I'LL START THE EVENT BY INTRODUCING OUR KEYNOTE SPEAKER, DR. ANNE SCHUCHAT. IT'S A GREAT PLEASURE TO DO SO. DR. SHOE CAT IS THE PRINCIPAL DEPUTY DIRECTOR OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION. SHE'S A REAR ADMIRAL IN THE UNITED STATES PUBLIC HEALTH SERVICE AND A MEMBER OF THE NATIONAL ACADEMY OF MEDICINE. SHE DID HER MEDICAL TRAINING IN THE DARTMOUTH SCHOOL OF MEDICINE AND THEREAFTER WENT TO NEW YORK CITY, TO NYU, TO DO HER RESIDENCY AND CHIEF RESIDENCY, AND THESE EXPERIENCES OCCURRED REALLY DURING THE EARLIEST DAYS OF THE HIV EPIDEMIC HERE IN THE UNITED STATES. FROM THERE, SHE BEGAN HER CAREER IN PUBLIC SERVICE AS AN AN ACADEMIC INTELLIGENCE OFFICER, YOU MAY KNOW THESE ARE THE DISEASE DETECTIVES THAT MANY OF US HAVE READ BOOKS ABOUT THAT INSPIRED SOME OF US TO BE HERE, INCLUDING MYSELF. FROM THERE, SHE BEGAN BECAME THE FIRST DIRECTOR OF THE ACTIVE BACTERIAL CORE SURVEILLANCE AND EMERGING INFECTIOUS PROGRAM NETWORK. THIS IS A LABORATORY NETWORK DESIGNED TO TRACK THE OCCURRENCE OF BACTERIAL PATHOGENS WITH THE CAPACITY TO IMPACT PUBLIC HEALTH IN THE UNITED STATES, AND IT WAS -- AND THESE INCLUDE THINGS LIKE GROUP A AND GROUP B STREP, AND IT WAS IN THIS CONTEXT THAT SHE BEGAN A VERY SUCCESSFUL EFFORT TO MANAGE THE BURDEN OF GROUP B STREP ON INFANTS THROUGH MEDICAL INTERVENTIONS AT PREGNANCY. SHE HAS HELD MANY POSITIONS AT THE CDC, INCLUDING THE CHIEF OF THE RESPIRATORY DISEASE BRANCH. SHE WAS THE DIRECTOR OF THE NATIONAL CENTER FOR IMMUNIZATION AND RESPIRATORY DISEASE PREVENTION FOR QUITE SOME TIME, SHE SERVED AS ACTING DIRECTOR OF THE CDC AS WELL. AND IF YOU'VE WATCHED THE NEWS FORT LAST DECADE OR, SO YOU CAN SEE THAT IN THESE CAPACITIES, SHE HAS HAD TO BE CRITICALLY INVOLVED AND HER LEADERSHIP WAS CRITICALLY INVOLVED IN THE RESPONSE TO AND MANAGEMENT OF A LONG LIST OF PUBLIC HEALTH THREATS TO THIS COUNTRY AND THE GLOBE, AND THESE INCLUDE ANTHRAX, SARS, EBOLA, NOW ZIKA, AND IF YOU LOOK IN PUBMED, AS I DID AND LOOK AT ROUGHLY 200 OR SO PAPERS, WHAT YOU CAN SEE IS THAT THIS IS MANIFEST NOT IN TERMS OF BOTH HER SERVICE BUT HER SCHOLARLY CONTRIBUTIONS TO THE LITERATURE, AND AN AMAZING BREADTH OF THINGS THAT SHE HAS WRITTEN INTERESTING PAPERS ABOUT. SO IT'S A REALLY GREAT PLEASURE TO HAVE YOU HERE TODAY, WE'RE VERY GRATEFUL THAT YOU HAVE THE TIME TO COME SHARE YOUR PERSPECTIVES ON GLOBAL HEALTH WITH OUR SCHOLARS. THANK YOU. [APPLAUSE] >> YOU'LL UNDERSTAND WHY I'M GETTING THE WATER IN A MOMENT. IT'S SUCH A PLEASURE TO BE HERE AND TO GET TO SPEAK WITH YOU, AND I SO ENJOYED LAST NIGHT A CHANCE TO TALK IN A LITTLE MORE INTIMATE CIRCUMSTANCES WITH A FEW OF YOU AND LOOK FORWARD TO TALKING TO MORE OF YOU LATER THIS MORNING. YOU HEARD KIND OF THE HIGH LEVEL WHAT I'VE BEEN DOING AND WHAT I WANTED TO DO TODAY IS GIVE YOU A LITTLE MORE PERSONAL SENSE OF MY STORY, AND POTENTIALLY IT WILL SPEAK TO SOME OF YOU ABOUT YOUR FUTURES. VI A LOT OF NOS NOSTALGIA BEING HERE ON THE NIH CAMPUS. I GREW UP IN WASHINGTON, D.C. IN MARYLAND, I TOOK A SUMMER CLASS HERE AT NIH, I WAS ACTUALLY ASSIGNED TO A SURGERY GROUP ACROSS THE STREET AT THE NAVAL MEDICAL CENTER BUT I DID DO A LITTLE BIT OF STUDYING HERE, AND WHEN I WAS IN HIGH SCHOOL, MY MOM, WHO'S AN ANTHROPOLOGIST, WAS TEACHING NURSES HERE AT THE CLINICAL CENTER AS THEY WERE GETTING -- GOING BACK TO SCHOOL FOR ADVANCED DEGREES. SHE WOULD COME HOME AND RAVE ABOUT THESE INCREDIBLE MAINLY WOMEN WHO WERE TAKING CARE OF REALLY COMPLICATED PATIENTS WHILE ALSO MANAGING TO GO BACK TO GRADUATE SCHOOL. SO IT'S A REAL PRIVILEGE TO BE AT NIH AND MEETING WITH THE INCREDIBLE STUDENTS IN THIS PROGRAM, AND TALKING VIRTUALLY TO THE INCREDIBLE STUDENTS IN CAMBRIDGE AND OXFORD, WHO I DO NOT HAVE CHILDHOOD MEMORIES OF. SO WHAT I WANT TO DO TODAY IS GIVE YOU A SENSE OF MY PATH OF HOW I REALLY WENT PUBLIC FROM BEDSIDE TO THE BIG PICTURE. I'M NOT SURE IF I REALLY DO HAVE LESSONS IN LEADERSHIP, BUT AS I THINK ABOUT THE EXPERIENCES I'VE HAD, THERE MAY BE SOME KERNELS THAT YOU CAN DIGEST IF YOU LIKE. SO WHEN I WAS ABOUT THIS AGE, I DECIDED THAT I WANTED TO BE A DOCTOR, AND MY FIRST MESSAGE IS TO BE AWARE OF MAJOR LIFE DECISIONS YOU MAKE WHEN YOU'RE STILL WEARING BARRETTES. NOW YOU MAY THINK, YOU YOUNGER PEOPLE MAY THINK YOU WERE THE FIRST PEOPLE WHO DISCOVERED THE SAVE THE PLANET TYPE OF MOVEMENT, BUT WHEN I WAS GROWING UP, THERE WAS A BACK TO NATURE MOVEMENT, SMALL WAS BEAUTIFUL, AND SO WHEN IT CAME TIME FOR ME TO THINK ABOUT HOW WAS I GOING TO BE A DOCTOR, MY GOAL WAS TO BE A DOCTOR IN A SMALL TOWN. SO SINCE I WAS ABOUT 8 OR 9 YEARS OLD, I WAS THINKING, I'M GOING TO MEDICAL SCHOOL, THEN I'M GOING TO FIND MYSELF A SMALL TOWN, I'M GOING TO SET UP PRACTICE, GET TO KNOW MY COMMUNITY AND REALLY I'LL GIVE BACK WHILE LEARNING AND BEING PART OF A COMMUNITY. SO WHEN IT CAME TIME TO GO TO MEDICAL SCHOOL, YOU MAY KNOW DANIEL WEBSTER SPOKE ABOUT THIS PLACE WHERE IT WAS A SMALL SCHOOL, BUT THERE WERE THOSE WHO LOVED IT. AND THAT WAS DARTMOUTH. SO THAT'S WHERE I ENDED UP IN MEDICAL SCHOOL IN A VERY TINY TOWN OF HANOVER, NEW HAMPSHIRE. THERE, I REALIZED MY FIRST MESSAGE OR LESSON FOR YOU, WHICH IS TO START SMALL. I ALSO MET THIS GENTLEMAN WHO SORT OF LOOKS LIKE A WIZARD AND ACTUALLY IS A WIZARD. HIS NAME IS, LITERALLY, ELMER FABBERKORN. HE IS A RETIRED EMERITUS NOW, BUT HE IS A PROFESSOR OF MICROBIOLOGY, AND TAUGHT US MEDICAL STUDENTS ABOUT MICROBIOLOGY. JUST A BRILLIANT, BRILLIANT TEACHER, AND, YOU KNOW, A HERO FOR MANY OF US WHO WENT THROUGH SCHOOL THERE. HE HAD A TRADITION OF TELLING US ABOUT INFECTIOUS DISEASES AND MICROBES BY READING FROM LITTLE SNIPPETS OF SOMETHING CALLED THE MMWR OR MORBIDITY AND MORTALITY WEEKLY REPORT. HE JUST WOULD FIND THE MOST FASCINATING STORIES IN THIS WEEKLY JOURNAL, AND IT TURNED OUT THAT THAT JOURNAL ORIGINATED FROM A SLEEPY PLACE IN ATLANTA, A GOVERNMENT BUREAUCRATIC ORGANIZATION CALLED THE COMMUNICABLE DISEASE CENTER, LATER THE CENTERS FOR DISEASE CONTROL AND PREVENTION. HE ALSO BROUGHT A FORMER STUDENT INTO OUR CLASSROOM, WHO TOLD US ABOUT HOW HE HAD GONE FROM INFECTIOUS DISEASE CAREER INTO BECOMING AN EPIDEMIC DETECTIVE OR DISEASE DETECTIVE THROUGH THE CDC. SO THIS WAS AN INTERESTING LITTLE PIECE OF WISDOM I HEARD AND JUST FILED AWAY IN THE PACK OF MY BACK OF MY HEAD. DURING MEDICAL SCHOOL I DID ELECTIVES OFF CAMPUS, IN FACT SOME EVEN OUT OF THE COUNTRY, AND WHILE I WAS AWAY FROM CAMPUS, MY CLASSMATES DECIDED THAT I SHOULD BE A CLASS SPEAKER FOR OUR GRADUATION, BECAUSE ANYONE WHO WAS IN THE ROOM SAID NO. SO