTING US AND THE WORLD. THE COVID-19 PANDEMIC. WHICH HAS TAKEN OVER 5 MILLION CAUSED 5 MILLION DEATHS WORLDWIDE AND OVER 800,000 IN THE UNITED STATES ALONE AND HAS CHANGED LIFE FOR EVERYONE. WE'VE SEEN DURING THE PAST TWO YEARS EXTRAORDINARY ADVANCES IN SCIENCE, AT THE SAME TIME INEQUALITIES IN NATIONAL AND GLOBAL HEALTH SYSTEMS, EXTRAORDINARY COOPERATION AND EXAMPLES OF OUTSTANDING LEADERSHIP. OUR SPEAKERS TODAY ARE IN THAT GROUP. DR. ANTHONY FAUCI TRULY NEEDS NO INTRODUCTION TO US. HE HAS BEEN THE PUBLIC FACE OF THE COVID PANDEMIC RESPONSE SINCE JANUARY OF 2020. AND IS CURRENTLY THE CHIEF ADVISER TO THE PRESIDENT OF THE UNITED STATES. AND A LEAD MEMBER OF THE NIH COVID-19 RESPONSE TEAM. TONY WILL SPEAK FIRST AND HIS LECTURE IS ENTITLED COVID THEN, NOW AND THE FUTURE. OUR SECOND SPEAKER DR. ROGER GLASS IS THE DIRECTOR OF THE NIH FOGARTY INTERNATIONAL CENTER FOR GLOBAL HEALTH. HIS WORK HAS SPURRED INTERNATIONAL COOPERATION IN VACCINE DEVELOPMENT AND DISTRIBUTION AS WELL AS TRACING THE EPIDEMIOLOGY AND TRANSMISSION DYNAMICS OF THE PANDEMIC ON A GLOBAL SCALE AND ROGER WILL SPEAK ON THE GLOBAL CHALLENGE COVID-19 AND FUTURE PANDEMICS. TO BOTH OF YOU, WE THANK YOU ENORMOUSLY FOR YOUR PARTICIPATION IN THE DEMYSTIFING MEDICINE PRESENTATION TODAY AND FOR YOUR VALUABLE TIME AND CONTRIBUTIONS. OUR FIRST SPEAKER IS DR. ANTHONY FAUCI AND THANK YOU TONY FOR BEING WITH US. >> THANK YOU VERY MUCH. IT'S A GREAT PLEASURE TO JOIN YOU AGAIN FOR THIS IMPORTANT SERIES OF LECTURES. AS I MENTIONED IN YOUR INTRODUCTION I WILL BE TALKING ABOUT COVID-19 THEN, NOW AND IN THE FUTURE. SO LET'S GET RIGHT TO IT. AS WE KNOW NOW WITHOUT ANY DOUBT THIS IS ONE OF THE MOST IMPORTANT AND HISTORIC PANDEMICS IN HISTORY CERTAINLY THE MOST SEVERE OF ANY RESPIRATORY ILLNESS OF A PANDEMIC NATURE THAT WE'VE SEEN IN OVER 100 YEARS. THE GLOBAL PANDEMIC IF YOU LOOK AT IT GLOBALLY IS ALMOST 300 MILLION CASES AND AS WAS MENTIONED OVER 5 MILLION DEATHS GLOBALLY. IF YOU LOOK AT THE CONFIRMED CASES WORLDWIDE ONE CAN SEE THE SEVEN DAY ROLLING AVERAGE FROM THE LEFT TO THE RIGHT OF THE VARIOUS SURGES THAT DIFFERENT COUNTRIES HAVE EXPERIENCED TO VARYING DEGREES OVER THE LAST TWO YEARS. BUT NOTE THAT EXTRAORDINARY VERTICAL SPIKE THAT WE'RE NOW CURRENTLY EXPERIENCING WITH OMICRON WHICH I WILL GET BACK TO IN A MOMENT. UNFORTUNATELY FOR US HERE IN THE UNITED STATES WE'VE BEEN ONE OF THE WORST HIT COUNTRIES IN THE WORLD. WITH OVER 50 MILLION CASES AND NOW EXCEEDING 820,000 DEATHS. THE DISTRIBUTION OF CASES PER 100,000 ARE MARKED BY THE DENSITY AND DARKNESS OF THE BLUE SHADE ON THIS SLIDE. CHILDREN ARE NOT SPARED FROM THIS. IF YOU LOOK AT IN THE UNITED STATES THERE HAVE BEEN ALMOST 7 MILLION CASES IN CHILDREN WITH ABOUT 76,000 HOSPITALIZATIONS. SEVERAL HOUSE OF WHICH HAVE EXPERIENCED MULTI-SYSTEM INFLAMMATORY SYSTEM AND OVER 1,000 DEATHS THUS FAR AMONG CHILDREN. THIS IS THE PATTERN THAT WE'VE ALL PAINFULLY EXPERIENCED OVER THE LAST TWO YEARS. AS YOU CAN SEE THE VARIOUS SPIKES IN THE SPRING OF 2020 THE SUMMER OF 2020 AND THEN THE FALL WINTER OF JUST THIS PAST YEAR WITH ANOTHER SURGE IN THE SUMMER WHICH WAS. COMING DOWN NICELY BUT THEN WE WERE HIT WITH YET AGAIN ANOTHER SURPRISE IF YOU WANT TO CALL IT THAT BUT WE'RE GETTING USED TO THEM NOW THAT THEY ARE NO LONGER SURPRISES. IS AN ALMOST VERTICAL SPIKE REFERRED TO BY SOME AS AN ICE PICK OF CASE THAT'S WE'RE SEEING RIGHT NOW IN THE UNITED STATES. OF NOTE AND I'LL GET BACK TO THIS IN A MOMENT THAT THE SPIKE IN CASES -- THERE HAS NOT BEEN A COMMENSURATE INCREASE IN HOSPITALIZATIONS OR DEATHS BUT REMEMBER BOTH OF THOSE ARE LATE LAGGING INDICATORS AND ALTHOUGH WE CAN TALK ABOUT THAT IN A FEW MINUTES WHEN I GET TO THAT NONETHELESS THIS IS SOMEWHAT COMFORTING NEWS ABOUT THE DISPARITY NOW BETWEEN CASES, HOSPITALIZATIONS AND DEATHS. LET'S TALK ABOUT SOME OF THE IMPORTANT ELEMENTS OF THIS HISTORIC OUTBREAK. FIRST THE VIE LOCAL GEE. THE HISTORY * IS VERY IMPORTANT TO OUR UNDERSTANDING. THE FONT IN RED ARE THE HUMAN CORONAVIRUS. THE HIGHLIGHTED YELLOW ARE THE PRECOVID SARS CO-V1 OUTBREAK IN 2002. THESE ARE THE COMMON COLD VIRUSES THAT ACCOUNT FROM 5-30% DEPENDING ON WHERE YOU ARE OF THE COMMON COLD A USUALLY RELATIVELY BENIGN DECIDES. AND THEN THIS MAY HAVE HAPPENED -- WHICH ANTIDATED THE COMMON COLD. WE HAD A PANDEMIC OUTBREAK OF A CORONAVIRUS WITH THE FIRST SARS CO-V1. 10 YEARS LATER THE SECOND NOT AS NEARLY AS IMPACTFUL AS SARS CO-V1 BUT THE MIDDLE-EAST RESPIRATORY SYNDROME. NOW WE'RE TALKING ABOUT NEW PANDEMIC VIRUSES THAT AS I MENTIONED BEGAN FROM 2002 AND 2012. WHERE ARE WE NOW TODAY? THE THIRD PANDEMIC OUTBREAK. THIS ONE FAR SUPERSEDING ALL OF THE OTHERS. BEGINNING WITH A PATTERN OF AN OUTBREAK IN A MARKET, A SEAFOOD WET MARKET IN THE WUHAN DISTRICT OF CENTRAL CHINA. A FEW DAYS LATER THE PUBLICATION OF THE SEQUENCE ON A PUBLIC DATABASE TELLING US ALL WHAT WE ACTUALLY SUSPECTED THAT THIS WAS A CORONAVIRUS. BUT AN UNUSUAL CORONAVIRUS. ONE THAT IS VERY CLOSELY RELATED ON THE TREE TO SEVERAL BAT VIRUSES THAT CIRCULATE IN THE ENVIRONMENT. MAKING IT CLEAR THAT THIS VERY LIKELY THOUGH NOT PROVEN YET WAS A NATURAL OUTBREAK FROM AN ANIMAL MODEL TO A HUMAN. SO A CLOSER LOOK AT THE VIROLOGY. AS I MENTIONED SOME BAT CORONAVIRUSES AND AN RNA VIRUS WITH A LARGE GENOME. AND THE SPIKE PROTEIN WITH THE RECEPTOR BINDING DOMAIN THAT BINDS TO THE ACE 2 RECEPTORS THAT ARE DISTRIBUTED IN THE UPPER AIRWAY AND OTHER CELLS AND OTHER ORGAN SYSTEMS THROUGHOUT THE BODY. THE TRANSMISSION NOW IS VERY WELL CHARACTERIZED. EXPOSURE TO RESPIRATORY FLUIDS. FINE RESPIRATORY DROPLETS BUT VERY, VERY CLEAR NOW ALTHOUGH THIS WAS SOMEWHAT IN DOUBT EARLY ON THAT THIS IS AN AEROSOL SPREAD VIRUS. WITH DEPOSITION OF AEROSOL OR DROPLETS ON THE MEMBRANES. EARLIER THEY THOUGHT MAYBE THERE WAS TRANSMISSION WITH CONTACT WITH CONTAMINATED SURFACES. IF THIS OCCURS IT IS EXTREMELY RARE. THE RISK IS GREATEST IN POOR VENTILATED AREAS BUT WITH CERTAIN ACTIVITIES HENCE EXERCISE. SUCH AS IN CHOIRS OR CHORUSES. SOME RATHER UNIQUE ASPECTS OF THIS VIRUS THAT A VIRUS THAT HAS ALREADY KILLED 820,000 AMERICANS AT LEAST A THIRD OF PEOPLE HAVE ABSOLUTELY NO SYMPTOMS AND NEVER DEVELOP SYMPTOMS. ANOTHER UNUSUAL ASPECT THAT WE DID NOT FULLY APPRECIATE UNTIL A FEW MONTHS INTO THE OUTBREAK IN THE UNITED STATES THAT ALMOST 60% OF ALL TRANSMISSION RELATE FROM SOMEONE WHO HAS NO SYMPTOMS. EITHER SOMEONE WHO NEVER DEVELOPED A SYMPTOM OR SOMEONE IN THE PRESYSTEMATIC STAGE. PREVENTION IS MULTI-FACETED. THE HALLMARK IS VACCINATION WITH A BOOST BUT AS SHOWN ON THIS SLIDE OTHER MEANS IMPORTANTLY THE WEARING OF MASKS AND TESTING AND ACTINGS ON RESULTS, PHYSICAL DISTANCING. HAND HYGIENE. STAYING OUT OF SAME IF YOU'RE SICK. CLINICAL COURSE: AS I MENTIONED MANY PEOPLE NEVER GET SYMPTOMS. FOR THOSE WHO DO PRESENT VERY MUCH LIKE A FLU-LIKE SYMPTOM WITH ONE EXCEPTION, A LOSS OF SMELL AND TASTE AND MIGHT LINGER FOLLOWING THE ACUTE PHASE. AGAIN FOR THOSE WHO DEVELOP SYMPTOMS ABOUT 80% ARE MILD TO MODERATE. ABOUT 15% TO 20% ARE SEVERE OR CRITICAL LEADING TO A WIDE RANGE OF CASE FATALITIES. UP TO 20% IN THOSE REQUIRING HOSPITAL VENTILATION I MEAN MECHANICAL VENTILATION. THOSE WHO GET SEVERE DISEASE FALL INTO A COUPLE OF CATEGORIES BASED ON THEIR INCREASE. OBVIOUSLY OLDER ADULTS, THE RATHER EXTREME ELDE EX-- EXTREME ELDERLY. THE MANIFESTATIONS ARE DOMINATED BY THE ACUTE RESPIRATORY DISTRESS SYNDROME. HOWEVER AS MORE EXPERIENCE ACCRUES WE KNOW THERE ARE NEUROLOGICAL, CARDIAC, ACUTE KIDNEY DISORDERS. PATHOGENIC EVENTS IN MULTIPLE ORGAN SYMPTOMS AND HYPER INFLAMMATION ALMOST AND HYPER INFLAMMATORY RESPONSE. AND I ALREADY MENTIONED THE MULTI-INFLAMMATORY SYSTEM IN CHILDREN. THERE ARE POST COVID CONDITIONS. SOME ARE READILY EXPLAINABLE. IF SOMEONE HAS A GREAT DEGREE OF ORGAN SYSTEM DYSFUNCTION REQUIRING PROLONGED HOSPITALIZATION. OFTEN ORGAN SYSTEM DAMAGE EXPLAINS A DIMINISHED PULMONARY FUNCTION. HOWEVER THERE ARE A CONSIDERABLE NUMBER OF PATIENTS WHO HAVE SIGNS AND SYMPTOMS THAT YOU CANNOT COMPLETELY EXPLAIN BY A READILY APPARENT PATHO BEGINIC PROCESS. THIS IS REFERRED TO AS LONG * COVID. THESE ARE SOME OF THE SYMPTOMS AND SIGNS OF LONG COVID. DOMINATED BY EXTREME FATIGUE, MUSCLE ACHES, LIGHT HEADEDNESS, AUTONOMIC DISTURBANCES SUCH AS TEMPERATURE