ON MY AIRPLANE RIDE HOME FROM OVERSEAS, I SCRIBBLED OUT A SPEECH FOR THE GRADUATION, THIS IS ME BEHIND THE PODIUM, AND THE REASON THAT I HAVE THIS WATER IS THAT THIS WAS MY VERY FIRST PUBLIC SPEAKING EVENT, AND I HAD MY LITTLE NOTES, I WAS ALL READY WITH MY 4-MINUTE MESSAGES, AND MY MOUTH WENT REALLY, REALLY DRY. AND SO EVERYONE WAS REALLY NICE TO ME ABOUT, LIKE, HOW IT WAS, EXCEPT MY DAD, WHO SAID WE HAD NO IDEA WHAT YOU WERE SAYING. MY DAD WAS HONEST. BUT I SHOW THIS PICTURE BECAUSE YOU CAN SEE, AS I WAS TRYING TO IMPART WISDOM TO MY CLASSMATES AND THEIR FAMILIES, THERE'S THIS FELLOW HERE SCRATCHING HIS HEAD, THAT IS THE SURGEON GENERAL, C. EVERETT COOP. HE WAS SURGEON GENERAL IN THE 80s, AND IN THE REAGAN ADMINISTRATION, AND HE BECAME A REAL HERO BECAUSE DESPITE THE ADMINISTRATION BEING FAIRLY SIGH SILENT ABOUT THE HIV EPIDEMIC, WHICH WAS EXPLODING, HE SAID THIS IS A PUBLIC HEALTH EMERGENCY AND BASICALLY SENT A MESSAGE TO EVERY SINGLE HOME IN AMERICA, REALLY SPEAKING OUT, ALSO SIMILAR ACTIONS ON TOBACCO AND SOME OTHER AREAS. I HAVE TO SAY MY KEY LESSON FROM MY YEARS IN A VERY SMALL TOWN IN NEW HAMPSHIRE WAS THAT I WAS NOT REALLY CUT OUT FOR A SMALL TOWN. SO MY NEXT LESSON FOR YOU IS TO LET GO. YOU CAN LET GO OF THOSE CHILDHOOD PLANS, IT'S OKAY TO DECIDE TO DO SOMETHING DIFFERENT, JUST BECAUSE FOR THE FIRST 22 YEARS OF YOUR LIFE, YOU'VE BEEN TELLING EVERYBODY YOU'RE GOING TO DO SOMETHING, YOU CAN ACTUALLY EXPLORE OTHER ROOTS AND SOMETIMES THAT'S VERY, VERY LIBERATING. SO I DID LET GO OF THAT CHILDHOOD PLAN, AND WENT TO THE OPPOSITE EXTREME AND DID MY MEDICAL INTERNSHIP RESIDENCY AND CHIEF RESIDENCY IN THE BIG APPLE. I ARRIVED IN 1984, THE SAME YEAR THAT THE HIV VIRUS WAS DISCOVERED. IT WASN'T AS EARLY IN THE HIV EPIDEMIC WHEN DR. QUINN OR OTHERS GOT INTO THE ACTION, BUT IT WAS A TIME WHERE, REALLY, THE FLAVOR OF MY MEDICAL TRAINING WAS VERY, VERY MUCH INFLUENCED BY THE AIDS EPIDEMIC. IT WAS AN INCREDIBLE PRIVILEGE TO LEARN MEDICINE DURING THAT PERIOD. IT WAS EMOTIONALLY VERY INTENSE AND IT HAD A VERY PROFOUND INFLUENCE ON ME. HERE YOU SEE SOME OF THOSE CLINICAL MANIFESTATIONS OF THE OPPORTUNISTIC INFECTIONS THAT HIV CAUSED, AND WHILE WHEN I WAS IN MEDICAL SCHOOL I GOT EXCITED ABOUT TROPICAL MEDICINE AND ALL THESE EXOTIC DISEASES -- THE LESSON I LEARNED FROM THE TIME IN NEW YORK WHICH I THINK IS SO IMPORTANT IN HOW YOU THRIVE IN YOUR WORK IS TO CONNECT. THAT FOR ME, THIS EMMERIMMERSIVE EXPERIENCE OF LEARNING FROM THE FAMILY, LEARNING FROM THE COLLEAGUES, THE FACULTY, AND TOTALLY THROWING MYSELF INTO IT, AFTER THOSE ADOLESCENT YEARS OF BEING VERY SEPARATE, I JUST IMMERSED MYSELF AND REALLY EMBRACED THE EXPERIENCE. SO I REALLY ENCOURAGE YOU TO NOT JUST FOCUS ON 20 YEARS FROM NOW WHEN YOU'RE GOING TO BE RUNNING A LAB AND DOING GREAT THINGS BUT REALLY, REALLY EXPERIENCE THE PRESENT AND CONNECT WITH THOSE AROUND YOU. THE WOMAN ON THE BOTTOM RIGHT HERE IS WAFA ELSADRA, A WORLD FAMOUS HIV RESEARCHER, BUT AT THAT TIME, SHE WAS AN ATTENDING AT THE MANHATTAN V.A., WITH WHERE I DID MY TRAWNING, AND I FOUND MYSELF WANDERING THE HALLS OF THE V.A. AS A SENIOR RESIDENT AND CHIEF RESIDENT, THINKING, GOSH, I'M NOT GOING TO GO AND BE A SMALL TOWN PHYSICIAN, WHAT THE HECK AM I GOING TO DO? WANDERED INTO HER OFFICE AND SHE SAID, HUH, WELL, YOU KNOW, THERE'S THIS KIND OF COOL PROGRAM AT THE CDC THAT YOU MIGHT BE INTERESTED IN, AND I REALIZED THAT WHAT SHE WAS TALKING ABOUT WAS WHAT I HAD HEARD ABOUT AS A MEDICAL STUDENT. SHE WAS TELLING ME ABOUT THE EPIDEMIC INTELLIGENCE SERVICE, OR THE EIS, ALSO SOMETIMES CALLED THE DISEASE DETECTIVE PROGRAM. THIS IS WHAT CDC LOOKED LIKE WHEN I GOT THERE, BUT THE EPIDEMIC INTELLIGENCE SERVICE IS A TWO-YEAR APPLIED EPI TRAINING. IT'S POSTGRADUATE ON THE JOB HANDS-ON TRAINING, EITHER IN ATLANTA AT OUR HEADQUARTERS OR IN FIELD POSITIONS IN STATE HEALTH DEPARTMENTS. YOU NEED AN ADVANCED DEGREE, WHICH ALL OF YOU ARE GETTING, BUT IT CAN BE FROM CLINICAL MEDICINE, VETERINARY DENTISTRY OR THE HARD SCIENCES. AND WE HAVE HAD MOLECULAR BIOLOGISTS, STATISTICIANS, MANY DIFFERENT KINDS OF PH.D.s COME THROUGH THE PROGRAM. YOU WORK ON OUTBREAKS AND OTHER THINGS, AND FOR ME, IT WAS A LIFE TRANSFORMING EXPERIENCE, A PLAN TO GO TO CDC FOR TWO YEARS AND FIGURE OUT WHAT I WOULD DO WHEN I GREW UP. IT TURNED OUT ALMOST 30 YEARS LATER, I'M CITY STILL THERE. SCARY. SO THIS EIS PROGRAM WORKS A LITTLE LIKE MEDICAL SCHOOL. YOU INTERVIEW WITH PROGRAMS, THEY INTERVIEW YOU, AND THEN YOU GO THROUGH THIS COMPUTER MATCH. AND I MATCHED IN THE BACTERIAL SPECIAL PATHOGENS BRANCH, AND MY SUPERVISOR WAS CLAIRE BROOM. SHE IS THE ONE WITH THE CHICKEN IN THIS PICTURE. CLAIRE WAS AN EIS GRADUATE HERSELF, AND THIS PICTURE WAS TAKEN WHEN BERKINA FASSA WAS STILL CALLED UPPER VOLTA AND SHE WAS THERE FOR A MENINGITIS OUTBREAK. SHE ARRIVED AT THIS VILLAGE, DID A LUMBAR PUNCTURE AND HELPED DIAGNOSE MENINGITIS AND WAS HELPING WITH A VACCINATION EFFORT. THE VILLAGE WAS VERY PLEASED WITH HER WORK AND GAVE HER A CHICKEN. WHICH TO ME IS THE GOAL THAT I ASPIRE TO IN LIFE. NO ONE HAS EVER GIVEN ME A CHICKEN FOR MY WORK, BUT I STILL HAVE YEARS LEFT TO TRY TO REACH THAT. CLAIRE WAS AN INCREDIBLE BOSS AND SUPERVISOR, AND SO MY KEY MESSAGE HERE OR LESSON IS TO FIND MENTORS. I WAS REALLY VERY FORTUNATE WITH HER. SHE TOLD ME A COUPLE THINGS THAT I PASS ALONG. SHE ENCOURAGED ME TO TAKE THE LONG VIEW IN A PROBLEM, NOT JUST WHAT'S THE QUESTION TODAY BUT WHAT'S THE LONG TERM QUESTION THAT WE'RE TRYING TO SOLVE. AND SHE ENCOURAGED ALL OF US WHO WORKED WITH HER TO HAVE FUN, THAT THE IDEA THAT SIGH SCIENCE AND EPIDEMIOLOGY AND INVESTIGATIONS SHOULD BE FUN, WE LIVED IN THE GROUP, IN THE BRANCH THERE. SO I HAVE OFTEN TOLD PEOPLE THAT IF YOU'RE NOT HAVING FUN IN WHAT YOU'RE DOING, THERE'S SOMETHING WRONG, BECAUSE THE OPPORTUNITIES AND PASSION AND EXCITEMENT ABOUT OUR FIELDS ARE REALLY EXTRAORDINARY. SO THE ONE AREA THAT I WAS ASSIGNED AMONG 10 WAS ONE OF THOSE AREAS THAT SHE ASKED ME TO TAKE THE LONG VIEW ON. IT WAS A BACTERIAL INFECTION CALLED GROUP B STREPTOCOCCUS. I WAS AN INTERNIST WHO HAD TRAINED AS A VETERANS' ADMINISTRATION HOSPITAL. I ESSENTIALLY HADN'T CARED FOR WOMEN SINCE I WAS IN MED SCHOOL, A LITTLE BIT ON MY ROTATIONS THROUGH BELLEVUE AND THE UNIVERSITY HOSPITAL, BUT MOST OF MY PATIENTS HAD HIV AND WERE MALE ACTUALLY AT THAT TIME. SOD IDEA THAT I WAS BEING ASSIGNED AN INFECTION THAT IS SPREAD FROM A PREGNANT WOMAN TO HER BABY DURING DELIVERY WAS EXTRAORDINARY. THE ISSUE WITH GROUP B