REGULATION, MOOD CHANGES, SLEEP DISORDERS AND BRAIN FOG OR COGNITIVE IMPAIRMENT PARTICULARLY THE INABILITY TO FOCUS OR CONCENTRATE. THE MEDICAL MANAGEMENT THE CONTROL OF SYMPTOMS SUCH AS WITH ANTIINFLAMMATORY. MOST PEOPLE WHO STAY AT HOME WITH FEVER OR ACHES ARE WELL CONTROLLED ON THIS. THOSE WHO HAVE MILD SYMPTOMS NOT REQUIRING END ORGAN SUPPORT WHICH MUST BE GIVEN IN THE HOSPITAL. USUALLY THINGS LIKE MECHANICAL VENTILATION, DIALYSIS AND OTHER SUPPORT OF ORGAN SYSTEMS THAT ARE FAILING. NOW WE'RE GOING TO FOCUS ON ONE OF THE THERAPIES APPROACHES. ANTIVIRALS. ONE CAN THINK OF THERAPY IN TWO MAJOR PILLARS. ONE, TARGETING THE VIRUS ITSELF. WE NOW HAVE A NUMBER OF APPROVED LIKE REMDESIVIR FULLY APPROVED BY THE FDA. RECENTLY PAXLOVID AND SEVERAL MONOCLONAL ANTIBODIES THAT HAVE BEEN USED SUCCESSFULLY AT LEAST WITH THE DELTA VARIENT. I'M GOING TO GET BACK TO OMICRON IN A MOMENT. BUT WITH PEOPLE WITH ADVANCED DISEASE OFTEN YOU HAVE TO MODERATE THE RESPONSE. SUCH AS WITH DEXAMETHASONE OR OTHER BLOCKERS OF PROCESSES SUCH AS -. NOW THE HALLMARK OF THE SUCCESSFUL RESPONSE. NAMELY VACCINES. RIGHT NOW IT'S VERY, VERY CLEAR WITH GOOD JUSTIFICATION THAT THE DEVELOPMENT OF VACCINES FOR SARS CO-V2 ARE THE MOST IMPORTANT BREAKTHROUGH OF THE YEAR OF 2020. WHICH IS THE REASON WHY SCIENCE MAGAZINE DEEMED IT AS SUCH. IT WAS A COMBINATION OF MANY YEARS OF BASIC RESEARCH IN DEVELOPING PLATFORM TECHNOLOGIES SUCH AS THE mRNA TECHNOLOGY AS WELL AS DESIGN GETTING THE PROPER CONFIRMATION OF THE PREFUSION SPIKE PROTEIN TO ALLOW FOR A HIGH DEGREE. AND SO NOW IN THIS COUNTRY AND MORE WORLDWIDE WE NOW HAVE THREE SEPARATE PLATFORMS, FIVE OF THE SIX IMOGENS USE THE PROGRAM DEVELOPED BY BARNEY GRAHAM AND JOHN AND OTHERS IN THE VRC. THE DEVELOPERS ARE SHOWN INTO THE COLUMN NEXT TO THE LEFT AND THE STATUS AS YOU KNOW THE BIOIN TECH FULLY APPROVED WITH THE BLA. MODENA AND J & AJ AND OTHERS. ON THEIR WAY TO APPLYING FOR AN EUA. LET'S TAKE A LOOK AT THE HISTORY OF THESE VACCINES. FIRST THE EFFICACY IN CLINICAL TRIALS. THESE ARE THE ORIGINAL PAPERS. THE RATHER STRIKING AND VERY WELCOMED RESULTS OF THE MULTI-THOUSAND CLINICAL TRIALS DONE ON THE mRNAs WITH 95% AND 94% EFFICACY. J&J HAD A DIFFERENT PROFILE. DONE IN MANY DIFFERENT COUNTRIES AND SHOWED A 72% EFFICACY OVER-ALL VERSUS MODERATE TO SEVERE DISEASE IN COVID-19 WITH AN 85% EFFICACY IN ALL REGIONS OF THE WORLD STUDIED. THE THIN THAT IS MOST GRATIFYING ABOUT ALL OF THIS IS THE EXTRAORDINARY REAL WORLD EFFICACY WHICH REALLY IS NOW DEFINED AS EFFECTIVENESS NAMELY WHEN YOU DO A CLINICAL TRIAL OFTEN THE RESULTS OF THE TRIAL ARE ALWAYS BETTER AT WHAT HAPPENS IN THE WHEEL WORLD. BUT WE'RE * SEEING REAL WORLD EFFICACY THAT IS STRIKING. I CAN GIVE YOU PAPER AND PAPER BUT IT'S BEST SAID THAT IF YOU LOOK IN OCTOBER OF 2021 AND THE COMPARISON BETWEEN UNVACCINATED PEOPLE IN THE UNITED STATES COMPARED TO FULLY VACCINATED PEOPLE IS A 5 TIME INCREASE RISK OF TESTING POSITIVE. 12 TIME INCREASED RISK OF BEING HOSPITALIZED AND 14 TIMES INCREASED RISK OF DYING IF YOU'RE UNVACCINATED COMPARED TO A FULLY VACCINATED PERSON. NOW WE'RE ALL AWARE OF THE IMPORTANCE OF BOOSTER SHOTS. WHY IS THAT THE CASE. IF YOU LOOK AT THE HIGH DEGREE OF EFFECTIVENESS IN THE COMMUNITY WHICH I JUST MENTIONED IN ALL THREE OF THE APPROVED OR AT LEAST EMERGENCY AUTHORIZED VACCINES IN THE UNITED STATES THE EFFICACY OR EFFECTIVENESS WANES OVER TIME. IT GOES DOWN FROM 88 TO 48%. AND AGAINST DEATH IT GOES DOWN ALSO. IT IS BETTER PROTECTIVE AGAINST SEVERE DISEASE BUT CLEARLY FIRST NOTICED IN ISRAEL AND NOW VERY CLEAR IN THE UNITED STATES THAT AS HIGH AS THE EFFECTIVENESS IS WE NEED A BOOST. NOW, LET'S TAKE A LOOK AT THE DATA OF BOOSTING. THERE ARE TWO THINGS THAT YOU MEASURE. ONE IS THE NEUTRALIZING ANTIBODY TIGHTERS AGAINST THE VACCINE MEASURED BY PSEUDO VIRUS ASSAYS OR WHOLE LIVE VIRUS ASSAYS OR THE CLINICAL PRESENTATIONS AND THE CLINICAL EFFECT. LET'S TAKE A LOOK AT THE INVITRO ANTIBODY STUDIES. THIS IS A SLIDE THAT LOOKS AT WHAT THE PREBOOSTER LEVEL OF ANTIBODIES ARE AGAINST DELTA. WHICH IS THE VARIENT THAT IS CAUSED THE MAJOR PROBLEM IMMEDIATELY PRIOR TO OMICRON. IT IS AT 55 IN THE YOUNGER INDIVIDUALS AND GOES WELL ABOVE 800 -- 28 DAYS AFTER THE THIRD SHOT BOOST OF THE MODENA PRODUCT. IF YOU LOOK AT THE ELDERLY IT GOES UP FROM 32 TO 706. CLEARLY A MAJOR RECONSTITUTION. LET'S TAKE A LOOK AT THE PFIZER -- IN THE GREEN -- FOCUS ON B1617 WHICH IS ACTUALLY DELTA. AGAIN IN YOUNGER INDIVIDUALS 241 ONE MONTH AFTER DOSE TWO WHICH SHOULD BE THE PEEK OF THEIR RESPONSE -- * IN THE ELDERLY AGAIN IN THE BLUE BARS IT GOES GREAT 123 TO 1479. NOW LET'S TAKE A LOOK AT SOME OF THE CLINICAL STUDIES THAT INDICATE THAT BOOSTER SHOTS RECONSTITUTE THE DIMINISHED PROTECTION AGAINST SYSTE SYSTEMATIC INFECTION, SEVERE DISEASE AND DEATH. THESE ARE REPRESENTATIVE SLIDES THAT ARE CLEARLY BEING REPEATED IN ANY COUNTRY THAT USES BOOSTER. IF YOU LOOK AT THE CALM LAIVE INCIDENTS * OF HOSPITALIZATIONS, SEVERE COVID AND DEATH LOOKING AT THE PINK TO RED IS WHAT YOU SEE AFTER TWO DOSES OF AN mRNA IN THIS CASE THE PFIZER. LOOK AT THE BLUISH LINES WHICH ARE AFTER THREE DOSES NAMELY A BOOST. IF YOU LOOK AGAIN HERE IN THIS STUDY THAT COMES FROM MULTIPLE DIFFERENT COUNTRIES AND IS CUMULATIVE INCIDENTS IT SAYS PLACEBO BUT THAT MEANS TWO DOSES AND A PLACEBO VERSUS TWO DOSES AND THEN THE THIRD BOOST OF AN mRNA. A STRIKING DIFFERENCE IN THE CUMULATIVE INCIDENCE OF INFECTION. FOR THAT REASON THE CDC IS NOW EXPANDED THE RECOMMENDATION FOR BOOSTERS WE'LL CROSS VIRTUALLY EVERYONE NOW THAT HAS BEEN GIVEN THE PRIMARY WITH SOME RECENT DECISIONS BY THE FDA TO EXPAND THAT EVEN TO YOUNGER INDIVIDUALS. OKAY. NOW WE HAVE THE CHALLENGE OF THESE VARIANTS WHICH REALLY RELATE A LITTLE BIT TO WHAT I SHOWED YOU ABOUT DELTA A MOMENT AGO. THESE ARE SOME OF THE VARIANTS THAT WE HAVE FACED. BETA THAT STARTED OFF IN SUB SAHARAN AFRICA AND THEN WE GOT DELTA. DELTA TOOK OVER BECAUSE ITS HIGH DEGREE OF ABILITY TO SPREAD FROM PERSON TO PERSON. IT WAS TWICE AS GREAT AS ALPHA WHICH IT BUMPED OFF THE TABLE AND THE VIRAL LOADS WERE UP TO A THOUSAND TIMES GREATER THAN ALPHA. LEADING TO ITS CLEAR-CUT INCREASED TRANSMISSION. IT RAPIDLY TOOK OVER THE WORLD. SEEN IN OVER 155 COUNTRIES. AND IT WENT WAY UP TO 99% OF ALL THE VARIANTS IN THE COUNTRY WERE DELTA. BUT NOW IF YOU LOOK FROM DECEMBER 4 THROUGH DECEMBER 25 JUST A FEW WEEKS IT TELLS YOU WHAT WE ALL KNOW THAT IT IS BEING REPLACED BY OMICRON AND THAT IS THE VARIENT THAT WE'RE DEALING WITH NOW WHICH HAS SOME DIFFERENT CHARACTERISTICS. -- WHY IS OMICRON DIFFERENT? IF YOU LOOK AT THE SPIKE PROTEIN ON THE LEFT THE OMICRON ON THE RIGHT YOU SEE RIGHT OFF THAT THOSE LITTLE LINES THAT ARE COMING OUT ARE AMINO ACID SUBSTITUTIONS RESULTING FROM MUTATIONS. THERE ARE MANY MORE WITH OMICRON. 50 IN TOTAL. 30 IN THE SPIKE PROTEIN AND 10 IN THE RECEPTOR BINDING DOMAIN WHICH LEADS TO DIFFERENCES IN TRANSMISSIBILITY, SEVERITY, VACCINE EVASION OF IMMUNITY AND POTENTIAL IMPACT ON THERAPEUTICS. LET'S TAKE A LOOK. THESE SLIDES SPEAK FOR THEMSELVES. IN EVERY COUNTRY THERE HAS BEEN A SHARP VERTICAL SPIKE AS SHOWN IN THE RED LINE WHICH IS OMICRON COMPARED TO THE BLUE LINE WHICH IS DELTA. NOTE SOUTH AFRICA SEEMS TO HAVE ALREADY PEAKED AND IS ON ITS WAY DOWN. HOPEFULLY THAT IS WHAT WE'LL SEE IN THE NEXT FEW WEEKS IN THIS COUNTRY. IT'S VERY CLEAR NOW FIRST HINTED AT IN SOUTH AFRICA BUT NOW CLEARLY IN THE UK AND ALREADY EVIDENCE IN THIS COUNTRY. BETA BLUE, DELL DO RED, OMICRON YELLOW AND COMPARE TO PORTION OF PEOPLE ADMITTED. ON OXYGEN. WITH SEVERE DISEASE. THE PROPORTION THAT DIED. THIS IS A LESS SEVERE VIRUS. LIKELY DUE TO A COMBINATION OF UNDERLYING IMMUNITY DUE TO INFECTION OR VACCINATION AS WELL AS A POSSIBLE DIMINUTION OF PATHOGENS OF THE VIRUS ITSELF. IT'S ALREADY SEEN IN THE UK, IN SCOTLAND, IN LONDON WHICH INTERESTINGLY WE HEARD TODAY THAT LONDON SEEMS TO HAVE ALREADY PEAKED WITH ITS VERTICAL SPIKE. THERE ARE EARLY SIGNALS THAT WE'RE SEEING THIS IN THE UPS FROM A STUDY IN HOUSTON. NOW IMPORTANTLY BACKING UP THE SUGGESTION THAT I MADE A LITTLE BIT AGO THAT THERE MAY BE ACTUALLY AN INHERENT LOWERING OF VIRALMENTS -- THAT WHEN YOU INFECT THEM THAT THE PATHOGENS IS MUCH DIFFERENT. OMICRON SEEMS TO REPLICATE VERY WELL IN THE UPPER AIRWAY AND BROWN SKY BUT * POORLY IN THE LUNG WHICH AGAIN ALTHOUGH YOU HAVE TO PUT THE CAVEATS THAT YOU HAVE WITH AN ANIMAL STUDY THIS IS PERFECTLY COMPATIBLE WITH A VERY HIGH DEGREE OF TRANSMISSIBILITY AND A LOWER DEGREE OF PATHOGENESIS. DOES IT EVADE IMMUNITY? WITHOUT A DOUBT. IF YOU LOOK AT THE OMICRON WAVE THE EFFECTIVENESS AGAINST SARCO V2 INFECTION GOES DOWN TO 33% UP FROM 80% PREOMICRON. IF YOU LOOK AT HOSPITALIZATIONS IT GOES DOWN STILL A DEGREE OF PROTECTION. 70 IS NOT BAD BUT CLEARLY IT GOES DOWN WHEN YOU TALK ABOUT HOSPITALIZATION. FORTUNATELY FOR US LOOK AT WHAT HAPPENS WHEN YOU GIVE A THIRD SHOT BOOST OF AN mRNA VACCINATION WHERE YOU HAVE THE LOWER -- AND THEN IT GOES UP BY 38 FOLD WITH THE BOOSTER. AGAIN A VERY, VERY STRONG ARGUMENT FOR BOOSTING INDIVIDUALS WHO HAVE BEEN FULLY VACCINATED. AGAIN A STUDY FROM UK HEALTH SECURITY AGENCY IN ENGLAND A REDUCTION IN THE RISK OF HOSPITALIZATION OF 81% FOLLOWING THE THIRD SHOT AND REDUCTION AGAINST HOSPITALIZATION IN ANOTHER STUDY OF 88%. SO WHAT IS THE BOTTOM LINE WITH OMICRON. THE VARIANT COMPROMISES THE EFFECTS OF THE TWO DOSE RNA FOR SURE AND REDUCES OVER-ALL PROTECTION. EVEN THOUGH AS I SHOWED YOU THIS CONSIDERABLE PROTECTION STILL REMAINING AGAINST SEVERE DISEASE. EARLY STUDIES INDICATE THAT BOOSTERS RECONSTITUTE ANTI BODIES AND ENHANCE PROTECTION AGAINST OMICRON. SO OUR REGIMENS APPEAR TO BE WORKING AND RIGHT NOW ALTHOUGH WE'RE MAKING A SPECIFIC BOOSTER IT APPEARS THAT BOOSTER AGAINST STRAINS CAN BRING UP THE PROTECTION EVEN AGAINST OMICRON. WHAT ABOUT THE POTENTIAL IMPACT ON THERAPEUTICS? SOME BAD NEWS AND SOME GOOD NEWS THE BAD NEWS IS THAT THE LILY AND REGENERON MONOCLONAL ANTIBODIES THAT WAS SO EFFECTIVE AGAINST DELTA DO NOT APPEAR TO BE EFFECTIVE AGAINST OMICRON. THE NEW ANTIBODY FROM GSK APPEARS TO BE QUITE EFFECTIVE AGAINST OMICRON AND AstraZeneca MONOCLONAL FOR PEOPLE WHO ARE IMMUNO COMPROMISED LOOKS GOOD AGAINST OMICRON. LUCKILY SOME OF THE VIRALS -- REMDESIVIR SEEM TO BE QUITE GOOD AGAINST THIS AT LEAST IN AN INVITRO SITUATION. WHAT ABOUT THE FUTURE? AGAIN WHAT IS THE END AGAIN FOR 2022 AND BEYOND? WHEN YOU THINK ABOUT OUTBREAKS THERE IS A PANDEMIC PHASE. A DECLINE IN ACCELERATION. THERE IS CONTROL. ELIMINATION AND ERADICATION. LET'S LOOK AT HISTORY. WE'VE ONLY ERADICATED ONE PARTICULAR PATHOGEN AND THAT IS SMALL POX. WE'VE ELIMINATED NAMELY DIDN'T WIPE IT OFF THE PHASE OF THE EARTH SEVERAL IMPORTANT PATHOGENS. BACK VACCINATION. POLIO, MEASLES. EXCEPT FOR SMALL POCKETS OF COMMUNITIES THAT ARE UNDER VACCINATED. SO WHAT ARE WE LOOKING AT? IT'S ONLY ASPIRATIONAL TO THINK THAT WE'RE GOING TO ELIMINATE SARS CO-V2 SO WE'RE GOING TO LIVE WITH IT AND THAT MEANS CONTROL. SO WHAT LEVEL OF CONTROL DO WE HAVE? CERTAINLY 90,000 HOSPITALIZATIONS THAT WE HAVE AS OF YESTERDAY IN THE HOSPITAL. 1300 DEATHS AND 400,000 CASES IS NOT ADEQUATE CONTROL. WE'VE GOT TO GET IT DOWN TO A LOW LEVEL WITH THE HOSPITALIZATIONS AND DEATHS ARE SO LOW THAT IT DOESN'T INSTILL FEAR IN SOCIETY AND DISRUPT EVERYTHING THAT WE DO AND GETS TO THE POINT WHERE WE HAVE ENOUGH PEOPLE PROTECTED WITH VACCINATION AND ARE PRIOR INFECTION THAT * WE HAVE A VIRUS THAT WILL ASSUME A MUCH LOWER LEVEL. I'LL STOP THERE AND I'M HAPPY TO ANSWER QUESTIONS >> THANK YOU VERY MUCH, TONY. ONE OF THE QUESTIONS THAT HAS POPPED UP IS -- IS THERE ANY WAY OF PREDICTING WHO IS LIKELY TO DEVELOP CHRONIC FORMS OF COVID INFECTION? EITHER GENDER, GENOME OR IS THERE ANY EVIDENCE THAT PROVIDES SOME OF THAT INFORMATION? >> THE ANSWER RIGHT NOW I WOULD NOT SAY CHRONIC FORM OF INFECTION. I WOULD SAY LONG COVID SYSTEM TOLOGY FOLLOWING THE CLEARANCE OF INFECTION. THERE ARE SOME STUDIES ONGOING RIGHT NOW. THERE DOESN'T APPEAR TO BE ANYTHING STRIKING. THERE ARE SOME PRELIMINARY EVIDENCE THAT MAYBE WOMEN ARE MORE INFECT WITH LONG COVID THAN MEN BUT IT'S GOING TO REQUIRE MUCH, MUCH LARGER STUDIES. >> AND ALSO CONSIDERABLE INTEREST -- HOW DO WE GO ABOUT DETERMINING WHETHER NEW VARIANTS APPEAR AND TO WHAT EXTENT HAS THE SYSTEM FOR THEIR DETECTION BEEN REVVED UP OR AMPLIFIED? >> A YEAR AGO, TWO YEARS AGO WHEN IT WAS TERRIBLE IN THE SENSE THAT WE REALLY DIDN'T HAVE ADEQUATE ENOUGH GENOMIC SURVEILLANCE TO BE ABLE TO DO SOMETHING. THE CDC HAS GREATLY IMPROVED THEIR ABILITY NOW TO SEQUENCE A SUBSTANTIAL PROPORTION OF ISOLATES TO GIVE A GOOD FEEL FOR WHAT IS OUT THERE IN THE COMMUNITY. WHICH IS THE REASON WHY WE NOW KNOW THAT ACTUALLY DELTA STARTED OFF AT 1% OR 2% AND HAD A DOUBLING TIME SO THAT WE WERE UP TO 90%. RIGHT NOW THE DOUBLING TIME OF OMICRON IS ABOUT TWO DAYS AND THE CDC IS SHOWING NOW THAT EVEN THOUGH IT'S ABOUT 70 PLUS PERCENT THROUGHOUT THE COUNTRY THERE ARE MANY REGIONS THAT HAVE WELL OVER 90% AND THAT IS DUE TO THE SURVEILLANCE THAT WE'RE TALKING ABOUT. >> IT'S ALSO BEEN AN INTEREST IN HOW DO WE KNOW WHEN A -- WHAT IS THE END OF A PANDEMIC LOOK LIKE? OR WHAT ARE THE DETERMINANTS THAT LEAD TO IDENTIFYING THE END OF THE PANDEMIC? >> WHEN I TRY TO -- THE ANSWER IS WE DON'T KNOW WHAT IT'S GOING TO BE. WE'LL KNOW IT WHEN IT HAPPENS. THAT DOESN'T SEEM LIKE A VERY SCIENTIFIC APPROACH BUT I TRY TO BREAK IT DOWN TO THE AUDIENCE BY GOING THROUGH WHAT WE KNOW HISTORICALLY ABOUTY RATIFICATION, ELIMINATION, CONTROL. IT'S SOMEWHERE IN THE CONTROL BOX BUT WHAT LEVEL OF CONTROL? I THINK IT WOULD HAVE TO BE WHERE IT DOESN'T DISRUPT SOCIETY. WE'RE GOING IS TO START AND YOU'LL PROBABLY HEAR ABOUT THIS REASONABLY SOON. PARTICULARLY WHEN YOU HAVE A VIRUS LIKE OMICRON WHICH HAS MUCH LESS SEVERITY THAN DELTA THAT WE'RE GOING TO BE FOCUSING MUCH OR ON HOSPITALIZATIONS AND DEATHS AS OPPOSED TO HOW MANY PEOPLE GET INFECTED. LIKE WE DON'T USUALLY COUNT THE NUMBER OF PEOPLE WHO GET A COLD THAT GET A PARA FLU. A RHINO VIRUS. BUT WE'RE GOING TO BE FOCUSING ON HOW MANY PEOPLE ARE SEVERELY IMPACTED. AND WHEN THAT NUMBER GETS TO A LOW LEVEL THAT THERE IS NO STRAIN ON THE HOSPITAL SYSTEM. NO STRAIN ON SOCIETY. THERE IS NOT A PERVASIVE FEAR THAT IF YOU'RE 80 YEARS OLD THAT YOU'RE GOING TO DIE IF YOU GET INFECTED THEN WE WILL BE ABLE TO LIVE WITH IT >> THERE ARE RECORDS IN ISRAEL THAT THEY ARE CONTEMPLATING OR HAVE BEGUN A SECOND ROUND OF BOOSTERS OR VACCINATION. I'M NOT SURE. WHICH. WELL IT'S A BOOSTER TO THE VACCINATION. IS THERE ANY EVIDENCE AS TO THE EFFECTIVENESS OF THAT. WOULD YOU ANTICIPATE SOMETHING LIKE THAT HAPPENING GLOBALLY? >> THE ISRAELIS ARE TALKING ABOUT A FOURTH SHOT ABOVE THE THIRD SHOT BOOST OF AN mRNA. THEY US ALMOST EXCLUSIVELY PFIZER. WITHOUT THE DURABILITY OF PROTECTION OF THE THIRD SHOT BEFORE WE START THINKING ABOUT THE FOURTH SHOT. WE MAY HAVE TO GET YET AGAIN ANOTHER SHOT. WE'RE USING THE TERMINOLOGY NOW KEEPING YOUR VACCINATIONS UP-TO-DATE RATHER THAN WHAT FULLY VACCINATED MEANS. OPTIMAL PROTECTION IS WITH A THIRD SHOT OF mRNA OR A SECOND SHOT OF A J&J. >> THERE IS INTEREST IN -- WHAT IS THE RELATIVE SENSITIVITY OF THE HOME KITS THAT ARE BEING USED FOR DETECTION OF THE ANTIGEN VERSUS THE PCR? AT ONE POINT IF SOMEONE HAS SOME SYMPTOMS THAT ARE SUGGESTIVE AND HAS A NEGATIVE ANTIGEN TEST IN ONE OF THE HOME KITS SHOULD THEY HAVE A PCR? >> IT DEPENDS ON WHAT YOU ARE USING THE TEST FOR. SO LET ME SEE IFIC LAY THIS OUT BECAUSE THERE IS ALWAYS UNDERSTANDABLY WHEN A LOT OF CONFUSION ABOUT THAT. WITHOUT A DOUBT THE PCR IS A HIGHLY SENSITIVE TEST. SO IF YOU REALLY WANT TO KNOW IF YOU'RE INFECTED THE PCR IS THE WAY TO GO. THAT IS USUALLY FOR SOMEONE WHO HAS SYMPTOMS AND NEEDS TO KNOW AM I INFECTED YOU WANT TO GET A PCR. IF YOU GO TO THE HOSPITAL AND YOU'RE COMING IN WITH SYMPTOMS THEY ARE GOING TO DO A PCR ON YOU. WHEN YOU RECOVER IT CAN STILL REMAIN POSITIVE BECAUSE IT PICKS UP FRAGMENTS OF THE VIRUS THAT MIGHT NOT BE REPLICATION COMPETENT. THEN THE ANTIGEN TEST. THERE ARE NOW 8 AND WILL SOON BE 9 AND 10 APPROVED TESTS. THEIR SENSITIVITY IN GENERAL IS LESS THAN THE PCR. HOWEVER, IF YOU FOR EXAMPLE DO THE BAR NEXT NOW TEST IT IS DEPENDING UPON WHETHER YOU DO IT PROPERLY OR WHAT STAGE YOU'RE IN EARLY OR MID-INFECTION IT'S ABOUT 80 SOME ODD PERCENT SENSITIVE. IF YOU DO TWO OR THREE OF THEM SEQUENTIALLY IT BECOMES AS SENSITIVE AS THE PCR AND THAT IS WORK THAT HAS COME OUT FROM A NUMBER OF GROUPS. HOWEVER, IF YOU GET A POSITIVE ANTIGEN TEST IT