STREP WAS CONTENTIOUS AT THE TIME. THERE HAD BEEN INTERVENTIONS -- RANDOMIZED CONTROLLED TRIALS HAD SHOWN GIVING ANTIBIOTICS DURING LABOR COULD PREVENT SPREAD FROM MOTHER TO BABY BUT THE MEDICAL COMMUNITY HADN'T ADOPTED THE STRATEGY. IT WASN'T PERFECT, IT REQUIRED A PRENATAL SCREENING, THERE WERE FALSE POSITIVES AND FALSE NEGATIVES, AND THE FIELD WAS ESSENTIALLY WAITING FOR SOME SORT OF MAGIC SIMPLE SOMETHING, AN APPROACH THAT WOULD BE EASIER, EITHER A VACCINE OR A RAPID TEST. SO AT THAT TIME, BEFORE THE INTERNET, PARENTS WHO HAD LOST BABIES TO GROUP B STREP STARTED RESEARCHING THE ISSUE, GOT TOGETHER AND SAID WOW, THERE'S AN INTERVENTION BUT NO ONE IS ACTUALLY USING IT, WHY DID I LOSE MY BABY? SO I GOT INVOLVED IN THE GROUP B STREP ISSUE. THIS PHOTOWAS TAKEN IN THE ERA OF SHOULDER PADS, WHEN WE CONVENED THE MEDICAL PUBLIC HEALTH MICROBIOLOGY STATE HEALTH DEPARTMENT AND PARENT COMMUNITY KOWN TO TRY TO COME UP WITH A SOLUTION. OBSTETRICIANS AND PEDIATRICIANS WERE AT LOGGER HEADS, COULD WE BRING THEM TOGETHER AND COME UP WITH AN APPROACH. WHAT CAME OUT OF THIS WAS THE FIRST CONSENSUS GUIDELINES ON HOW TO PREVENT PERINATAL GROUP B STREP. SO MY LESSON FROM THIS PHASE OF MY LIFE IS TO LISTEN. THIS WAS KIND OF A COMPLICATED SITUATION, BUT LISTENING TO THE PEDIATRICIANS, LISTENING TO THE OBSTETRICIANS AND VERY MUCH LISTENING TO THE COMMUNITY WAS IMPORTANT. I KNOW THOSE OF YOU WORKING ON HIV HAVE REALLY -- THAT VISCERAL EXPERIENCE, THAT THE COMMUNITY ROLE IN DEMANDING FASTER CURES FOR HIV REALLY HAS BEEN IMPORTANT. THE COMMUNITY ROLE IN EBOLA IN WEST AFRICA, AND REALLY TAKING COMMAND OF THE OUTBREAKS IN THE COMMUNITIES IS ESSENTIAL. SO I THINK WE ALL NEED TO MAKE SURE WE'RE LISTENING. I AM REALLY, REALLY PROUD OF THIS SLIDE. YOU KNOW, IN SCIENCE, WE THINK WE NEED A NEW VACCINE, OR WE NEED A NEW DEVICE. BUT THE IMPACT THAT WE'VE HAD ON EARLY ONSET GROUP B STREP INFECTIONS, THOSE INFECTIONS IN THE FIRST WEEK OF LIFE WHICH COULD BE FATAL OR CAUSE LONG TERM DISABILITY, WE'VE REDUCED THE INCIDENCE BY 80%. THAT IMPACT IS NOT FROM A NEW BREAKTHROUGH VACCINE OR A NEW TOOL. IT'S FROM APPLICATION OF A DRUG THAT HAD OPINION AROUND BEEN AROUND FOR 50 YEARS, BASICALLY GETTING THE CLINICAL COMMUNITY TO COME TOGETHER WITH ESSENTIALLY A SOCIAL WILL THAT WE WILL STANDARDIZE TREATMENT OF THIS CONDITION, AND WE'VE PREVENTED ALMOST 90,000 CASES SINCE THAT TIME. SO IT'S A REALLY GRATIFYING ISSUE AND ONE WHERE, YOU KNOW, YOU ALL WILL BE INVOLVED IN THINGS LIKE THIS IF YOU DO TAKE THE LONG VIEW AND REALIZE SOMETIMES THE ANSWER IS RIGHT IN FRONT OF YOU. IT'S NOT A LONG TERM INVESTMENT THAT YOU NEED TO MAKE. SO MY NEXT LITTLE STORY IS ABOUT THE NEXT CHAPTER OF THE MENINGITIS STORY. SO I TOLD YOU CLAIRE WAS INVOLVED WITH RESPONDING TO OUTBREAKS OF MENINGITIS IN WEST AFRICA, AND I, TOO, WAS INVOLVED IN THE MENINGITIS STORY. BOTH IN HELPING WITH SOME VACCINE TRIALS IN WEST AFRICA, AND THEN IN THIS MEETING, WHICH WAS A MEETING WITH EXPERTS FROM THE REGION TO TRY TO DEVELOP GUIDELINES FOR MANAGING OUTBREAKS. THIS WAS A VERY MEMORABLE MEETING FOR ME. I FELT VERY OUT OF PLACE. I WAS THE ONLY AMERICAN AT THE MEETING. I WAS THE ONLY PERSON WHO WAS NOT A NATIVE BORN FRANKOPHONE SPEAKER, AND I WAS ASSIGNED TO BE THE RAPPORTTEUR TO TAKE THE MEETINGS IN FRENCH. SO I GOT REALLY HUFFY ABOUT THAT. I SORT OF THOUGHT THIS IS REALLY STRANGE THAT I HAVE DO THE MINUTES AND I DON'T EVEN SPEAK FRENCH VERY WELL. I GOT IN MY MIND THAT THIS MUST BE BECAUSE I'M THE ONLY WOMAN AT THE MEETING. AND I GOT A LITTLE BIT OUT OF SORTS WITH THAT. THEN THE FELLOW TO MY LEFT, A LOVELY PREVENTIVE HEALTH LEADER FROM GUINEA, OFFERED TO BE MY CO-RAPPORTEUR. HE AND I WORKED ON THE MINUTES LATE AT NIGHT, I CALLED HIM THE PROFESSOR BECAUSE HE WOULD NOT LET ME WRITE THE MINUTES WITHOUT THE CORRECT ACCENTS ON EVERY WORD AND THE RIGHT TENSE OF VERB AND SO FORTH, BUT WE DEVELOPED A GOOD FRIENDSHIP AND RELATIONSHIP THROUGH THAT EFFORT, AND I LATER LEARNED THAT WHOEVER IS AT THESE MEETINGS FROM CDC IS THE RAPPORTEUR. IT HAD NOTHING TO DO WITH MY BEING THE ONLY WOMAN AT THE MEETING. I ALSO LEARNED BEING THE RAPPORTEUR IS THE BEST THING BEING AT THEET MEE METEOROLOGISTINGS BECAUSE YOU GET TO WRITE THE RECOMMENDATIONS AND SORT OF WHAT DID EVERYBODY AGREE TO. SO THIS HAD IMPACT TO ME, AND MY MESSAGE TO YOU FOR THE FUTURE FOR WHEREVER IT MAY APPLY IN YOUR LIFE IS TO MAKE MISTAKES. SOMETIMES YOU CAN LEARN MORE FROM YOUR MISTAKES THAN FROM YOUR SUCCESSES. I NEXT WANTED TO TURN TO THE STORY OF SARS BRIEFLY. THIS IS THE SEVERE ACUTE RESPIRATORY SYNDROME, WHICH BROKE OUT IN -- BROKE OUT VISIBLY IN 2003. YOU KNOW, SOMETIMES TRUTH IS STRANGER THAN FICTION. SOME YOU HAVE MAY HAVE SEEN THE MOVIE CONTAGION WHERE A VIRUS SPREADS AROUND THE WORLD INSTANTLY AND CAUSE ALL SORTS OF PROBLEMS. WE CAN TALK ABOUT THIS IN THE Q & A IF YOU WANT BECAUSE YES, IT'S TRUE, I DID GET TO MEET KATE WINSLET WHILE SHE WAS PREPARING FOR THIS PART. BUT THE FIGURE ON THE RIGHT IS REALLY THE STORY HERE, THAT -- AND THIS IS JUST INCREDIBLE TO ME. THIS IS FROM THE MMWR, BUT PEOPLE WHO STAYED AT THE SAME HOTEL IN HONG KONG ON THE SAME NIGHT, ON THE SAME FLOOR, ACQUIRED THIS VIRUS AND LAUNCHED OUTBREAKS IN SEVERAL CONTINENTS. TORONTO, IN SINGAPORE, IN EUROPE, YOU KNOW, IT WAS REALLY UNBELIEVABLE. AND IN MANY HOSPITALS IN HONG KONG. SO THE MOVIE "CONTAGION" DID SORT OF MODEL SOME OF THE SPREAD AND THE DESTRUCTION THE VIRUS HAD ON THAT PARTICULAR TRUE STORY. I WAS REALLY -- I WAS AT A POINT IN MY CAREER WHERE I WAS NO LONGER THE DISEASE DETECTIVE, I WASN'T THAT FRONT LINE PERSON, I WAS A SUPERVISOR OF THEM. I THOUGHT I WOULD NEVER 50 TO THE FIELD GO TO THE FIELD AGAIN. I FIGURED I'M ON THIS END OF THE PHONE, SUPPORTING PEOPLE IN THE FIELD. BUT THE SARS OUTBREAK WAS PRETTY BAD, AND SOME OF THE INTERNATIONAL WORK, PEOPLE WANT SOMEONE A LITTLE MORE SENIOR, SO I WAS ASKED TO GO TO CHINA TO WORK IN BEJING WITH THE WORLD HEALTH ORGANIZATION TEAM THERE, BRINGING A COUPLE EIS OFFICERS WITH ME. THE SITUATION IN BEJING WAS INCREDIBLE. THEY HAD TAKEN OVER THE HOSPITAL SYSTEM. 