MEANS THAT URINE AFFECTED. THERE ARE VERY FEW FALSE POSITIVES. AND NO TEST IS 100%. BUT IT IS MORE INDICATIVE IF IT'S POSITIVE YOU KNOW IT'S POSITIVE. IF IT'S NEGATIVE IT MAY NOT BE SENSITIVE ENOUGH TO PICK UP YOUR INFECTION. DOES THAT MAKE SENSE? >> THAT IS VERY HOPEFUL. I'M SURE THERE IS SOME CONSIDERABLE CONFUSION. QUESTIONS ABOUT INDIVIDUALS WHO HAVE BEEN FULLY VACCINATED AND WHO HAVE SEVERE DISEASE OR DIE IN THE FATE A CASES THAT DIE DID THEY HAVE SOME IMMUNO DEFICIENCY. >> WELL YOU KNOW * AS WE'VE OFTEN SAID ALL OF LIFE IS A BELL SHAPED CURVE. IF YOU COMPARE THE UNVACCINATED TO THE VACCINATED THE DEATHS AND THE HOSPITALIZATIONS ARE OVER OVERWHELMINGLY MORE IN THE UNVACCINATED. IT'S VERY HEAVILY WEIGHTED TOWARD THE ELDERLY AND THOSE WITH UNDERLYING CONDITIONS THAT. DOES NOT MEAN THAT A 45-YEAR-OLD HEALTHY VACCINATED AND BOOSTED PERSON IS NOT GOING TO WIND UP IN THE HOSPITAL AND DIE BUT IT WOULD BE EXTREMELY UNUSUAL AS OPPOSED TO A 95-YEAR-OLD PERSON WHO IS VACCINATED AND BOOSTED. SO, ITS HEAVILY WEIGHTED TO THE ELDERLY AND THOSE WITH UNDERLYING CONDITIONS. >> WHAT DO YOU THINK ARE THE MAJOR PROBLEMS IN TRYING TO TAKE THE ADVANCES OF SCIENCE AND THE ANNUAL BODIES AND VACCINES TO THE PUBLIC AT LARGE TO HAVE A GREATER RESPONSE AND ACCESSIBILITY? WOULD YOU LIKE TO COMMENT ABOUT THAT? THERE IS A DIFFERENCE BETWEEN ACCESSIBILITY AND RESPONSE. BECAUSE THE VACCINES ARE OVERWHELMINGLY ACCESSIBLE IN THIS COUNTRY. AND YET WE HAVE ABOUT 34 MILLION PEOPLE WHO ARE ELIGIBLE TO BE VACCINATED WHO ARE NOT GETTING VACCINATED. THAT IS A BIG, BIG PROBLEM. AND THAT HAS TO DO WITH ANTIVAX WITH MAKING DECISIONS ABOUT PUBLIC HEALTH BASED ON POLITICAL IDEOLOGY. THAT IS IN MY MIND ONE OF THE GREATEST STUMBLING BLOCKS TO AN ADEQUATE RESPONSE IN THIS COUNTRY. IS THAT THERE IS A DEGREE OF POLITICAL DIVISIVENESS THAT HAS ENTERED INTO THE EQUATION OF ADEQUATE INTERVENTIONS AND THE PROPER UTILIZATION OF HIGHLY EFFECTIVE TOOLS. THAT IS A REAL PROBLEM. THAT IS GOING TO KEEP THIS LINGERING LONGER THAN IT NEEDS TO. >> ALL RIGHT. I WANT TO THANK YOU ON BEHALF OF ALL OF US VERY MUCH. YOU'RE A VERY BUSY MAN AND WE APPRECIATE YOU PROVIDING THIS VALUABLE INFORMATION. THANK YOU AGAIN. >> THANK YOU. IT'S ALWAYS A PLEASURE TO BE WITH YOU. >> YOU'RE WELCOMED. NOW OUR SECOND SPEAKER IS ROGER GLASS. THE TITLE OF HIS TALK IS THE GLOBAL CHALLENGE OF COVID AND FUTURE EPIDEMICS. >> THANK YOU. AND LET ME START BY THANKING TONY WHO HAS BEEN SO TERRIFIC BOTH IN THE PRESENTATION AND IN HIS LEADERSHIP AND SPEAKING TRUTH TO POWER AND DELIVERING ON THE SCIENCE AND REALLY REPRESENTING US SO WELL, TONY. WE OWE YOU A GREAT DEBT OF THANKS. LET ME GENUINE. I'LBEGIN -- WIN. >> I WANT TO TALK ABOUT THE FUTURE. THANKS TO TONY THE RIGHT MAN AT THE RIGHT TIME WHO HAS HELPED US ALL. I ALSO WANT TO STATE THAT DR. MYSELF AND DR. -- VOGEL HAVE NO CONFLICTS OF INTEREST. AND MY TALK WILL BE OUTLINED FIRST TO DISCUSS THE IMPACT OF COVID-19 PANDEMIC ON SOCIETY. HOW THE SCIENTIFIC ENTERPRISE HAS CHANGED. THE IMPORTANCE OF BUILDING RESEARCH CAPACITY AND GLOBAL PARTNERSHIPS TO IMPROVE PANDEMIC RESPONSES IN THE FUTURE. AND FINALLY, A SPECIAL SECTION ON THE VALUE OF MODELING. AND WHAT DOES THE FUTURE HOLD FOR BIOMEDICAL SEARCH. IT'S BEEN OVER A HUNDRED YEARS SINCE THE GREAT INFLUENZA. WHAT HAVE WE LEARNED SINCE? I FOUND IT INTERESTING THAT THE PANDEMIC WAS TRULY HISTORIC BUT OUR BASIC CONDITIONS AND CONTROL MEASURES HAVE NOT CHANGED FOR A HUNDRED YEARS. MASKING. SOCIAL DISTANCING. NOT COUGHING AND SNEEZING IN SOMEONE'S FACE. IT'S AMAZING HOW LITTLE HAS CHANGED EXCEPT FOR SOME OF THE NEW SCIENCE. THIS PANDEMIC MORE DEATHS THAN THE SPANISH FLU. ALTHOUGH A LOWER FATALITY RATE. WE'VE SEEN ALL KINDS OF PROBLEMS WITH IT IT'S BEEN HISTORIC. OVER 5 MILLION DEATHS. THE UNIVERSITY OF WASHINGTON HAS SUBJECTED THAT THAT IS ONLY HALF OF THE NUMBER OF DEATHS DUE TO THIS. AND ALSO STRIKING IS THE FACT THAT THERE HAVE BEEN OVER 9 BILLION VACCINE DOSES ADMINISTERED IN A LITTLE OVER A YEAR. REALLY A QUITE REMARKABLE ACHIEVEMENT. SO THE PANDEMIC HAS AFFECTED US ALL. WE'VE ALL LIVED THROUGH THIS. THE SHUT DOWN OF TRAVEL. BUSINESS LOCKDOWNS. MENTAL HEALTH. STRESS AND SCHOOLS AND ENTERTAINMENT. OUR LIVES HAVE ALL BEEN IMPACTED AND AFTER TWO YEARS AS YOU CAN SEE WITH OMICRON WE'RE STILL LEARNING ABOUT THE VIRUS AND THE CONSEQUENCES AND THINKING ABOUT THE FUTURE. LARRY AND DAVID AT HARVARD ESTIMATED THE IMPACT IN ECONOMIC TERMS AND FOR THE UNITED STATES AND FELT THAT THE VACCINE WAS A $16 TRILLION VIRUS. ALSO THE COMMENT THAT SARS PANDEMIC IS THE GREATEST THREAT TO PROSPERITY AND WELL-BEING THE U.S. HAS ENCOUNTERED SINCE THE GREAT DEPRESSION. THAT IS SOMETHING IMPORTANT. DESPITE THE FACT THAT WE'VE USED THAT 9.2 BILLION DOSES OF VACCINE WHEN YOU LOOK AT THE DISTRIBUTION OF THOSE IN THE WORLD YOU CAN SEE IN AFRICA ONLY 8% OF ALL OF THESE VACCINES HAVE REACHED THE AFRICAN CONTINENT. A TROUBLING ISSUE ABOUT VACCINE EQUITY. AND SOMETHING THAT I WANT TO DISCUSS IN THIS TALK. AND THE PANDEMIC WE SEE AS A WAKE-UP CALL. A TEACHING MOMENT. THE AFRICAN UNION HAS FOR A LONG TIME ENCOURAGED CONSTITUENT COUNTRIES 55 TO INVEST IN HEALTH RESEARCH. BUT VERY FEW HAVE PUT THE INVESTMENTS IN AND NOW THEY ARE IN A SITUATION WHERE ALL OF THE COUNTRIES HAVE BEEN IMPACTED. ALL PRESIDENTS IN AFRICA ARE ENGAGED. SOME VERY STRONGLY INVESTED IN RESEARCH AND THE LIKE. ALL ECONOMIES HAVE SUFFERED. ALL PEOPLE'S HEALTH AND WELFARE HAS BEEN IMPACTED. THESE COUNTRIES HAVE FOUND THEMSELVES NOW DEPENDENT UPON THE INTERNATIONAL COMMUNITY FOR ITS DIAGNOSTICS, DRUGS AND VACCINES AND PPE. QUITE REMARKABLE. WELL I JUST CAME BACK IN DECEMBER FROM RWANDA WHERE THINGS SEEM QUITE DIFFERENT. I HAD TO BE SCREENED BEFORE I GOT ON THE AIRPLANE GOING IN AND GOING OUT AND QUARANTINED FOR TWO DAYS UNTIL I WAS COVID NEGATIVE. THEY VACCINATED OVER 90% OF THEIR POPULATION WITH TWO DOSES AND THEY ARE IN THE PROCESS OF VACCINATING EVERYONE IN THE RURAL AREAS AND THEY ARE MASKING PER WHERE EVEN IN PERSONAL VEHICLES AND THEY ARE PLANNING AN mRNA FACILITY IN THE COUNTRY. WORKING ON GRANTS FOR GENOMICS. THEY HAVE AN ENGINEERING INSTITUTE AND THEY ARE DOING AMAZING THINGS. SO I WAS HEARTENED TO SEE THE RATES WERE LOWER THAN IN MOST PLACES IN THE UNITED STATES. KNOWLEDGE OF THE PANDEMIC IS SPREAD IN EVOLUTION IMPACT HAS COME FROM GLOBAL PARTNERSHIPS. WE HAVE NOT DONE THIS ONLY ON THE U.S. CONTINENT. THE SURVEILLANCE MAPS AND THE DATA ARE FROM AROUND THE WORLD. THE CLINICAL TRIALS OF DRUGS AND VACCINES HAVE BEEN UNIVERSE 58. THEY'VE BEEN FROM ALL OVER. *. CLINICAL TRIAL SITES. VACCINES HAVE BEEN PROVIDED FOR MANY COUNTRIES AND MANUFACTURERS INCLUDING THE SHY NIECE, RUSSIANS AND INDIANS HAVE BEEN STRIKING. INDUSTRY AND FINANCIAL INSTITUTIONS HAVE BEEN INVOLVED TO SEE WHAT THEY COULD DO AND INTERNATIONAL ORGANIZATIONS AND ACADEMIC INSTITUTIONS ARE ALL INVOLVED. THEY ALL HAVE A ROLE TO PLAY. THIS IS A PANDEMIC THAT IS MOBILIZED EVERYONE. BECAUSE WE'RE ALL IN THIS TOGETHER AND THE PANDEMIC WON'T GO AWAY ANYWHERE UNTIL IT'S CONTROLLED EVERYWHERE. WELL I HAD THE PLEASURE OF SPENDING TIME WITH JOHN, THE DIRECTOR OF THE AFRICAN CDC IN RWANDA. HE IS EXTRAORDINARY AND HE HAS BEEN PUSHING PROGRAMS FOR FIVE YEARS INCLUDING THIS PROGRAM. THE PARTNERSHIP FOR VACCINE MANUFACTURER IN AFRICA. AND HE HAS WRITTEN RECENTLY THAT TWO YEARS IN COVID LESSONS OF THE WORLD AND NATURE AND HE ARGUES THAT AFRICA NEEDS TO GUARANTEE ITS OWN HEALTH SECURITY. FINDING AN AFRICAN SOLUTION TO AN AFRICAN GLOBAL PROBLEM. HE ALONG WITH CHRISTIAN HAPPY HAVE COME UP WITH FIVE CRITICAL ELEMENTS. INVESTING IN HEALTH AND DISEASE. BUILDING REGIONAL CONTROL AND CAPABILITIES. ACCELERATING TRANSLATIONAL RESEARCH AND DEVELOPMENT. THOSE DIAGNOSTICS AND VACCINES AND DRUGS THAT NEED TO BE TRANSLATED AND RESEARCHED IN COUNTRY. INVESTING IN SURVEILLANCE. SO HE HAS BEEN VERY CLEAR. AND I JUST WANT TO NOTE THAT CHRISTIAN HAPPY AND JOHN ARE BOTH INVOLVED WITH NIH. CHRISTIAN HAPPY IS A RECIPIENT OF THE AWARD WHO MADE THE FIRST SEQUENCE OF A COVID STRAIN IN NIGERIA WITHIN A FEW DAYS OF ITS -- ITS EY IDENTIFICATION. SO THEY BOTH HAVE STRONG LEADERSHIP QUALITIES. BORN LEADERS. AS TONY MENTIONED THE OUTBREAK BEGAN IN CHINA SO WE HAVE TO THANK THE CHINESE FOR PUTTING THE SEQUENCE EARLY ON AS A PUBLICATION WHICH WAS THE BLUEPRINT FOR MOST VACCINES SO THAT TYPE OF INTERNATIONAL COLLABORATION IS KEY. THOSE SEQUENCES HAVE NOW BEEN FOLLOWED AND ARE BEING LOOKED AT AROUND THE WORLD AND TONY MENTIONED HOW THAT HAS HAPPENED BUT WHAT IS INTERESTING IN AFRICA IS THAT AT THE BEGINNING OF THE PANDEMIC ONLY THREE COUNTRIES IN AFRICA ONLY THREE SITES COULD SEQUENCE STRAINS IN THE FIRST WEEKS. SOMETHING THAT REALLY HAS TO BE REMEDIED AS WE GO FORWARD AND THINKING ABOUT GLOBAL SURVEILLANCE. AS AN EXAMPLE WE HAD A FELLOW JESSICA MANNING AT FOGARTY HAS MOVED TO NIAID AND IS ASSIGNED TO THE NATIONAL CAMBODIAN NATIONAL LAB. SHE AND HER GROUP SEQUENCED THE FIRST STRAINS OF COVID CAMBODIA. SO EXTENDING THAT GLOBAL NETWORK. WHEN OMICRON EMERGED IN NOVEMBER YOU CAN SEE HERE THE NUMBER OF STRAINS AND THEIR MIGRATION AROUND THE WORLD. QUITE IMPRESSIVE AND THIS ALSO HAS A LINK TO FOGARTY WHERE YOU CAN SEE THE IN INVESTOR * WAS IN TRAINING IN OUR AIDS PROGRAM BEFORE AND IS NOW THE LABORATORY DIRECTOR IN BOTSWANA. THIS BEGAN AND THE IDEA OF GETTING LEADERSHIP IN THE FIELD IN AFRICA AND BUILDING AROUND THOSE LEADERS IS ABSOLUTELY ESSENTIAL GOING FORWARD. THE ABILITY TO DO THE SEQUENCES HAS BEEN A RAPID ADVANCE OF TECHNOLOGIES THAT BECOME LESS COSTLY. PORTABLE. SMALL SCALE AND ACCESSIBLE TO ALL AND WITH THAT AT FOGARTY ALONG WITH MANY PARTNERS JOHNS HOPKINS AND THE AFRICAN CDC WORKING TO TRAIN PEOPLE IN SEQUENCES SO THEY WOULD BE PREPARED FOR THE NEXT PANDEMIC OR FROM WATCHING THIS PANDEMIC AS IT GOES ON. WE'VE DEVELOPED THIS AS A COURSE WHICH HAVE BEEN USED THROUGHOUT AFTER AT DEVELOPING WORLD AND WHERE EVER IT IS NEEDED WITH PACKAGES AND SOFTWARE TOGETHER WITH JOHNS HOPKINS AND YOU CAN SEE SOME OF THE INVESTIGATORS IN PROVIDING SUPPORT FOR THIS. THIS IS SOMETHING THAT WILL BE AN ESSENTIAL TOOL IN PUBLIC HEALTH LABORATORIES HENCEFORTH. I WANT TO NOW BECAUSE THIS SURVEILLANCE HAS BEEN SO INTERESTING MODELING IN THIS PANDEMIC HAS BECOME A NICHE FIELD IN THE PAST. AND CECILE LEADS A GROUP AND I WILL GIVE HER A FEW MINUTES TO DESCRIBE THE IMPORTANCE OF MODELING AND HOW THIS COULD HELP ANY COUNTRY IN ACCESSING THE BURDEN OF THE DISEASE. >> THANK YOU. GO BACK. PERFECT. THANKS. SO OUR CENTER HAS MAINTAINED A GLOBAL NETWORK ON INFLUENZA AND RESPIRATORY VIRUSES FOR TWO DECADES NOW. AND WE'VE USED THIS RELATIONSHIP BUILT IN PEACETIME TO STUDY THE COVID-19 PANDEMIC. SO I WILL SHOW YOU A LITTLE BIT OF OUR WORK WITH COLLEAGUES IN SOUTH AFRICA AND CHINA TODAY. SO VERY EARLY ON THERE WAS VERY LITTLE DATA ON THE PATIENT LEVEL ON COVID-19. SO WE RELIED ON DIGITAL SURVEILLANCE WHICH IS AN APPROACH -- SUCH AS THE WEB OR SOCIAL NETWORK TO MONITOR INFECTIOUS DISEASE. -- -- USED THE CHINESE SOCIAL MEDIA WHICH IS TARGETED AT MEDICAL PROFESSIONALS AND AGGREGATES LOCAL NEWS FROM [ INDISCERNIBLE ] BUT ALSO LOCAL DOCTORS TO CREATE A DATABASE OF PATIENT DATA. SO WE HAD AT THE TIME IN JANUARY 2020 A FEW HUNDRED CASES BUT YOU COULD ALSO SEE INTERESTING INFORMATION. YOU CAN SEE THE AGE DISTRIBUTION OF THESE CASES WITH THE BLUE CURVE OF PRESENTING THE RELATED RISK OF BEING DISEASESSED BY AGE AND INCREASING IN OLDER AGE GROUP WHICH IS A DEFINING ISSUE. AND ON THE RIGHT-HAND SIDE YOU CAN SEE HOW THE SOCIAL MEDIA BASED DATA IN LIGHT BLUE CORRESPONDS TO GROUND TROOP DATA THAT WAS RELEASED BY THE CHINESE CDC. WE MADE THIS DATABASE. IT WAS ONE OF THE FIRST TO BE AVAILABLE TO THE PUBLIC AND WE'VE NOW EXPANDED ON THE DIGITAL SURVEILLANCE IDEAS WITH COLLABORATORS WHERE WE'RE LOOKING AT BOTH COVID-19 BUT ALSO SOME OF THE DISEASES SUCH AS MEASLES. THROUGHOUT THE PANDEMIC WE'VE BEEN WORKING CLOSELY WITH CHINA AND PARTICULARLY WITH OUR LONG-TERM COLLABORATOR ON FLU. IT HAS MANY LABORS OF INTERVENTION. AND ONE OF THE INTERESTING STUDIES WAS TO MONITOR CONTACTS CLOSELY. SO YOU SEE A CONTACTS BETWEEN DIFFERENT AGE GROUPS. WITH RED REPRESENTING HIGH INTENSITY OF CONTACTS. ON BASELINE YOU CAN SEE FREQUENT CONTACTS BETWEEN CHILDREN IN SCHOOLS AS WELL AS BETWEEN ADULTS AND THEIR CHILDREN AND THEN THE SQUARE IN THE MIDDLE REPRESENTS CONTACTS AT WORK. AND THE MIDDLE GRAPH YOU SEE CONTACTS DURING THE LOCKDOWN PERIOD WHICH WAS VERY STRICT IN CHINA AND YOU CAN SEE A LOT OF CONTACTS THAT HAVE DISAPPEARED THAT YOU CAN SEE ON THE RIGHT-HAND SIDE. THE CHANGES IN CONTACTS -- [ INDISCERNIBLE ] AS MONITORED BY GPS PHONES WHICH IS ONE OF THE INDICATORS OF CONTACTS AND PREVENTION USE FOR OTHER PANDEMICS. WE COULD USE THEM TO -- MODELS AND LOOK AT THE DIFFERENT IMPACT OF TRANSMISSION. WE SEE AN UNCONTROLLED EPIDEMILOGICA--EPIDEMIC IN RED. WE DO NOT INTERRUPT TRANSMISSION AND ALSO THE TOTAL SIZE OF THE OUTBREAK IS [ INDISCERNIBLE ] SO CLOSING SCHOOL IS NOT ENOUGH. SO WITH CHINA STILL WITH -- WE'VE BEEN ABLE TO LOOK AT DETAILED CONTACT TRACING DATA THAT THEY HAD FROM WUHAN PROVINCE AND THIS WAS AT THE VERY BEGINNING OF THE OUT BLACK. THE NETWORK ON THE RIGHT PRESENTED TRANSMISSION OF COVID-19 CASES FROM ABOUT 1100 COVID-19 INFECTIONS. THE DIFFERENT COLORS REPRESENTING DIFFERENT CITIES WITHIN THE PROVINCE. AND YOU CAN SEE A HISTOGRAM. YOU CAN SEE THAT ABOUT 70% OF CASES -- -- SECONDARY INFECTION. THERE WAS STRICT CONTACT TRACING AND QUARANTINE AS WELL AS SOCIAL DISTANCING BUT SOME CASES [ INDISCERNIBLE ] SO A LOT OF PE -- PET HETEROGENEITY. WE ALSO SEE THAT CASES WITH FEVER ARE COMING FROM WUHAN WAS THE EPICENTER OF THE OUTBREAK. THEY WERE SUSPECTINGS THEY HAD COVID AND ALSO A LOT OF TRANSMISSION OF THE HOUSEHOLD AND THE FAMILY OF OVER 80% IS IN THAT SETTING BECAUSE -- SO NOT MUCH CONTACT IS HAPPENING OUTSIDE OF THE FAMILY. SO WE CAN ALSO USE THIS DATA ON CONTACTS AND TRANSMISSION. HERE WE WERE INTERESTED IN DOING JUST CASE BASED INTERVENTION WHICH WE SEE ON THE LEFT AND THAT MEANS DETECTING CASES ISOLATING THEM AND QUARANTINING CONTACTS AND THEN ON THE RIGHT-HAND SIDE WE LAYER CASE INTERVENTIONS WITH SOME LEVEL OF SOCIAL DISTANCING AND WE CAN SEE THAT BECAUSE THERE IS A HIGHER RATE OF TRANSMISSION BUT ALSO A LOT OF OF THE TRANSMISSION IS IN THE PRESYSTEMATIC PHASE IT'S VERY DIFFICULT. SO YOU WANT TO BE IN THE BLUE AREA WHICH IS WHERE THE REPRODUCTION NUMBER IS BELOW ONE AND YOU'RE NOT ABLE TO SUSTAIN A PANDEMIC. IF YOU LOOK ON THE RIGHT -- AND LAYER IT WITH SOCIAL DISTANCING -- YOU THEN ARE BETTER ABLE TO REALLY INTERRUPT TRANSMISSION AND THIS IS A STRATEGY THAT A NUMBER OF COUNTRIES HAVE TRIED TO ADOPT. SO WE'VE BEEN WORKING WITH COLLEAGUES IN SOUTH AFRICA AND AT THE NATIONAL INSTITUTE OF COMMUNICABLE DISEASE. AND WHAT IS INTERESTING ABOUT SOUTH AFRICA IS THAT MOST OF THE EPIDEMIC HAS BEEN DRIVEN BY NATURAL INFECTION. THE VACCINE HAS BEEN LATE COMING. BUT IT'S VERY INTERESTING TO TRY TO UNDERSTAND NATURAL IMMUNITY. SO TO HAVE A STRONG COHORT -- FOLLOWING PARTICIPANTS FOR OVER A YEAR THROUGH THREE DIFFERENT WAYS OF INFECTION WHICH YOU CAN SEE HERE IN GRAY. AND THEN PEOPLE ARE PCR'D EVERY THREE DAYS AND THEN TESTED EVERY THREE MONTHS. AND YOU CAN SEE THAT AT THE END OF THE DELTA WAVE MAY OF 2021 WE SEE ABOUT 60% OF PARTICIPANTS HAD BEEN NATURALLY INFECTED AND MODELING THE RISK WE SEE THAT PRIOR INFECTION IS 85% PROTECTED BY ANY VARIENT. IT WOULD BE QUITE DIFFERENT WITH OMICRON. AND WE ALSO SEE -- [ INDISCERNIBLE ] SIMILAR TO WHAT WE SEE OF VACCINATION. SO WE CAN USE THIS CAREFUL LEHMAN TOWARD COHORT TO MAKE PROJECTIONING OF WHAT WILL HAPPEN NEXT. *. WE'RE MAKING PROJECTION OF THE OMICRON WAVE. AND THE RELATED TRANSMISSIBILITY TRANSMISSIBILITY. THEN WE'RE LOOKING AT THE PROJECTED ATTACK RATE IN SOUTH AFRICA WHICH WE PROTECT TO BE AROUND 70%. THE FOURTH GRAPH PRESENTS THE OUTBREAK AND ON THE RIGHT-HAND SIDE THE PORTION OF INFECTIONS. [ INDISCERNIBLE ] SO IN ADDITION TO DOING THIS SHELTER IN PROTECTION OF OMICRON WE CAN USE THIS DATA TO THINK ABOUT THE LONGER TERM CONSEQUENCES. WHAT COULD BE THE CONSEQUENCES OF IMPRINTING WHICH IS THE IDEA 6 WHAT HAVE WHAT YOU'VE SEEN IN THE PAST WILL DRIVE THE FUTURE VARIANTS. *. SO WE'VE ALSO BEEN ABLE TO LOOK AT SOUTH AFRICA DATA TO UNDERSTAND THE IN DIRECT CONSEQUENCES OF THE PANDEMIC AND THAT IS THE CONSEQUENCES ON A RANGE OF CHRONIC INFECTION. THIS IS A TOPIC THAT IS STUDIED A LOT. BUT WE RELIED ON THE SURVEILLANCE FROM THE PRIVATE HEALTH CARE