16 HOSPITALS WERE DESIGNATED AS SARS HOSPITALS. IF YOU DIDN'T HAVE SARS, YOU WERE MOVED OUT OF THE HOSPITAL. IF YOU HAD SARS, YOU WERE MOVED IN TO THE HOSPITAL. WE DIDN'T HAVE A DIAGNOSTIC TEST AT THAT PHASE OF THE OUTBREAK, AND IF YOU WERE GOING TO A HOSPITAL, IT WAS A GOOD CHANCE YOU WERE GOING TO COME OUT OF IT WITH SARS INSTEAD OF GOING INTO IT WITH SARS. SO IT WAS A REALLY DIFFICULT PROBLEM. AND ONE OF THE MOST PRESSING ASPECTS OF IT WAS THAT NURSES AND DOCTORS AND OTHER HEALTHCARE WORKERS WERE GETTING IT. AND THEY WERE DYING FROM IT. I GOT THERE AND MY COUNTERPART FROM WHO SHOWED ME AROUND THEIR WAR ROOM, THE FIRST NIGHT I WAS THERE, AND TOLD ME ABOUT THE COLLEAGUES HE HAD WHO WERE ON RESPIRATORS, YOU KNOW, PROFESSORS OF MEDICINE WHO WERE, YOU KNOW, SUCCUMBING TO THIS CONDITION, BECAUSE REALLY, THE MORE PATIENT CONTACT YOU HAD, THE MORE AT RISK YOU WERE BEFORE APPROPRIATE INFECTION CONTROL WAS TAKEN. SO IT WAS A REALLY MEANINGFUL EXPERIENCE TO BE PART OF THE RESPONSE, AND I HELPED WITH A NUMBER OF THINGS, BUT I ALSO GOT TO KNOW MY COUNTERPARTS PRETTY WELL THERE. IT WAS STRESSFUL, PEOPLE WERE DYING, THERE WAS A LOT OF POLITICAL PRESSURE, THEY'D ALREADY FIRED THE HEALTH MINISTER AND FIRED THE MAYOR OF BEJING FOR COVERING UP THE STORE EE BUT BY THE TIME I WAS THERE, THINGS WERE STARTING TO TURN AROUND. MY COLLEAGUE AND I LEFT ONE OF OUR MEETINGS AND WALKED IN FRONT OF THE BEJING CDC AND WE SAW THIS TRUCK, AND WE DECIDED THAT I WAS DONATING THE TRUCK AND WE WOULD STAGE A PHOTOOP HERE. SO SHE'S VERY PROFESSIONAL, MAINTAINING HER COMPOSURE, BUT I COULDN'T STOP LAUGHING ABOUT THE IDEA. SO MY LESSON FROM THIS, YOU'RE GOING TO BE INVOLVED IN ALL KINDS OF SCIENTIFIC AND MEDICAL EXCITING IMPORTANT ACTIVITIES, BUT YOU KNOW, THERE'S PEOPLE THAT YOU'RE WORKING WITH AND GETTING TO KNOW THEM IS ACTUALLY REALLY IMPORTANT. AND SOMETIMES IT'S THROUGH THE RELATIONSHIPS AND FRIENDSHIPS THAT YOU REALLY HAVE LASTING IMPACT. THE CDC HAS BEEN WORKING IN CHINA FOR DECADES NOW, AND IT'S REALLY THE BONDS THAT WE HAVE WITH OUR COUNTERPARTS THAT CAN HELP US WITH QUICKER ACCESS TO INFLUENZA STRAINS AND REALLY BETTER SCIENCE ON BOTH SIDES. SO I ENCOURAGE YOU TO HAVE A LITTLE FUN, WHATEVER YOU'RE DOING. I HAD MY NEXT BIG PUBLIC SPEAKING EFFORT DURING THE SARS CONFERENCE. WHILE THEY WENT A LITTLE BITTER THAN MY DARTMOUTH GRADUATION EXPERIENCE, I COULDN'T FIND A PHOTOFROM A PRESS CONFERENCE WHERE I DID NOT LOOK TERRIFIED. SO MY MESSAGE HERE IS JUST KEEP AT IT, YOU KNOW, SO I HAVE, OVER THE YEARS, GOTTEN SON MEDIA TRAINING BUT ALSO HAD QUITE A BIT OF PUBLIC EXPERIENCE WITH THE MEDIA, AND I WOULD JUST SAY, YOU KNOW, WHEN IN DOUBT, BE YOURSELF. YOU KNOW, I MIGHT LOOK TERRIFIED THERE, BUT I KIND OF KNEW MY STUFF AND I WAS -- I THINK ALL OF US ON THE WHO TOO TEAM WERE HELPFUL IN BEING THE STRAIGHT SHOOTERS WITH THE MEDIA, TELLING THE STORY WHEN IT WAS BAD FOR CHINA AND THEN WHEN IT GOT BETTER, WE COULD BE CREDIBLE BECAUSE WE WERE BEING HONEST AND BEING OPEN. MY NEXT BIG MEDIA EECHTS EVENTS OCCURRED IN 2009. THIS WAS A REALLY -- I THINK A LOT OF YOU STUDENTS WERE PROBABLY PRETTY YOUNG DURING THIS PERIOD OR MAYBE YOU WERE IN EARLIER STAGES OF YOUR EDUCATION, BUT IN EARLY APRIL, IN MID APRIL, 2009, WE STARTED TO WORK UP SOME STRAINS OF INFLUENZA, AND IN AN EARLY RELEASE ON APRIL 21ST, WE REPORTED ON TWO CHILDREN IN SOUTHERN CALIFORNIA WHO HAD A NEW STRAIN OF INFLUENZA. IT WAS A STRAIN THAT WAS OF SWINE ORIGIN. IT HADN'T BEEN SEEN IN PEOPLE. AND BOTH KIDS WERE FINE BASICALLY, THEY WERE ALREADY BETTER BY THE TIME WE GOT THIS DIAGNOSIS. BUT WE DID AN EARLY RELEASE AND WE SAID, YOU KNOW, LOOK FOR YOUR STRAIN, SEE IF YOU HAVE IT, IF THERE'S ANY CASES, PLEASE REPORT THEM IN. AND TWO DAYS LATER, WE HAD ACCUMULATED FIVE MORE CASES. ALL SEVEN WERE FINE, ONLY ONE OF THE SEVEN HAD BEEN HOSPITALIZED. THE SEVEN CASES WERE EITHER IN CALIFORNIA OR TWO OF THEM WERE IN TEXAS. AND WE DECIDE TODAY HOLD A PRESS CONFERENCE. IT WAS THE MOST UNUSUAL PRESS CONFERENCE I'VE BEEN PART OF. WE HAD A LOT OF MEDIA IN THE ROOM AND A LOT OF MEDIA ON THE PHONE. WE HAD BEEN WORKING WITH THE MEDIA FOR A FEW YEARS ON PANDEMIC PREPAREDNESS. WE REPORTED THIS EFFORT AND SO WE BASICALLY SAID, YOU KNOW, THERE'S SEVEN PEOPLE IN THE UNITED STATES WHO HAVE A NEW STRAIN OF FLU, EVERYBODY IS FINE. HALF OF THE REPORTERS SAID, WHY ARE YOU HAVING THIS PRESS CONFERENCE? AND THE OTHER HALF OF THE REPORTERS SAID, IT'S THE END OF THE WORLD. SO SOME OF THOSE REPORTERS WERE RIGHT. IN ANY WAY, THE NEXT MORNING, WE KNEW THAT PEOPLE IN MEXICO WERE DYING FROM THE VERY SAME NEW STRAIN OF INFLUENZA, AND THAT THERE WAS A SCHOOL IN QUEENS, NEW YORK THAT HAD A VERY RIP ROARING OUTBREAK OF A RESPIRATORY ILLNESS THAT HAD EVERY SIGN OF BEING THIS SAME VIRUS. ALTHOUGH WE DIDN'T CONFIRM IT UNTIL THAT WEEKEND. THE CIRCUMSTANCES THAT ARE NEEDED FOR A PANDEMIC ARE A NOVEL STRAIN THAT'S CAPABLE OF CAUSING SEVERE DISEASE THAT'S EASILY SPREAD. SO WE HAD A NEW STRAIN, WE HAD PEOPLE DYING IN MEXICO AND WE HAD THIS VERY BIG OUTBREAK IN A SCHOOL IN NEW YORK. WERE WE HAVING A PANDEMIC? WE DIDN'T ACTUALLY KNOW. WE DID ACTIVATE OUR EMERGENCY OPERATIONS CENTER AND BEGAN WORKING ACROSS GOVERNMENT IN BOTH THE FEDERAL, STATE AND LOCAL LEVEL IN PREPARING FOR WHAT DID BECOME THE FIRST PANDEMIC OF THE 21ST CENTURY. YOU MAY REMEMBER THIS IS MILDER THAN WE HAD PLANNED FOR OR YOU MAY REMEMBER THIS SAYS, YOU KNOW, I GOT SENT HOME FROM CAMP BECAUSE OF THE H1N1 OUTBREAK, BUT IT WAS SEVERE PARTICULARLY IN YOUNG PEOPLE, AND IT WAS UNEXPECTEDLY NOT A PROBLEM IN THE ELDERLY WHO USUALLY DIE FROM THE DISEASE. 60 MINUTES CALLED AND SAID COULD WE INTERVIEW SOME CDC FOLKS FOR A STORY ABOUT FLU? AND IF YOU KNOW 60 MINUTES, KNOW THAT IF YOU GET CALLED AND ASKED TO BE ON 60 MINUTES, YOU USUALLY GET FIRED, SO I WAS NOT VERY BIG ON BEING THE ONE TO BE INTERVIEWED, BUT I WAS INTERVIEWED FOR IT. THE MEAN STORY WAS, KNOW, THIS HIGH SCHOOL ATHLETE WHO FORTUNATELY RECOVERED, BUT DEVELOPED, YOU KNOW, JUST CRITICAL ILLNESS. HE WAS -- THEY FOLLOWED HIM FROM THE FOOTBALL FIELD TO THE ICU, WHERE HE WAS FOR MANY MONTHS, BUT HE RECOVERED AND HAS BECOME ACTUALLY A BIG FLU CHAMPION FOR VACCINATION. THE VERY BEST DAY OF THE 2009 PANDEMIC WAS OCTOBER 5TH, BECAUSE IT WAS THE DAY WHERE WE FINALLY GOT INFLUENZA VACCINE AGAINST THIS PANDEMIC, AND WERE ABLE TO START VACCINATING. WE STARTED VACCINATING WITH PEDIATRIC ICU NURSES IN MEMPHIS, AND AGAIN, THE ISSUE OF MAKING FRIENDS AND HAVING PREECK SITIONING RELATIONSHIPS, THE WOMAN ON THE LEFT, SUSAN COOPER, I'D MET ABOUT TWO YEARS EARLIER IN A PUBLIC HEALTH LEADERSHIP TRAINING PROGRAM. SHE TURNED OUT TO BE ACTING HEALTH COMMISSIONER OF THE STATE AT THE TIME OF THE PANDEMIC, ABOUT YOU BUT MEETING YOUR PEERS BEFORE THE EMERGENCY REALLY CAN HELP WITH THE EFFECTIVENESS OF THE RESPONSE. I WAS SURPRISED AS SUN WHO'D SOMEONE WHO WORKED IN VACCINATION FOR YEARS AND SEEING THE HESITANCY THAT PARENTS HAVE ABOUT VACCINATION THAT PEOPLE LINED UP AT DAWN IN THE WINTER TO GET VACCINE. IT WAS HEARTENING AND WE HAVE HAD SOME IMPROVEMENTS IN FLU VACCINATION SINCE THE PANDEMIC AND SEEING SOME PEOPLE SUFFERING DISPROPORTION NALLY. IN THE END, IT WAS AN UNUSUAL PANDEMIC, MODERATE IN TERMS OF HOSPITALIZATIONS, AND MINOR IN TERMS OF DEATHS. USUALLY WE'LL HAVE TWO TO FOUR TIMES AS MANY DEATHS IN A TYPICAL INFLUENZA SEASON, BUT BECAUSE THIS RELATIVELY SPARED THE ELDERLY, WE HAD LESS THAN EXPECTED DEATHS IN THE ELDERLY AND WAY MORE THAN EXPECTED DEATHS IN YOUNG PEOPLE. NOW ONE OF THE PRIVILEGES OF BEING A SPOKESPERSON OR A PUBLIC FACE OF THE INFLUENZA PANDEMIC IS THAT YOU GET TO ENGAGE WITH THE PUBLIC, AND I LEARNED A LOT FROM THE REPORTERS, I LEARNED A LOT FROM COMMUNITY ENGAGEMENTS, AND ONE DAY I GOT THIS BOX IN THE MAIL AND IT WAS FROM THIS GENTLEMAN IN CALIFORNIA WHO LIKES TO MAKE DIE DIARAMAS AND SENDS THEM TO PEOPLE ON TV. YOU SEE THIS LITTLE SYRINGE THAT SAYS H1N1 ON IT, A LITTLE PIG WITH WINGS. I TREASURE THIS, I HAVE TO SAY IT WAS A SURPRISE. THE OTHER THING I NEVER EXPECTED TO HAPPEN WAS THAT I MADE "VOGUE." I WAS NOT ELECTED TO MY FROM MY HIGH SCHOOL CLASS AS MOST LIKELY TO APPEAR IN "VOGUE." IT SAYS A HERE, THAT'S ANNE, THAT WAS ME. I WANT TO CAUTION YOU THAT THE EDITORS DID NOT NECESSARILY SELECT ME FOR EVERYTHING. SO MY NEXT LESSON IS THAT IN PUBLIC HEALTH, IT IS NOT ABOUT ME, IT'S NOT ABOUT US. IT'S REALLY ABOUT THE PEOPLE THAT WE SERVE AND THE PUBLIC THAT ARE OUT THERE, SO WHILE IT IS KIND OF EXCITING TO MEET KATE WINSLET OR TO BE SORT OF IN VOGUE, OUR JOBS ARE TO LOOK OUTSIDE AND TO LOOK AT THE PUBLIC AND REALLY BE PUBLIC SERVANTS, AND THAT, TO ME, IS WHAT HAS BEEN SO MEANINGFUL ABOUT SHIFTING FROM THE SMALL TOWN DOC TO PUBLIC HEALTH AND PUBLIC SERVICE, EVEN IF IT MEANS THE UNIFORM FORM AND THE FABULOUS WARDROBE BECAUSE I REALLY DO FEEL LIKE SERVING THE PUBLIC IS A PRIVILEGE. I WANT TO KIND OF COME BACK TO THE MENINGITIS STORY. I TOLL YOU ABOUT THE OUTBREAKS AND THE RESPONSE AND SOME EARLY VACCINE TRIALS. THROUGH MAN EXTRAORDINARY PUBLIC-PRIVATE PARTNERSHIP, THE GATES FOUNDATION FUNDED SOMETHING CALLED THE MENINGITIS VACCINE PROJECT, LED BY THE WORLD HEALTH ORGANIZATION AND THE PROGRAM FOR APPROPRIATE TECHNOLOGY FOR HELP OR PATH, CDC AND OTHERS WERE PART OF THIS SPECIFICALLY FOR AFRICA, WHERE EPIDEMIC WAVES OCCURRED AND DISRUPTED HEALTH SERVICES AND REALLY AFFECTED YOUNG, HEALTHY PEOPLE. A VACCINE NOW DEVELOPED BY SERUM INSTITUTE OF INDIA CHARGING LESS THAN A DOLLAR A DOSE HAS REACHED 235 MILLION AFRICANS, AND THE EPIDEMICS CAUSED BY MENINGITIS A ARE GONE. SO JUST WITHIN MY CAREER, WE'VE GONE FROM REPEATED EPIDEMICS DEVASTATING SOME OF THE POOREST COUNTRIES IN THE WORLD TO PEOPLE NOT HAVING TO WORRY ABOUT THAT PARTICULAR TYPE OF MENINGITIS ANYMORE. SO KIND OF IN WRAPPING UP, YOU KNOW YOU KNOW THIS BECAUSE YOU'RE ALREADY IN A PROGRAM THAT INVOLVES THE U.S. AND THE U.K., BUT THE WORLD IS REALLY PRETTY SMALL RIGHT NOW. THERE'S A LOT OF INTERESTING, DIFFICULT, COMPLICATED, CHALLENGING PROBLEMS OUT THERE, BUT IN OUR SMALL WORLD ENVIRONMENT, I REALLY HOPE THAT YOU ALL WILL THINK BIG, AND HAVING MET A NUMBER OF YOU, I'M PRETTY SURE THAT YOU'RE GOING TO DO AMAZING THINGS. SO I WANTED TO END WITH A LITTLE BIT OF MY PERSONAL PHILOSOPHY, IN CASE I HAVEN'T GIVEN YOU ANY OF MY PERSONAL PHILOSOPHY YET. YOU KNOW, THERE HAVE BEEN HARD DAYS. I'VE HAD, YOU KNOW, LIKE ALL OF YOU, I'VE HAD THOSE DAYS WHERE YOU FINISH AND YOU THINK, OH, MY GOODNESS, HOW ARE WE GOING TO DEAL WITH THAT, WHATEVER THE NEXT THING IS. I THINK CLAIRE WAS TALKING ABOUT ALL THE ANIMALS DIED, YOU KNOW, OR, YOU KNOW, OH, NO, YOU KNOW, NOW IT'S BREAKING OUT IN THIS COUNTRY, OR WE HAVE A REALLY SCARY SITUATION ON OUR HANDS. THERE'S A HAITIAN PROVERB ABOUT MOUNTAINS, BE ON MOUNTAINS, WHENEVER YOU CLIMB A MOUNTAIN, THERE'S ANOTHER MOUNTAIN. I LITERALLY WOULD WALK HOME SOME DAYS DURING THE PANDEMIC, YOU KNOW, THINKING INITIALLY ABOUT HOW ARE WE GOING TO -- THAT WAS BAD CALL, LIKE WHAT ARE WE SUPPOSED TO DO ABOUT THIS, AND REALIZE IN PUBLIC HEALTH, WHAT WE DO IS SOLVE PROBLEMS. WHEN YOU'VE SOLVED ONE PROBLEM, YOU SEE THE NEXT PROBLEM. IF YOU DIDN'T HAVE ANY PROBLEMS TO SOLVE, WHAT WOULD YOU BE DOING? SO I REALLY DO THINK THAT ESPECIALLY FOR THOSE OF YOU IN THE DISCOVERY WORLD, A PROBLEM IS AN OPPORTUNITY, AND REALLY SOMETHING THAT MIGHT BE TEMPORARILY FRUSTRATING BUT IN THE LONG RUN, CAN BE INCREDIBLY IMPACTFUL. SO JUST TO RECAP HERE MY LITTLE LESSONS IN LEADERSHIP OR LESSONS IN LIFE, AND THANK YOU SO MUCH FOR INVITING ME TO BE HERE WITH YOU. THANK YOU. [APPLAUSE] >> WE HAVE TIME FOR QUESTIONS. ANGELA HAS A MICROPHONE, SHE'LL COME FIND YOU. I'LL START WITH ONE. WHAT WERE THE CHALLENGES THAT YOU SORT OF GRAPPLED WITH THE FIRST TIME THAT YOU WENT ABROAD, THE TRAVEL, WHAT IS IT LIKE TO TAKE ON THE -- >> THANK YOU. YEAH, THERE WERE SOME THEMES, I'M TRYING TO THINK -- YOU KNOW, THERE ARE A COUPLE THINGS, I THINK MY FIRST THREE TRIPS WERE TO HAITI, COSTA RICA AND BERKI NEFASA. SO A LITTLE DIFFERENT PROBLEMS IN EACH. THE FIRST WERE IN THE LATE 80s, EARLY 90s, WHERE I WAS A YOUNG WOMAN. IN AFRICA IN PARTICULAR, THE CULTURE WAS, YOU KNOW, GRAY HAIR WAS IMPORTANT, SO I FEEL REALLY GOOD NOW. BUT THE ISSUE OF THE OLDER YOU WERE, THE MORE YOU WERE LIKELY TO BE USEFUL. AND IN SOME OF THE CULTURES, BEING A WOMAN AT THAT TIME WAS NOT NECESSARILY EXPECTED. IN COSTA RICA, MY FIRST INTERNATIONAL OUTBREAK WAS TO COSTA RICA, AND THE PERSON WHO HAD INVITED ME WAS A SENIOR WOMAN MICRO BIOLOGIST WHO WAS AWESOME, SHE WAS ANOTHER MENTOR AND SHE KNEW ABSOLUTELY EVERYBODY IN THE COUNTRY, OPENED EVERY DOOR FOR ME AND REALLY HELPED IN TERMS OF THE CAPACITY THAT I COULD OFFER. IN BOTH HAITI -- ACTUALLY IN ALL THREE PLACES, HAITI, COSTA RICA AND WEST AFRICA, I WAS WORKING IN ANOTHER LANGUAGE. I KNEW FRENCH AND SPANISH BUT THEY WEREN'T FLUENT. AND SO I HAD THAT PRESSURE OF TRYING TO BE PROFESSIONAL AND CAPABLE BUT ALSO BE GRAMMATICAL AND COHERENT, SO THAT WAS A LITTLE BIT TRICKY. I HAVE TO SAY WHEN I WENT TO CHINA AND HAD AN INTERPRETER, IT WAS LIKE, WOW, THIS IS SO MUCH EASIER. BUT I DO THINK AT CDC AND AT NIH, I'M SURE AT OXFORD AND CAMBRIDGE, YOU KNOW, FEELING CONFIDENT IN YOUR TECHNICAL WORK HELPS TREMENDOUSLY. SO WHEN I WAS SENT TO COSTA RICA FOR THE OUTBREAK, IT WAS AN OUTBREAK OF LISTERIOSIS, I HAD BEEN WORKING ON IT BY A YEAR AT THAT POINT. I WAS DOING A BIG NATIONAL CASE CONTROL STUDY. I HAD