SYSTEM WHICH IS CALLED MED CARE. AND WE SEE THOSE AT THE BOTTOM GRAPHS HERE. WHAT IS GOOD IS THEY HAVE HISTORICAL DATA BEFORE COVID-19 WHICH IS IN BLUE WHICH ALLOWS US TO CREATE A BASELINE LEVEL OF HOSPITALIZATION MIRRORING WHAT COULD HAVE HAPPENED IF COVID-19 WAS NOT CIRCULATING. AND THE DIFFERENCE BETWEEN THE BLUE LINE VERSUS THE BLACK WHICH IS WHAT HAPPENED WE CAN SEE THE IMPACT OF THE PANDEMIC. SO HERE WE'RE LOOKING AT THE IMPACT OF RESPIRATORY ADMISSIONS. AND WITH CHILDREN WE'RE SEEING FEWER HOSPITALIZATION THAN IN NORMAL YEARS. HOWEVER IN ADULTS WE'RE SEEING MORE HOSPITALIZATIONS THAN IN NORMAL YEARS DUE TO COVID-19 AND WE THINK SOME OF THE CHANGES THAT ARE EXPLAINED. IN BLUE WE HAVE THE VIRUSES AND IN ORANGE WE HAVE THE COVID-19. SO THIS WAS COVID-19 BUT THE INTEREST WAS TO LOOK AT OTHER CONDITIONS NOT RELATED TO COVID-19. WE'RE LOOKING AT 19 DIFFERENT CONDITIONS THAT LEAD PEOPLE TO THE HOSPITAL. SOME ACUTE. SOME CHRONIC. WE'LL FOCUS ON THE TOP LEFT FOR A SECOND. THIS IS FOR NONCOVID-19 PNEUMONIA AND INFLUENZA HOSPITALIZATIONS. PRELOCKDOWN IS THE REFERENCE BEFORE COVID-19 AND ON THE Y AXIS WE HAVE DIFFERENT PHASES LINED UP CHRONOLOGICALLY. AND YOU CAN SEE THAT FOR PNEUMONIA AND INFLUENZA WE SEE A SUBSTANTIAL DECREASE MORE THAN 50% FOR SOME OF THE PERIOD RELATED TO PAST YEARS. BECAUSE WE THINK THERE HAVE BEEN FEWER RESPIRATORY VI VIRUSES BEYOND COVID-19. BUT WE ALSO SEE SOME OF THE CHANGES FOR A RANGE OF CARDIOVASCULAR CONDITIONS AND CANCERS AND INJURY. THOSE CHANGES ARE BECAUSE PEOPLE AVERTED THE HEALTH CARE SYSTEM DURING LOCKDOWN AND PERHAPS 13469 CONDITIONS ARE BEING MISDIAGNOSISSED OR MISTREATED BECAUSE PEOPLE DIDN'T REALLY CARE FOR IT AND THAT MIGHT TRANSLATE INTO -- [ INDISCERNIBLE ] IN THOSE CONDITIONS AFTER COVID-19. THIS IS MY LAST SLIDE. I HOPE TO GIVE YOU AN OVERVIEW OF WHAT MODELING HAS BECOME AS A TOOL. TO HELP US ANTICIPATE THE PROGRESSION OF THE PANDEMIC AND ALSO THE CONSEQUENCES OF THE PANDEMIC ON A RANGE OF CONDITIONS AND WE THINK IT'S VERY IMPORTANT IN BUILDING SO THAT PEOPLE CAN LOOK AND UNDERSTAND THE DATA AND MONITOR THE PROGRESS OF THE PANDEMIC. THANK YOU ROGER AND BACK TO YOU. >> THANK YOU VER CECIL. WE THINK DATA SCIENCE IS IMPORTANT FOR ALL KINDS OF HEALTH INTERVENTIONS AND ALL KINDS OF RESEARCH. IT'S ESSENTIAL TO GO ALONG WITH INNOVATION. THIS IS LAUNCHED. $5 MILLION TO 12 AFRICAN COUNTRIES WITH 15 OTHER INSTITUTES BESIDES THE FOUR OF US. OTHER CHANGES THAT HAVE OCCURRED THROUGH SCIENCE. THE FACT THAT ALL OF THE RESEARCH THAT IS GOING ON NOW MUCH OF THE RESEARCH IS FOUND IN PREPRINTS AS OPPOSED TO THE PEER REVIEW LITERATURE WHICH HAS THE ADVANTAGE OF GETTING SEEN RAPIDLY WHEN IT'S VALUABLE AND ALSO THAT NONPEER REVIEWED THINGS CAN BE SEEN. BUT IT'S THE SPEEDED UP REVIEW THAT CAN BE VIEWED QUICKLY. THE EMERGENCY USE AUTHORIZATION THAT WAS PIONEERED IN THE UNITED STATES HAS GONE THROUGHOUT THE WORLD AND MANY COUNTRIES NOW LIKE INDIA HAVE GIVEN EMERGENCY USE AUTHORIZATIONS TO NEW VACCINES BEFORE THE FULL-TIME TO MONITOR FOR SEVERAL YEARS TO SEE VACCINE LONG-TERM ADVERSE CONSEQUENCES OF VACCINE. WE'VE SEEN IN THE U.S. ELEVATION OF SCIENCE IN THE U.S. GOVERNMENT. ERIC LANDER IN THE CABINET AND TONY AS THE CHIEF MEDICAL ADVISOR WE WOULD LOVE TO SEE CABINET MINISTERS IN AFRICAN COUNTRIES WHO ARE CONCERNED ABOUT SCIENCE, RESEARCH AND HEALTH. BUT SCIENCE AND RESEARCH AND SPECIFICALLY. THIS WOULD CHANGE THE WAY WE VIEW THINGS. THIS IS SO IMPORTANT. THE PANDEMIC AND DEALING WITH THE EQUITY ISSUES THAT THE G-7 SPECIFICALLY GOT TOGETHER JUST RECENTLY AND DECIDED THAT SEVERAL INTERVENTIONS WERE CLEARLY IMPORTANT TRYING TO GET GLOBAL SURVEILLANCE AND DETECTION OF NEW OUTBREAKS BY A SURVEILLANCE NETWORK THAT COULD IDENTIFY OUTBREAKS WITHIN A WEEK. DEVELOPING NEW VACCINES WITH A TARGET OF LESS THAN 100 DAYS. CONSTRUCTING VACCINE CONSTRUCTS FOR 20 FAMILIES OF VIRUSES SO WE CAN TAKE THEM OFF THE SHELF WHEN A NEW PANDEMIC OCCURS. THIS WOULD PROTECT THE PLANET AND EMBRACE THE FUTURE. BEYOND THAT WE'VE HAD AN ISSUE OF DISINFORMATION AND I WAS STRUCK IN ROWS WANDA HOW LITTLE VACCINE HESITANCY THERE WAS. PEOPLE WERE EXCITED TO GET THE VACCINE. THEY WERE PREPARED TO RECEIVE IT WHEN IT WA IT WAS THERE. SOMETHING THAT NEEDS TO BE STUDIED. VACCINE MANDATES ARE BEING USED IN SOME COUNTRIES AND NOT OTHERS. SOMETHING THAT WE'RE CONSIDERING HERE BUT WOULD LOVE TO SEE HOW THE OTHER COUNTRIES RESPOND TO THIS. HAS COVID TAUGHT US ANYTHING ABOUT PANDEMIC PREPAREDNESS. WE HAVE TO STUDY THIS CAREFULLY BECAUSE WE HAVE TO KNOW HOW TO DO THINGS BETTER NEXT TIME. MY SON IS A MEDICAL STUDENT. HE SPENT TWO YEARS IN VIRTUAL LEARNING SO I HOPE THAT VIRTUAL LEARNING IS AS QUALITY AS THE REAL THING. MAYBE IT'S BETTER. BUT THAT IS SOMETHING THAT WE'RE GOING TO SEE MORE OF. BUT IT'S CERTAINLY PORTABLE TO OTHER COUNTRIES. THE GLOBAL RESPONSE OF THE PANDEMIC HAS BEEN EXTRAORDINARY. EVERYONE IS INVOLVED IN TRYING TO HELP BRING ABOUT AN END TO THIS PANDEMIC BECAUSE WE'RE ALL IN THIS TOGETHER. PHO -- THE GLOBAL ALLIANCE FOR VACCINES. THE AFRICAN UNION. PRIVATE SECTOR, INDUSTRY ARE ALL LOOKING IN INVESTING IN AFRICA IN DIFFERENT WAYS. AFRICAN GOVERNMENTS ARE ALL ON-BOARD. THE G-7. THE ACADEMIC CENTER. WHAT CAN WE DO? THE TWO OF THINGS THAT WE CAN PROVIDE IN THIS SETTING ARE TRAINING AND RESEARCH AND I THINK THE EXPANSION OF THESE IN AFRICA AS WE'VE DONE WITH AIDS AND HAS BEEN SO EFFECTIVE IN THE PAST 30 YEARS. PETER MY DEPUTY AND I MADE A COMMENTARY WHICH STATES THAT [ INDISCERNIBLE ] OF HEALTH RESEARCH CAPACITY AS AN ESSENTIAL ELEMENT OF PANDEMIC PREPAREDNESS. WHEN WE LOOK AT THE LEADERS IN AFRICA AND BEYOND JOHN LEADING THE AFRICAN CDC, LINDA GRAY IS HEAD OF THE SOUTH AFRICAN MEDICAL RESEARCH COUNCIL WORKING TO GET VACCINE MANUFACTURERS IN AFRICA. SLIM -- -- WORKING TO GET DIAGNOSTICS WITH THE AFRICAN UNION. JEAN NACHEGA WORKING ON SIM POSE YAM US JUST LIKE THIS ONE. AND DR. WU. THOSE FOREIGN LEADERS TRAIN THROUGH NIH AND FOGARTY PROGRAMS ARE REALLY OUR LINK TO THE WORLD TO BUILD BACK THE FUTURE. CHALLENGES GOING FORWARD. BUILDING THAT EPIDEMIC SURVEILLANCE SYSTEM TO IDENTIFY NEW OUTBREAKS. ESTABLISHING CENTERS TO MAKE VACCINES, DRUG SUPPLIES AND DEVICES LOCALLY. MULTIPLE PROVIDERS OF KEY INGREDIENTS THAT ARE AVAILABLE. ACCELERATE RESEARCH UNDER VACCINE GROUPS. ACCESSING COLLATERAL DAMAGE. CAN WE GRANT BIOSECURITY. THE SAME PRIORITY AS MILITARY SECURITY. SO HOW DO WE PREPARE FOR THE NEXT PANDEMIC? WELL FIRST WE HAVE TO RECOGNIZE THAT WE WON'T BE SAFE UNTIL WE ALL ARE SAFE AND THIS INCLUDES PEOPLE IN LOW AND MIDDLE INCOME COUNTRIES WHO DON'T YET HAVE ACCESS TO VACCINES AND DIAGNOSTICS AND DRUGS AND THAT WILL BEGIN WITH SETTING UP THE GLOBAL SURVEILLANCE AND MODELING SUPPORT. WE HAVE TO GET THE AFRICAN LEADERS AND UNION WHO ARE NOW MOTIVATED TO RESPOND TO BUILD ON THEIR PLAN THROUGH THE AFRICAN CDC AND DEFINITELY A BIOTECH INDUSTRY WHICH SOME OF THE COUNTRIES HAVE JUST BEGUN TO DO. PEOPLE ARE INTUNE TO DO THINGS. THE GLOBAL COMMUNITY IS TRYING TO HELP IN ALL SORTS OF WAYS. NOT ALWAYS WELL COORDINATED BUT THE SPIRIT IS THERE. AND ULTIMATELY GLOBAL COLLABORATIONS HAVE DEMONSTRATED AS WITH HIV THAT THESE DISCOVERIES IN SCIENCE CAN LEAD TO INDUSTRY AND FUNDING PARTNERSHIPS THAT HAVE TURNED THAT PANDEMIC OF HIV INTO A CHRONIC DISEASE. WE HAVE A WAYS TO GO WITH COVID BUT THIS IS SOMETHING THAT WE MUST PURSUE TODAY. I WANT TO GIVE A BIG SHOUT OUT TO WIN -- WHO HAS DEVELOPED THIS INCREDIBLE PROGRAM. AND DAN KASTNER. YOU'VE DONE A GREAT SERVICE TO THE MEDICAL COMMUNITY AND THE WORLD TO PUT THESE ON THE WEB AND ARCHIVE THEM. AND DAN YOU HAVE BIG SHOES TO FILL. THANK YOU SO MUCH FOR LETTING ME SPEAK TO YOU TODAY. >> THANK YOU, THANK YOU VERY MUCH ROGER. .