INTERVIEWED MORE PEOPLE WITH LISTERIOSIS, THERE WERE PEOPLE FROM ALL OVER THE WORLD, EVEN THOUGH I WAS DEALING WITH SPANISH AND A DIFFERENT CULTURE, HAVING MY FACTS TOGETHER AND BEING AN EXPERT THAT THEY REALLY VALUED THAT I KIND OF KNEW THE LITERATURE AND DYNAMICS, AND THE OTHER THING IS I HAD ALL OF CDC BEHIND ME, SO WHAT I DIDN'T KNOW, I HAD THE ABILITY TO PREACH BACK. THAT'S REALLY ANOTHER IMPORTANT LESSON. I THINK SOMETIMES WE THINK OF THE SCIENTIST AS THE LONE INVESTIGATOR, BUT YOU HAVE A NETWORK, YOU HAVE MENTORS, YOU HAVE COLLEAGUES, THESE DAYS YOU CAN CALL ANYBODY UP. YOU CAN REACH OUT AND REALLY GET INSIGHTS AND PARTNERSHIP OFTEN. SO I THINK RECOGNIZING THAT I WASN'T ALONE, THAT I DID HAVE CAPACITY AND -- I GAINED MORE CONFIDENCE OVER THE YEARS, BUT THAT I KIND OF KNEW MY STUFF BUT IF I DIDN'T, I HAD PLACES TO GO FOR MORE HELP, THOSE DID HELP. THE OTHER THING WHICH IS STILL THE CASE FOR THOSE OF YOU DOING INTERNATIONAL WORK IS JUST THE REALITY CHECK ON INFRASTRUCTURE. YOU KNOW, IN HAITI, IN -- I MEAN, COSTA RICA WAS IN PRETTY GOOD SHAPE, BUT IN HAITI AND WEST AFER CAR, YOU WEST AFRICA, CHECKING YOUR EXPECTATIONS ABOUT HOW LONG SOMETHING WAS GOING TO TAKE, YOU KNOW, THAT YOU HAD TO GET THE DRY ICE TOO, NOT JUST, YOU KNOW, GET THE LAB TO WORK CORRECTLY, THAT THE COMMUNICATION IN THOSE DAYS WAS BEFORE EMAIL, YOU KNOW, THAT -- NOT RELIABLE PHONE LINES AND YOU ALMOST PRETTY MUCH -- I MEAN, TOM WOULD SAY THIS, I'M SURE, THAT YOU HAD TO GO TO THE COUNTRY TO MAKE PROGRESS, YOU REALLY COULDN'T DO IT LONG DISTANCE IN THOSE DAYS. AT LEAST THE KIND OF WORK THAT I WAS DOING. SO I WOULD SAY THINGS HAVE CHANGED AT CDC, WE NOW HAVE OFFICES IN OVER 50 COUNTRIES. AND WE HAVE REAL LONG TERM PARTNERSHIPS WITH THE MINISTRIES OF HEALTH AROUND THE WORLD, SO IN MANY OF THE PLACES THAT WE'RE WORKING, WE HAVE A LOT TO BUILD ON, AND OF COURSE TECHNOLOG TECHNOLOGY HAS ADVANCED, IT'S A LOT EASIER TO DO THINGS. OFTEN NOW, THE RELATIONSHIPS ARE VERY MUCH OF PEERS, FOR SURE IN CHINA, IT'S A PEER TO PEER RELATIONSHIP NOW. LONG ANSWER, BUT A LITTLE BIT OF INFORMATION. >> THANK YOU. >> THANK YOU FOR THE BEAUTIFUL TALK FIRST OF ALL. AND MY QUESTION, ACTUALLY IT'S JUST A COMMENT ON WHERE YOU THINK THINGS MIGHT GO IN THE FUTURE. DURING THE EBOLA EPIDEMIC IN WEST AFRICA, I THINK ALL OF US REACHED ACROSS AGENCIES TO DEAL WITH A VERY DIFFICULT SITUATION THAT WE HAD NOT FACED BEFORE WITH A REALLY DEVASTATING DISEASE. AND ONE OF THE THINGS, EVEN WITH THAT, THE INFRASTRUCTURE IN WESTERN AFRICA IS STILL REALLY IN DESPERATE SHAPE, AND WORKING IN THE FIELD THERE WITH DETECTION OF REALLY SERIOUS DISEASES HAS BEEN QUITE CHALLENGING, AND I KNOW WE WORKED TOGETHER VERY WELL DURING THAT TIME, AND I WAS WOS WONDERING IF YOU HAD ANY THOUGHTS ON HOW NIH AND CDC CAN REALLY HELP THE INFRASTRUCTURE IN AFRICA, EITHER WORKING THROUGH WHO OR WITH OUTSIDE ORGANIZATIONS LIKE THE GATES FOUNDATION, AND REALLY TO IMPROVE OUR ABILITY FIRST TO DETECT DISEASE AND MONITOR DISEASE, BUT THEN HOPEFULLY EVEN TO TREAT DISEASE. >> THANK YOU. I THINK IT'S A REALLY EXCITING TIME, BOTH FOR THE GLOBAL HEALTH OPPORTUNITIES AND FOR THE CONTRIBUTIONS THAT OUR INSTITUTIONS AND THE PEOPLE IN THE INSTITUTIONS CAN MAKE. I SHOULD MENTION THERE'S SOMETHING CALLED THE GLOBAL HEALTH SECURITY AGENDA. WHICH WAS LAUNCHED IN FEBRUARY 2014, BEFORE EBOLA OUTBREAKS SCOPE WAS RECOGNIZED, BUT REALLY GOT LEGS WITH THE EBOLA EPIDEMIC IN TERMS OF GETTING QUITE A BIT OF EMERGENCY FUNDING FROM CONGRESS. THE GOAL OF THE GLOBAL HEALTH SECURITY AGENDA IS TO HELP EVERY COUNTRY BE ABLE TO FIND, STOP AND PREVENT EPIDEMICS. IT WASN'T A COINCIDENCE THAT THE EBOLA OUTBREAK WAS SO TERRIBLE IN GUINEA, SIERRA LEONE AND LIBERIA. THEY HAD THE THREE WEAKEST PUBLIC HEALTH SYSTEMS IN THE WORLD. THEY REALLY HAD VERY LIMITED INVESTMENT, THEY'D GONE THROUGH CIVIL WARS, THEY REALLY, YOU KNOW, JUST HAD -- WE'RE JUST -- WERE JUST COMING OUT OF REBUILDING FROM THE CIVIL WAR ERAS. THE GEOGRAPHY AND THE COMMUNITIES WERE PRETTY REMOTE, PARTICULARLY IN PARTS OF GUINEA, WHERE THE OUTBREAK STARTED. IT WAS CLEAR WHEN THERE WAS IMPORTATION OF EBOLA VIRUS IN NIGERIA NO TO A COUNTRY THAT HAD THEIR OWN WEALTH BUT ALSO YEARS OF INVESTMENT WITH INTERNATIONAL PARTNERS AND PUBLIC HEALTH CAPACITY THROUGH PEPFAR, THROUGH THE POLIO ERADICATION PROGRAM, THROUGH OTHER THINGS, THAT WE COULD HAVE HAD A TOTAL NIGHTMARE. THE POPULATION OF NIGERIA IS ENORMOUS. THE VIRUS WAS THERE. THEY HAD 20 CASES. THEY WERE ABLE TO DO 19,000 HOME VISITS TO TRACK CONTACTS AND SNUFF OUT THE OUTBREAK, AND WE HAD 11,000 DEATHS IN THE THREE WEST AFRICAN COUNTRIES. SO IN NIGERIA, IT REALLY SHOWED THAT HAVING A LITTLE BIT OR A MODERATE PUBLIC HEALTH INVESTMENT COULD STOP AN OUTBREAK. THAT WAS A POTENTIALLY REALLY BAD OUTBREAK. SO RIGHT NOW, THE U.S. GOVERNMENT AND DOZENS OF OTHER COUNTRIES ARE WORKING TOGETHER TO TRY TO IMPROVE PUBLIC HEALTH CAPACITY IN THESE COUNTRYIES, ESSENTIALLY NOT -- TRYING TO PREVENT US EVER FROM GOING THROUGH AN EBOLA EPIDEMIC AGAIN. THE OTHER THING THAT EMERGED FROM THE EBOLA RESPONSE WAS THAT WHO RECOGNIZED THAT THE PACE OF RESEARCH CAN'T KEEP UP WITH OUTBREAKS. WE DID BETTER THAN EVER IN EBOLA, WE LAUNCHED THREE LARGE TRIALS OF EBOLA VACCINE. WE HAD PEOPLE HERE AND PEOPLE IN THE MILITARY RESEARCHING EBOLA VACCINES, SO WE HAD A COUPLE CANDIDATES THAT WERE ALMOST READY FOR SMALL SCALE STUDIES THAT WE RUSHED INTO LARGE SCALE TRIALS RAPIDLY, BUT IT WASN'T FASTER THAN THE VIRUS WAS SPREADING, SO THE TRIALS GOT LAUNCHED PRETTY MUCH AFTER THE OUTBREAK WAS ON THE DECLINE FROM TRADITIONAL MEASURES, CONTACT TRACING, INFECTION CONTROL AND SO FORTH. BUT THE WHO CAME UP WITH A BLUEPRINT FOR RESEARCH AND DEVELOPMENT IN THE CONTEXT OF OUTBREAKS AND AN ORGANIZATION CALLED SEPI HAS FORMED THAT'S TRYING TO BE A COALITION TO BRING TOGETHER DONOR COUNTRIES, INDUSTRY, PUBLIC SECTOR AND PRIVATE SECTOR, TO SAY WHAT'S THAT TOP GROUP OF PATHOGENS THAT WE REALLY SHOULD GET ADVANCE TODAY HAVE SOME CANDIDATES READY FOR, NO MARKET, WE MAY NEVER HAVE AN OUTBREAK, BUT WE WANT TO BE AHEAD OF THE CURVE BY THE TIME WE HAVE ONE. SO THERE'S A LOT OF ACTIVITY RIGHT NOW. AS INDIVIDUAL RESEARCHERS, THOUGH, I REALLY DO ENCOURAGE YOU IN THE WORK THAT YOU'RE DOING, I KNOW SOME OF YOU HAVE INTERNATIONAL PARTNERSHIPS AS PART OF YOUR STUDY, TO REALLY TAKE THAT LONG VIEW. THE FIRST PROJECTS I HAD IN WEST AFRICA, I WAS ASKED TO DEVELOP VACCINE TRIALS FOR PHASE 1/2 TRIALS OF CANDIDATE VACCINES. I'M SUPPOSED TO GET A STUDY GOING, WE NEED TO GET THE ANSWER, YOU KNOW, THERE WAS A TIME PRESSURE INVOLVED, AND I WOULD SAY THAT IN RETROSPECT, I PROBABLY DID A LITTLE MORE MYSELF INSTEAD OF HANDING IT OFF AND EMPOWERING THE LOCAL PEOPLE TO DO THE BRAIN POWER SIDE OF IT. WHEN I WENT TO SIERRA LEONE TO WORK ON THE VACCINE TRIAL, IT STARTED COMPLETELY DIFFERENT. LIKE THIS IS -- IT'S THE SIERRA LEONE PEOPLE'S TRIAL, THEY'RE DESIGNING IT, WE'RE SUPPORTING IT, WE WANTED THERE TO BE A LEGACY AFTERWARDS, AND SO I REALLY DO ENCOURAGE YOU TO -- IT MAY TAKE LONGER BUT TO DO THINGS IN A WAY THAT REALLY BUILDS CAPACITY SO THERE'S SOMETHING LEFT, NOT JUST A SCIENTIFIC ANSWER BUT SOMETHING THAT'S GOING TO BE MEANINGFUL THAT'S OWNED BY THE LOCAL PARTNERS YOU HAVE. FOR SURE IN CHINA, THE RELATIONSHIP WAS VERY, VERY DIFFERENT THAN WE'VE COME IN TO HELP YOU, YOU KNOW, WE'RE WORKING WITH YOU AND REALLY WANT TO SUPPORT YOU TO HAVE MORE CAPACITY LATER. AGAIN A LONG ANSWER BUT YOU GUYS DON'T HAVE A LOT OF QUESTIONS. THERE WE GO, BACK THERE. >> THANKS AGAIN FOR THE REALLY GOOD TALK OF COURSE. AND I WAS WONDERING ABOUT THE SLIDE WHICH YOU SAID WAS YOUR FAVORITE SLIDE, WHICH WAS ABOUT THE STREP B. I THINK IT WAS REALLY INSPIRING THAT IT ACTUALLY WORKED TO HAVE THE COMMUNITY COME TOGETHER ALONG WITH THE PATIENTS AND THE ADD ADVOCACY GROUPS, AND I WAS WONDERING IF THERE WAS ANY MORE OPPORTUNITY TO DO THAT, WHAT MADE THAT EFFECTIVE, AND YEAH, WHETHER YOU SEE IT BEING APPLIED MORE OR LESS NOW AND HOW WE CAN MAKE THAT BETTER, BECAUSE I THINK THAT WAS A REALLY INSPIRING STORY. >> THANK YOU FOR LETTING ME TALK A LITTLE MORE ABOUT GROUP B STREP. I FEEL LIKE I'M HAVING FLASHBACKS THIS MORNING TO SOME OF THESE ERAS. THERE WERE A COUPLE THINGS THAT I LEARNED -- I LEARNED SO MUCH FROM THAT WHOLE EXPERIENCE. ONE THING WAS THAT THE CLINICAL GROUPS WERE SEEING IT FROM DIFFERENT SPER SPEC PERSPECTIVES. FOR A PEDIATRICIAN, A BABY WITH GROUP B STREP IN THE FIRST FEW DAYS OF LIFE COULD NOT SURVIVE, BLIND OR DEAF, JUST REALLY TERRIBLE LONG TERM PROBLEMS, AND THEY REALLY WANTED TO DO SOMETHING ABOUT IT. FOR THE TYPICAL OBSTETRICIAN, YOU KNOW, THEY NEVER SAW IT. MOST WOMEN HAD HEALTHY DELIVERIES, THEY WEREN'T CARING FOR THE BABIES. AND IT WAS RELATIVELY RARE. AN OBSTETRICIAN COULD MANAGE ONE MOM WHO HAD A BABY WITH GROUP B STREP IN THEIR WHOLE CAREER. IN THE 70s AND 80s, THEY WERE DEALING WITH IT EVERY DAY. SO GETTING THE GROUPS TOGETHER HELPED SORT OF LISTEN TO THESE OTHER PERSPECTIVES, AND THE PARENTS WERE CRITICAL JUST AS THE PATIENTS WERE CRITICAL ON AIDS BECAUSE PARENTS WERE BRINGING A SENSE OF URGENCY. THEY WERE LIKE, WE DON'T HAVE 10 YEARS, YOU KNOW, WHY DIDN'T I KNOW ABOUT THIS? THEY WERE SAYING WE DON'T NEED THE PERFECT, LET'S GO WITH THE GOOD AND THEN WE'LL GET THE PERFECT LATER. THE OTHER THING THAT I LEARNED FROM THAT, AND IT WAS ONE OF THOSE STAYING UP ALL NIGHT WRESTLING WITH WHAT WE SHOULD DO, WAS THE ISSUE OF COMPROMISE. THAT CDC WAS KIND OF BRINGING DATA TO THE TABLE. WE STARTED SURVEILLANCE SO YOU COULD ACTUALLY MEASURE HOW MUCH THERE WAS. WE DID A COST-EFFECTIVENESS ANALYSIS WHICH SAID ANYTHING IS BETTER THAN NOTHING, YOU KNOW, YOU COULD ARGUE THIS STRATEGY OR THAT STRATEGY, BUT ANY STRATEGY WAS BETTER THAN NOTHING. YOU KNOW, VERY MINIMAL RUSKS, VERY MINIMAL COSTS OF TRYING TO HAVE A STANDARD PREVENTION APPROACH, AND CONSISTENTLY APPLYING ONE OF 19 STRATEGIES WAS COST-EFFECTIVE OR COST SAVING. BUT THE COMPROMISE ISSUE WAS, I WOULD SAY WE WENT INTO THAT CONSENSUS MEETING, IF YOU WILL, WITH THIS IDEA THAT WE HAD PUT OUT A DRAFT GUIDE LINE, WE GOT THOUSANDS OF COMMENTS, WE WERE DISCUSSING HOW TO ADDRESS THE COMMENTS, AND WE WERE NEGOTIATING ABOUT WHAT TO DO. I WOULD SAY CDC WENT IN WITH HERE'S WHAT WE THINK IS THE RIGHT STRATEGY, AND WHAT CAME OUT OF THAT MEETING WAS NOT THAT STRATEGY. IT WAS SORT OF AT THE TIME THE OBSTETRICIANS WERE SAYING, WE DON'T REALLY WANT TO GO WITH THAT. THEY WANTED ANOTHER STRATEGY. THEN THERE WAS A, WELL, WE CAN DO AN EITHER/OR, LIKE THERE HAS TO BE A STRATEGY BUT IT CAN BE EITHER THIS ONE OR THAT ONE. WE WENT INTO THAT PHASE OF THE DISCUSSIONS THINKING, WELL, WE KNOW THIS ONE BASED ON EVERYTHING WE KNOW IS PROBABLY MORE EFFECT TI, SHOULD WE JUST GO WITH THAT AND IGNORE THE OBSTETRICIANS, OR SHOULD WE TRY TO GET EVERYBODY TO PUT OUT THE SAME RECOMMENDATIONS, BECAUSE CDC HAD GUIDELINES, THE PEDIATRICIANS HAD GUIDELINES, OBSTETRICIANS HAD GUIDELINES AND SOUL SEARCHING, WHAT'S THE RIGHT THING TO DO, FOLLOW THE EVIDENCE, VERSUS WHO ARE THE -- THE OBSTETRICIANS HAD TO IMPLEMENT WHATEVER HAPPENED. SO WE WENT WITH THIS COMPROMISE& THING, WHICH WAS EITHER/OR. I REMEMBER MY FIRST INTERVIEW WITH THE "NEW YORK TIMES," THE GUY'S LIKE, WELL THIS, IS A TOTAL COPOUT. I STAYED UP ALL NIGHT TO GET THE PAPER AND SEE HOW POORLY I WAS QUOTED IN IT. LIKE WHY ARE YOU DOING THIS? BUT IT WAS TOTALLY THE RIGHT THING TO DO. BECAUSE WHAT HAPPENED WAS THAT GUIDELINE CAME OUT, AND THERE WAS A NEW STANDARD OF CARE AND OBSTETRICIANS ADOPTED ONE OR THE OTHER. ONE OF MY FAVORITE STUDIES THAT OUR TEAM DID WITH THIS ACTIVE BACTERIAL CORE SURVEILLANCE NETWORK WAS A RETROSPECTIVE COHORT STUDY THAT COMPARED THE TWO STRATEGIES. YOU COULDN'T HAVE DOCS INDIVIDUALLY RANDOMIZE THEIR PATIENTS TO THIS STRATEGY OR THAT STRATEGY BECAUSE THE PRACTICE HAD TO HAVE A WHOLE STRATEGY AND THE SAMPLE SIZES WERE RIDICULOUS, BUT WE ENDED UP WITH THIS COHORT STUDY OF ABOUT 6,000 BIRTHS THAT REPRESENTED ABOUT 100,000 BIRTHS IN TERMS OF THE WAITING, AND JUST BY CHANCE, 50% GOT ONE STRATEGY, 50% GOT THE OTHER. WE WERE ABLE TO SHOW THAT THE ONE STRATEGY WAS SIGNIFICANTLY BETTER THAN THE OTHER STRATEGY SO WE WERE ABLE TO UPDATE THE GUIDELINES WITH THE SINGLE STRATEGY AND OBSTETRICIANS HAD REALLY COME ALONG BY THEN. SO I THINK THAT SENSE OF COMPROMISE WHICH -- YOU KNOW, YOU GUYS ARE YOUNG, YOU'RE PURE, LIKE I'LL NEVER COMPROMISE, BUT COMPROMISE CAN BE A REALLY GOOD THING, AND THE OTHER THING IS THAT THEORY AND PRACTICE ARE REALLY DIFFERENT, SO IF THERE'S A REASON THAT THEY REALLY DON'T WANT TO GO THERE, YOU KNOW, YOU MIGHT WANT TO LISTEN TO THAT. SO I WOULD SAY THE GENERAL THING FOR THAT PHASE OF MY EXPERIENCE WAS DOING THE SCIENCE ISN'T ENOUGH, YOU HAVE TO APPLY IT, YOU HAVE TO DELIVER IT, AND WHETHER WE'VE GOT INVENTION OF THE HPV VACCINE AT NIH HERE, WE CAN'T JUST INVENT T WE HAVE TO DELIVER IT, WE HAVE TO GET THOSE LIVES TO BE SAVED OR THOSE CANCERS PREVENTED, SO THE FOLLOW-THROUGH IS REALLY IMPORTANT. BUT I DO THINK THAT QUESTION OF