-- IT'S EXCITING TO SEE HOW THIS TRULY IS BEING TRANSLATED INTO A PLAN OF GLOBAL ACTION RATHER THAN JUST GLOBAL RECOGNITION WHICH BECAME APPARENT DURING THE EPIDEMIC. WE HAD A GLITCH IN THE SUBMITTING OF QUESTIONS. SO NOT ALL OF THE QUESTIONS THAT WERE SUBMITTED WAS IT POSSIBLE TO PRESENT TO HIM WHILE HE WAS WITH US BUT WE'LL FORWARD THEM TO HIM. WE APOLOGIZE. WITH SPECIFICALLY ROGER WHAT DO YOU THINK -- WHY DO YOU THINK THE PEAK OF INFECTION IS DECREASING SO RAPIDLY IN SOUTH AFRICA? WHAT DO YOU BELIEVE -- WHAT ARE THE MECHANISMS THAT COULD BE RESPONSIBLE FOR THAT AND IS PART OF THAT DUE TO VAC NATION? AND THE * PUBLIC HEALTH RESPONSE. >> THAT IS A QUESTION FOR THE MODELER. IT IS SO BIG THAT IT'S GOING TO COME QUICKLY AND GO QUICKLY. CECIL CAN YOU COMMENT ON THAT? >> YEAH. BUT YOU ANSWERED IT WONFULLY, ROGER. * WE DON'T THINK IT'S INTERVENTIONS OR VACCINATION. BECAUSE WHAT WE HEAR ON THE GROUND IS NOTHING REALLY HAPPENED IN TERMS OF INTERVENTION AND THE VACCINE ROLLOUT IS STILL RELATIVELY SLOW. WITH THE HIGH TRANSMISSION RATE YOU WOULD EXPECT IT TO BE SPIKEY AND BURN ITSELF OUT QUICKLY WHICH IT HAS. >> CAN WE BELIEVE THAT WE'RE GOING TO BE BETTER IN THE U.S. BY FEBRUARY OR MARCH? THAT IS A QUESTION FOR TONY? >> YES. WE HOPE SO. >> DO YOU THINK IT WILL BE GOING AWAY IN THE U.S. BY FEBRUARY OR MARCH, CECIL. WHAT ANSWERS DO THEY PROVIDE? >> WE'RE RUNNING PREDICTIONS COMBINING RESULTS FROM DIFFERENT MODELS IN THE U.S. WHICH PREDICTIONS IS WHAT WAS RELEASED TODAY AND OUR PREDICTION IS THE PEAK OF THE EPIDEMIC WILL BE REACHED WITHIN ONE TO THREE WEEKS. VERY SOON. DEFINITELY BY JANUARY. ALIGNING WITH TONY'S PROJECTSESES IT WILL BE MUCH BETTER BY FEBRUARY. BUT THE SEVERITY OF THE DISEASE -- [ INDISCERNIBLE ] AND THAT WILL LEAD TO HOSPITALIZATIONS IN UNVACCINATED PEOPLE. >> THANK YOU. >> THE QUESTION IS -- THE USE OF MODELING IS DEPENDENT UPON THE RELIABILITY ACCURACY OF THE INFORMATION THAT IS PROVIDED FOR THE MODELING SYSTEM. TO WHAT EXTENT, ARE THERE PROBLEMS IN ACCESSING THAT KIND OF INFORMATION PARTICULARLY IN MANY OF THE COUNTRIES IN AFRICA THAT YOU REFERRED TO? >> SO YES AND NO. HAVING WORKED ON A LOT OF DATA I WILL SAY THAT THE U.S. IS ACTUALLY A DATA POOL COUNTRY COMPARED TO WHAT WE SEE IN EUROPE. VERY DETAILED DATA AND THE ABILITY TO RUN THESE COHORTS OF FIFA THAT ARE FOLLOWED CLOSELY. PERHAPS SOMEHOW WE DON'T SEEM TO HAVE IN THE U.S. IT'S A COMPLICATED SYSTEM IN THE U.S. BUT WE CAN FIND VERY DETAILED AND GOOD DAT DATE -- DATA [ INDISCERNIBLE ] WHERE DATA IS MUCH FASTER AND THE WAY TO TRY TO USE THIS IS TO USE MODELS FROM NEIGHBORING COUNTRY OR TO DO SCENARIOS. IF MY PARAMETER IS THIS OR THAT WOULD THAT CHANGE MY PROJECITONSES? THERE IS A WAY TO HANDLE THE UNCERTAINTY OF THE DATA >> A QUESTION ROGER, WHAT IS THE INVOLVEMENT OF FOGARTY WITH RESPECT TO THE COVID PROBLEM IN LATIN AMERICA? >> LATIN AMERICA HAS BEEN IN SOME WAYS SPECIAL. BECAUSE THEIR HIGH RATES OF VACCINATION. FOR COVID. SO WE HAVE HAD LIMITED INVOLVEMENT IN LATIN AMERICA BECAUSE THE SETTING IN AFRICA IS SO MUCH DIFFERENT AND SO MUCH UNDER RESOURCED. SO I CANNOT GIVE YOU A FULL UPDATE WITHOUT GOING TO OUR RECORDS. WE HAVE GRANTS IN LATIN AMERICA BUT NOT AS MANY AS WE HAVE IN AFRICA AND LOW-INCOME COUNTRIES. 7 >> SO IS THAT TRUE FOR MEXICO AS WELL? >> MEXICO HAS DONE NICE WORK WITH AND HAS GOOD EPIDEMIOLOGY. AND HAS DONE NICE WORK WITH COVID IN COLLABORATION WITH CECIL'S GROUP IN MODELING. 78 >> WHAT IS THE CURRENT STATUS OF PET FAR. IS IT STILL ACTIVE IN AFRICA OR IS ITS FUNDING CONTINUING? >> FUNDING IS CONTINUING. THE PRISON IS NOT YET A SIGNED A NEW DIRECTOR BUT JOHN THE HEAD OF THE AFRICAN CDC HAS BEEN OFFERED THE POSITION BUT IT REQUIRES SENATE CLEARANCE. SO, THAT IS UP IN THE AIR RIGHT NOW. THERE IS A POSITION THAT WILL BE FILLED AND THE PROGRAM WILL BE CONTINUING. THE ADDITIONAL QUESTION IS WHETHER THERE WILL BE A BROADENING OF MANDATE TO INCLUDE COVID ACTIVITIES AS WELL AS HIV. AND IT'S REMARKABLE TO US THAT HAVING INVESTED FOR SO LONG IN HIV RESEARCH IN MANY COUNTRIES THAT THOSE PEOPLE WHO HAVE THAT EXPERIENCE IN TRAINING AND HISTORY IN RESEARCH HAVE BEEN SO READY TO ADAPT TO WORKING NOW WITH ANOTHER PANDEMIC AND TO ASSUME THOSE LEADERSHIP POSITIONS. ANYTHING THAT WE DO IN CAPACITY BUILDING FOR COVID WILL HAVE RETURNS IN THE FUTURE. >> VALERIE ASKED WOULD YOU SAY THAT THE UNITED STATES HAS THE RESPONSIBILITY OF SHARING VACCINE PATENTS AND INCREASING ACCESSIBILITY OF VACCINATIONS UNTIL AFRICA IS UP AND RUNNING ON ITS OWN? >> THAT IS A QUESTION THAT IS CURRENTLY UNDER DISCUSSION. I THINK BIG PHARMA FEELS THAT THEY CAN TURN UP THE NOTCH AND PRODUCE MORE VACCINES. THE EVIDENCE IS THAT SO FAR VERY FEW AS YOU SAW LESS THAN 8% OF THE VACCINES PRODUCED HAVE GONE TO AFRICA. AND EVEN COMPANIES LIKE MODENA HAVE BEEN SLOW TO EMBRACE A GLOBAL AGENDA. SO THAT IS ONE OF THE REASONS WHY AFRICANS WANT TO DEVELOP A MANUFACTURING CAPACITY. SOME OF THAT WILL BE WITH DECK TRANSFER. THERE IS DISCUSSION UNDERWAY. FOR RESEARCH INSTITUTE THAT CAN WORK WITH NEW VACCINES THAT MIGHT BE OF PARTICULAR INTEREST IN AFRICA SO I THINK WE HAVE A LONG WAY TO GO THERE BUT SHORT-TERM THE FACT THAT WE'VE GOTTEN 9 BILLION DOSES OF VACCINE OUT IN THE PAST YEAR WITH NEW PRODUCTION COMING ON-BOARD IN INDIA AND IN THE UNITED STATES AND THAT MEANS THERE WILL BE A GOOD SUPPLY OF VACCINES FOR THE NEXT TWO OR THREE YEARS. >> CHRIS ASKED HOW ARE THE CROWDED POOR CITIES SUCH AS THOSE IN INDIA, PAKISTAN RELATIVELY SPARED WHEN THEY HAVE NO VACCINES? I KNOW THERE HAVE BEEN BAD DAYS IN INDIA BUT WHY IS THE DEATH RATE IN THE UNITED STATES WITH ITS 70% VACCINATION HIGHER THAN IN COUNTRIES WITH 5% TO 10% VACCINATION? >> AT LEAST I DON'T KNOW IN INDIA EXACTLY BUT IN AFRICA THE AGE DISTRIBUTION IS SUCH THAT THERE ARE FEWER OLDER PEOPLE AND THOSE ARE THE PEOPLE MOST LIKELY TO DIE FROM COVID. SO THE YOUNGER THE HEALTHIER YOU ARE THE LESS LIKELY YOU ARE OF DYING. SO THAT MAY EXPLAIN SOME OF IT. ALSO THE INDIANS HAVE BEEN EXTRAORDINARY WHILE THEY MISSED THE FIRST PANDEMIC OR THE% PEAK THE SECOND PEAK WAS TERRIBLE. DESPITE THE FACT THAT THEY MADE LOTS OF VACCINES. MODI REQUEST THAT THE VACCINE COMPANIES IN INDIA NOT EXPORT THEIR VACCINES UNTIL THE INDIAN POPULATION WAS IMMUNIZED AND THAT CHANGED IMMUNIZATION COVERAGE. INDIA WAS A DARKER PINK BUT NOT A RED SO THE COVERAGE IS -- THEY ARE IMMUNIZING SEVERAL MILLION PEOPLE A DAY. IT IS EXTRAORDINARY. >> DAN ASKS WHETHER THERE IS SOME CONJECTURE REGARDING THE POSSIBLE EVOLUTION OF COVID-19 IN THE SETTING OF INDIVIDUALS WITH INCOMPLETELY TREATED HIV AS IS SEEN IN SOME AREAS OF SUB SAHARAN AFRICA HAS THE MODELING PROVIDED ANY INSIGHTS ON THESE RELATIONSHIPS? >> LET ME START WITH THAT AND THEN I ASK CECIL. WHAT IS INTERESTING IN THIS OMICRON STRAIN IS IT WAS FIRST SEEN QUITE A WHILE AGO AND THEN THERE IS NO EVOLUTION OF THIS STRAIN UNTIL JUST RECENTLY UNTIL NOVEMBER. A FLAT LINE. SO YOU HAVE A VIRUS THAT HAS NOT CHANGED FOR A YEAR AND A HALF. HOW COULD THAT BE? WHERE CAN IT HIDE? AND ONE OF THE HYPOTHESIS IS SOMEONE WHO WAS IMMUNO COMPROMISED WHO CARRIED THAT TRAIN FOR THE DURATION. IT IS AN INTERESTING SPECULATION. ANY OTHER INSIGHTS TO THIS, CECIL? >> THAT IS THE PRIMARY -- THERE IS ALSO A SECOND -- PRESUMABLY OF THAT SAME PATIENT. [ INDISCERNIBLE ] AND THE MODELING THAT ALLOWS YOU TO UNDERSTAND THE RELATIONSHIP. IT'S NOT THE TRANSMISSION THAT WE TALKED ABOUT TODAY. THERE IS SOME EVOLUTIONARY WORK BEING DONE AT THE UNIVERSITY OF WASHINGTON ON THIS AND THIS IS ALSO SOMETHING THAT WE SEE IN THE FLU WHERE PEOPLE WHO ARE IMMUNO COMPROMISED GENERATE STRAINS THAT ARE SEEN IN THE POPULATION. [ INDISCERNIBLE ] >> THE QUESTION ASKED BY -- HOW DO YOU JUSTIFY THE WIDE AVAILABILITY OF BOOSTERS IN THE UNITED STATES WHILE LOW AND MIDDLE INCOME COUNTRIES HAVE VERY LOW VACCINATION COVERAGE DUE TO LACK OF SUPPLY? YOU WANT TO COMMENT ABOUT THE QUESTION OF SUPPLY AND AVAILABILITY? REGARDING BOOSTERS PARTICULARLY IN AFRICA? OR LATIN AMERICA. >> THAT IS REALLY WHERE THE ISSUE OF EQUITY IN VACCINE DISTRIBUTION COMES ABOUT. AND I THINK MOST RECENTLY AS SUPPLY HAS GOTTEN GREATER WE CAN BE MORE GENEROUS IN THE SUPPLIES PRESENTED TO THE CO-VAX FACILITY. THE GROUP THAT IS RECEIVING VACCINES AND DONATIONS FROM MULTIPLE COUNTRIES WITH THE IDEA THAT THIS WOULD GO OUT TO AFRICA AND LOW-INCOME COUNTRIES TO TARGET 20% OF THE POPULATION WHO ARE AT HIGHEST RISK. THE ELDERLY AND HEALTH CARE WORKERS. THAT HAS NOT HAPPENED YET. COUNTRIES MAY MAKE VACCINE ARE HARD PReSED TO GIVE UP THEIR VACCINES UNTIL THEIR OWN POPULATIONS HAVE BEEN FULLY IMMUNIZED BUT NOW THAT WE HAVE A SURPLUS IN THE U.S. WE'RE CONTRIBUTING MORE TO THE CONTINENT. ONE OF THE PROBLEMS IS THE INABILITY TO HAVE THE REFRIGERATION FOR THE LOW TEMPERATURE PFIZER VACCINE. VACCINES THAT ARE SUITABLE AT REFRIGERATED TEMPERATURES ARE MUCH MORE SUCCESSFUL AND SINGLE DOSE VACCINES WOULD BE OPTIMAL IF THEY DIDN'T NEED TO BE BOOSTED. >> WE HAVE AN IMPORTANT QUESTION FROM A PRIMARY CARE PHYSICIAN. HOW DO I DECIDE WHETHER TO RECOMMEND ANTIVIRAL VERSUS MONOCLONAL THERAPY IN THIS TIME OF OMICRON. WOULD A STANDARD PCR DIFFERENTIATE OMICRON FROM DELTA? CAN YOU COMMENT ABOUT THAT? >> THE -- RIGHT NOW THAT IS A DIFFICULT DECISION. IF SOMEONE HAS AN INFECTION AND THEY AR IMMUNO COMPROMISED -- WHETHER THERE IS A SUITABLE MONOCLONAL FOR THAT STRAIN OR WHETHER REMDESIVIR AND THE OTHERS ARE MORE APPROPRIATE BUT I'M NOT A CLINICIAN. >> WE'LL FORWARD THAT TO TONY AND HAVE HIM RESPOND. >> AMELIA ASKS THAT YOU PREDICTED 34 DAYS OF OMICRON OUTBREAK IN SOUTH AFRICA THE PEAK HAS PASSED. DOES IT APPEAR THAT YOUR PREDICTIONS WERE VERY CLOSE? >> YES. THE EPIDEMIC IS IS NOT OVER YET. IT IS ON ITS WAY DOWN AS HAS BEEN MENTIONED BUT I THINK WE'RE GOING TO BE CLOSE. >> OKAY. SO WE ANXIOUSLY WILL SEE AND HOPE THAT THINGS WILL FOLLOW-THROUGH. A COUPLE OF INQUIRIES AS TO WHETHER THERE IS -- WHETHER FOGARTY -- HOW DOES FOGARTY APPROACH VACCINE EQUITY ISSUES? AND YOUR PROGRAMS. IS THERE A SPECIAL APPROACH TO THAT IMPORTANT PROBLEM? OR I IS THIS IS A LOCAL PROBLEM >> EQUITY IS QUITE SPECIFIC. WE'RE INTERESTED IN TRAINING LOCAL PEOPLE. TO PROVIDE LOCAL ANSWERS AND TO MAKE LOCAL DECISIONS. SO WE'VE TRAINED PEOPLE FOR INSTANCE LIKE -- SLIM WHO'S HEAD OF THE COVID ADVISORY COMMITTEE FOR THE MINISTRY OF HEALTH IN SOUTH AFRICA. THIS IS A DECISION THAT THEY HAVE TO MAKE FOR THEIR OWN PEOPLE. -- BUT OUR CONTRIBUTION IS TO HELP TRAIN LEADERS TO ADDRESS THESE. SOMETHING THAT WE'RE ALL CONCERNED WITH WHEN WE SEE THE INEQUITY AND HOW WE CAN ADDRESS THAT. AN ISSUE THAT WE HAVE AT HOME AS WELL. GETTING VACCINES TO THE POOREST COMMUNITIES. >> ROGER IN YOUR OPINION WHAT COUNTRY OR COUNTRIES HAVE HAD THE MOST EFFECTIVE PUBLIC HEALTH RESPONSE AGAINST THE COVID PANDEMIC AND WHAT LESSONS COULD WE LEARN AS A GLOBAL COMMUNITY-BASED UPON THOSE INDIVIDUAL COUNTRY EXPERIENCES? >> WELL FOR HIGH INCOME COUNTRIES I WAS ON THE PHONE YESTERDAY WITH A SENIOR VIROLOGIST IN AUSTRALIA WHO SAID THEY'VE DONE WELL IN CONTROLLING THE PANDEMIC. THEY HAVE HIGH LEVELS OF IMMUNIZATION. THEY HAVE VERY FEW DEATHS SO THEY'VE DONE ALL OF THE RIGHT THINGS. AND I MUST SAY I WAS IMPRESSED IN RWANDA. A POOR COUNTRY WITH HOW MUCH THEY'VE DONE FROM THE ONSET TO NOT LET FOREIGNERS >>> THE COUNTRY WITHOUT BEING SCREENED AT THE BORDERS. PUTTING MESS CA -- MASKING IN AND SHUTTING DOWN SOCIAL DISTANCING. 7 AND WHEN THEY PREPARED TO HAVE VACCINES THEY WENT RIGHT INTO THE -- POPULATIONS AND THEY COULD ABSORB AND USE THEM IMMEDIATELY. IT WAS QUITE A UNIQUE SITUATION AND WITH A COUNTRY THAT IS HIGHLY COMMITTED TO ITS PUBLIC HEALTH SYSTEM. >> IN AUSTRALIA I BELIEVE THAT INDIVIDUALS HAVE BEEN PREVENTED FROM MOVING FROM ONE STATE AREA TO ANOTHER. WHICH IN THE FACE OF LOW INFECTION RATES LOW CLINICAL INFECTION RATES AND DIFFERENT COMMUNITIES IT CAN CAUSE QUITE AN UPROAR. THE AUSTRAILIAN PUBLIC -- DO YOU HAVE ANY COMMENTS ABOUT HOW POLICIES, HOW DO YOU BALANCE WHAT INDIVIDUALS WANT TO DO AND WHAT REGULATIONS REQUIRE THEM TO DO? IS IT POSSIBLE TO GO TOO FAR WITH REGULATIONS? >> WHEN WE'RE HAVING THE SAME PROBLEM IN THE UNITED STATES OF WHAT CAN WE MANDATE? WE CAN MANDATE FEDERAL EMPLOYEES AND EMPLOYEES OF COMPANIES MORE THAN 100 TO BE IMMUNIZED AND TO BE TAKEN CARE OF BUT WE CANNOT MANDATE EVERYONE. THAT IS A REAL CONTROVERSY. IF WE HAD OUR WAY AS PUBLIC HEALTH PHYSICIANS WE WOULD SAY EVERYONE SHOULD WANT TO BE VACCINATED SO WE WOULDN'T HAVE TO MANDATE. PEOPLE ARE HESITANT AND UNCERTAIN AND IF YOU MANDATE IT WILL ONLY THE BELIEF IS THAT IT WILL ONLY LEAD TO A NEGATIVE RESPONSE. A RESPONSE THAT WE REALLY DON'T WANT. SITES HOW YOU LOOK AT PRIVATE RIGHTS OR INDIVIDUAL RIGHTS AND THAT IS ONE THAT WE HAVE NOT SOLVED HERE IN THE UNITED STATES. >> WHEN DID THAT DEVELOP HISTORICALLY IN THE UNITED STATES? I SEEM TO RECALL THAT THE PUBLIC HEALTH RESPONSE FOR EXAMPLE TO TYPHOID IF SOMEONE WAS A CARRIER THEY COULD BE LITERALLY PUT AWAY IN ISOLATION. I BELIEVE DURING THE POLIO EPIDEMIC THERE WERE MANDATES WITHIN -- I'M NOT SURE IF THEY WERE FEDERAL OR NOT. BUT CHILDREN COULD NOT GO TO SCHOOL IF THEY WERE NOT VACCINATED. ALL OF THAT. WHEN DID IT CHANGE? >> ONE THING THAT CHANGED WAS IN THE CARTER ERA THE MANDATE TO BE IMMUNIZED BEFORE CHILDREN WENT TO SCHOOL WAS PUT IN PLACE. THAT YOU USED TO BE ABLE TO OPT OUT. YOU WERE IN UNTIL YOU PROTESTED BUT THAT LAW REALLY ALLOWED FOR CONTROL OF MEASLES IN THE UNITED STATES. IT WAS FLUF -- INFLUENCAL AND SUCCESSFUL. NOW WE'RE ALL IMMUNIZED AGAINST POLIO EXCEPT FOR A FEW. AND WE'VE PERIODICALLY HAVE HAD TINY OUTBREAKS. I HAVE NOT HEARD OF ANY IN THE RECENT PAST BUT THEY STILL WERE A PROBLEM. >> SO IF YOU WOULD ENGAGE IN A LITTLE PERHAPS SPECULATION CERTAINLY OPINION -- IN TODAY'S MEDICAL POSSIBILITIES WE CAN VACCINATE TO BASICALLY PREVENT HELP -- HEPATITIS B VIRUS. WE CAN TREAT HEPATITIS "C." WE HAVE DRUGS THAT CONVERT HIV INTO A CHRONIC LIVABLE DISEASE AND WITH COVID WE SEEM TO HAVE EVERYTHING IN THE WAY OF PREVENTION, TREATMENT AND SO FORTH. BUT IN YOUR VIEW HOW DO WE GET TO THE POINT WHERE ALL OF THESE THINGS BECOME AVAILABLE TO POPULATIONS RICH AND POOR AROUND THE WORLD. TO WHAT OBSERVES -- EXTENT DOES THE SCIENTIFIC COMMUNITY HAVE TO WORK WITH THE POLITICAL REALITIES. WHAT IS YOUR PERSONAL VIEW AS TO WHAT DO YOU THINK THE FUTURE IS GOING TO HOLD FOR MAKING THESE THERAPIES TRULY AVAILABLE TO EVERYBODY AT A COST THAT CAN BE HANDLED? IS THIS A DREAM OR IS THERE REALLY A REASONABLE POSSIBILITY? >> GREAT QUESTION. WHEN YOU LOOK AT THE HIV EXPERIENCE THOSE DRUGS THAT WERE TENS OF THOUSANDS OF DOLLARS IN THE U.S. 25 YEARS AGO ARE NOW INEXPENSIVE, THEY ARE MADE IN INDIA AT LOW COST AND NOT FOR REIMPORTATION TO THE UNITED STATES. THERE HAS BEEN A SHARING OF INTELLECTUAL PROPERTY SO THEY COULD BE MADE OFFSHORE AT LOW COST FOR THE DEVELOPING WORLD AND THEY ARE SUPPLIED THROUGH PET FAR FOR EXAMPLE. WE DON'T UNDERSTAND THE BEHAVIORAL -- THE BEHAVIOR OF PEOPLE TAKING DRUGS. PETER SMALL SAID THE BIGGEST PROBLEM IN MEDICINE OF DRUG ABUSE IS PEOPLE FAILING TO TAKE THEIR DRUGS. IF SOMEONE WERE TO TAKE THEIR DRUGS ROUTINELY FOR HIV THEY WOULD HAVE A CHRONIC DISEASE AND LIVE AN ALMOST NORMAL LIFE. YET SO MANY PEOPLE FOR REASONS OF DEPRESSION, MENTAL HEALTH PROBLEMS STOP TAKING THEIR DRUGS AT DIFFERENT TIMES AND SET THEMSELVES UP. THERE IS A WHOLE AREA OF BEHAVIORAL RESEARCH ABOUT TAKING DRUGS. WITH HEPATITIS "C" THERE ARE COUNTRIES NOW THAT ARE IN THE PROCESS OF TRYING TO HAVE A ROLLOUT A SCREENING AND TREATMENT. AND THAT IS AVAILABLE NOW IN MANY COUNTRIES OF THE ANTIVIRALS OF DIFFERENT BRANDS ARE AVAILABLE AT A LOW COST IN SOME COUNTRIES AND THERE ARE NATIONAL ROLLOUTS WITH SCREENING AND TREATMENT. SO I THINK THAT WE ALWAYS START HERE IN THE UNITED STATES WITH HIGH COST VACCINES AND DRUGS. AND AFTER WE'VE SATURATED OUR MARKET THERE IS A REAL EFFORT TO MOVE ON. I THINK THAT IS WHERE WHO HAS DEVELOPED THIS INTERNATIONAL PATENTS POOL TO ADDRESS THAT. THERE ARE ECONOMIC ISSUES AND BEHAVIORAL ISSUE ABOUT TAKING THE DRUGS AND VACCINES WHEN YOU HAVE THEM. IT JUST TAKES TIME. AND THAT IS A REAL CHALLENGE IN GLOBAL HEALTH. HOW DO WE DEAL WITH EXACTLY THOSE ISSUES. >> ALL RIGHT. I WANT TO THANK YOU ON BEHALF OF ALL OF THOSE LISTENING AROUND THE WORLD FOR YOUR PRESENTATION TO YOU AND YOUR COLLEAGUE AND ALSO [ INDISCERNIBLE ] >> THANK YOU VERY MUCH. THIS HAS BEEN A REAL -- PLEASURE >> BEFORE WE GO OFF THE AIR NEXT TUESDAY WE HAVE WHAT IS AN EXTRAORDINARY OPPORTUNITY TO DISCUSS ONE OF THE MOST EXCITING DISCOVERIES IN MEDICINE PROBABLY IN THE LAST 50 YEARS OR MORE. AND IS THAT WAS THE DISCOVERY OF HILOCOBACTOR AS THE AGENT IN PEPTIC ULCER DISEASE. SPEAKER WILL BE WITH US FROM PERTH, AUSTRALIA AND MARTIN BLAZER WHO HAS WORKED FURTHER ON THE RELATIONSHIP BETWEEN ORGANISMS LIKE THIS AND THE HOST AND THE DEVELOPMENT OF CHRONIC DISEASE INCLUDING CANCER WILL BE WITH US TO BE THE SECOND SPEAKER. AND THE OFFICIAL TITLE IS THE SPLIT PERSONALITY OF HELEOBACTOR-PYORLI. THANK YOU ALL AND WE'LL SEE YOU NEXT WEEK.