CAN WE BRING PEOPLE TOGETHER,, I THINK WE'RE DOING BETTER AT IT IN TERMS OF PUBLIC HEALTH AND HEALTHCARE NOW, THERE'S MORE CONVENING. PROBABLY CONGRESS ISN'T COMPROMISING AS MUCH, BUT THE MEDICAL AND PUBLIC HEALTH COMMUNITY ARE DOING A LOT OF THAT. IS THERE ANOTHER QUESTION? >> IF WE CAN HOLD ON TO THE QUESTIONS INCLUDING THOSE THAT ARE NOW COMING IN FROM ACROSS THE POND UNTIL THE MENTOR DISCUSSION, THE PANEL DISCUSSION. IF I CAN INVITE THE PANELISTS TO THE FRONT OF THE ROOM. WHILE PEOPLE ARE MOVING AROUND, JOIN ME IN THANKING DR. SCHUCHAT ONE MORE TIME FOR A TERRIFIC TALK. [APPLAUSE] AND IT'S MY PLEASURE TO HAND THIS MICROPHONE TO OX-CAM SCHOLAR AARON WHO WILL NOW BE FULLY IN CHARGE OF THE NEXT POORGS OF THE PORTION OF THE EVENT. >> GOOD MORNING, EVERYONE. MY NAME IS ERIN, THIRD YEAR NIH OX-CAM STUDENT WORKING TOWARDS MY PH.D. IN THE LABORATORIES OF DR. CAROL -- PROFESSOR AT THE UNIVERSITY OF OXFORD AND PROFESSOR JOEL AT THE OXFORD RESEARCH UNIT IN BANK CLOCK, THAILAND. MY RESEARCH FOCUSES ON DEVELOPING NEW SENSORS TO DETECT ANTIMALARIAL DRUGS AND I'LL BE MODERATING OUR PANEL TODAY. DR. SCHUCHAT IS JOINED BY OUR MENTOR PANEL, WHICH CONSISTS OF ALL NIH INVESTIGATORS WHOSE RESEARCH CAN BE APPLIED TO IMPROVE HEALTH GLOBALLY. SO FIRST WE HAVE DR. HANS ACKERMAN. HE RECENTLY TRANSITIONED TO A TENURED TRACT INVESTIGATOR POSITION AT THE LABORATORY OF MALARIA AND VECTOR RESEARCH AT NIAID. PREVIOUSLY THE HEAD OF THE PHYSICIAN LOLG SECTION AT THE SICKLE CELL BRANCH OF NHLBI, AND HIS RESEARCH FOCUSES ON UNDERSTANDING AND TREATING VASCULAR COMPLICATION OF MALARIA AND SICKLE CELL DISEASE. HIS GROUP STUDIES GENETIC VARIATIONS THAT AFFECT THE SEVERITY OF SYMPTOMS OF BOTH MA MALARIA AND SICKLE CELL AND HE CONDUCTS CLINICAL RESEARCH AT THE NIH AND WITH COLLABORATORS IN MA MAUI. HE ALSO COMPLETED HIS PH.D. AT THE UNIVERSITY OF OXFORD SO HE CAN RELATE TO SOME OF US IN REGARDS TO HIS TRAINING. DR. CARE LENA MURRAY IS THE CHIEF OF THE MOS IMMUNITY AND VECTOR COMPETENT SECTION WITHIN NIAID. HER RESEARCH STUDIES INTERACTIONS BETWEEN THE MOS IMMUNE SYSTEM AND PLASMODIUM PARASITES TO UNDERSTAND HOW THEY AFFECT MALARIA TRANSMISSION. SHE JOINED THE LABORATORY OF MALARIA AND VECTOR RESEARCH IN 2003. AND SHE BECAME A SENIOR INVESTIGATOR IN 2010. DR. TOM QUINN IS THE CHIEF OF THE INTERNATIONAL HIV AND STD SECTION AT THE LABORATORY OF IMMUNOREGULATION AT NIAID. HIS RESEARCH FOCUSES ON TRANSMISSION OF SEXUALLY TRANSMITTED DISEASES IN LOW RESOURCE SETTINGS, UNDERSTANDING FACTORS THAT AFFECT TRANSMISSION, AS WELL AS DEVELOPING AND ASSESSING NOVEL INTERVENTIONS TO PREVENT TRANSMISSION. DR. QUINN'S RESEARCH LAB IS LOCATED AT JOHNS HOPKINS UNIVERSITY, WHERE HE'S A PROFESSOR OF MEDICINE AND ALSO THE DIRECTOR OF THE JOHNS HOPKINS CENTER FOR GLOBAL HEALTH. SO FOR THIS PORTION OF OUR PROGRAM, WE HAVE ABOUT 50 MINUTES OF OPEN QUESTION AND ANSWER WITH OUR PANELISTS. WE ENCOURAGE THE STUDENTS WATCHING FROM OXFORD AND CAMBRIDGE TO SUBMIT QUESTIONS VIA TWITTER OR EMAIL TO THE OX CAM OFFICE. MAYBE I WILL START WITH THIS QUESTION THAT WE RECEIVED FROM JOHN MARCO IN THE U.K. SO HE ASKS: COULD YOU TALK ABOUT THE DEVELOPMENT OF COLLABORATIONS WITH BASIC RESEARCHERS, ESPECIALLY WITH RESPECT TO GENOMICS AND THE CHAINS OF TRANSMISSION THROUGH SEQUENCING OF PATIENT SAMPLES? ANY OF YOU CAN TALK. I THINK YOU HAVE IT ALL FIGURED OUT, PRESS A BUTTON ON YOUR MIC AND YOUR MIC SHOULD BE ON. >> I CAN START AND MAYBE LET OTHERS BEGIN. I HAVE TO SAY, ONE OF THE WOWIST PARTS OF THE EBOLA RESPONSE WAS THAT PARTNERSHIP BETWEEN THE PUBLIC HEALTH MEDICAL AND BASIC SCIENCE TYPE OF RESEARCHERS, THE OUTBREAK IN LIBERIA HAD REALLY BEEN STOPPED AND THINGS WERE LOOKING PRETTY GOOD, AND THEN THERE WAS A NEW CASE OF A NEW CLUSTER AND THE QUESTION WAS, WHERE DID THIS COME FROM? THERE WAS AN NARD NAT AMOUNT INORDINATE AM OUNT OF WORK INVOLVED WITH DOGS RIGHT AROUND WHERE IT WAS DETECTED, BUT SEQUENCING IN THE FIELD, THEY WERE ABLE TO SHOW THAT THE STRAIN THAT HAD EMERGED THERE HADN'T COME FROM GUINEA, HADN'T COME FROM, YOU KNOW, THE ONGOING EBOLA THAT WAS STILL AROUND IN THE REGION, BUT HAD COME FROM WHAT WAS CIRCULATING IN LIBERIA SIX MONTHS EARLIER IN ANOTHER PART OF THE COUNTRY, AND THAT WAS THE FIRST CLEUR TO THE SEXUAL TRANSMISSION OF EBOLA, AND THE PERSISTENCE IN SEMEN. THE WOW PART FOR ME WAS NOT JUST THE SEXUAL TRANSMISSION AND THAT YOU COULD UNCOVER THIS MYSTERY, BUT THAT IN A PLACE WHERE WE COULDN'T DO -- IT WAS VERY HARD TO DO THE BSL4 KIND OF HANDLING OF SPECIMENS, THAT THERE COULD BE SEQUENCING IN A LITTLE TINY DEVICE. THAT WAS REALLY DEVELOPED FOR EBOLA IN RAPID PACE BECAUSE OF THESE BASIC INVESTMENTS THAT WERE BEING MADE. I THINK OTHERS OF THE FOLKS ARE WAY MORE INVOLVED IN THAT WORLD THAN I AM. >> I'LL GO SECOND AND THEN, HANS, YOU WANT TO JUMP IN. IT'S A GREAT QUESTION. I'M GLAD FROM WHERE IT CAME FROM. FROM OXFORD. MAINLY BECAUSE MY CHIEF COLLABORATOR RIGHT NOW IS AT OXFORD. HE DOES MOLECULAR SEQUENCING OF HIV, AND WE'VE BEEN UTILIZING THIS SEQUENCE DATA AND WE DO ULTRA DEEP SEQUENCING WITH THEM AND WHOLE GENOME SEQUENCING. FOR A NUMBER OF REASONS, THERE ARE MULTIPLE TYPES OF HIV AND VARIED JE NECESSITY, SO WE CAN TRY TO UNDERSTAND WHY SOME PEOPLE PROGRESS FASTER THAN OTHERS IN THE PAST. NOW WE TREAT EVERYONE WITH ANTIRETROVIRAL DRUGS IMMEDIATELY AFTER WE FIND OUT THEY'RE INFECTED AND THAT IS PREVENTING THAT PROGRESSION BUT IN THE PAST, IT WAS VERY IMPORTANT THAT WITH TRY TO UNDERSTAND THE PATHOGENICITY OF HIV BECAUSE IT WAS SO VARIED IN INDIVIDUALS. THE SECOND PART -- HIS NAME IS CHRISTOPHE FRASIER AT OXFORD, HE WAS AT IMPERIAL YAL BUT STARTED A GENTLEMAN NE TICS INSTITUTE AT OXFORD, IS THAT WE'VE BEEN DOING NETWORKING ANALYSIS, AND I THINK THAT'S PART OF THE QUESTION, HOW DO YOU USE THE SEQUENCING TO ACTUALLY FIND OUT MORE ABOUT THE TRANSMISSION KINETICS OF A PATHOGEN LIKE EBOLA, AND WE DID THE SAME WITH HIV, AND WE ACTUALLY FOUND IN OUR WORK WITH HIM CERTAIN HOT SPOTS OF TRANSMISSION. SO THAT WE COULD BETTER INTERVENE. WE COULD FIND OUT WHO IS HAVING SEX WITH WHO. IT STARTED TO GET INTO THE ETHICAL ERA OF, YOU KNOW, HAVE THESE INDIVIDUALS KNOWINGLY ADMITTED TO HAVING SEX YOU'LL SEXUAL TRANSMISSION OR OTHER INJECTING DRUG USE, AND WE'VE BEEN DOING THE INJECTING DRUG USE TRANSMISSIONS IN INDIA, WHERE IT'S QUITE RAMPANT. WITH THAT KNOWLEDGE, WE COULD THEN INTERVENE. BECAUSE THE MAIN MESSAGE, ONE THING IS THE KNOWLEDGE OF THE SCIENCE AND THAT'S EXCITEING TO REALLY UNRAVEL SOME MYSTERIES, BUT THEN ULTIMATELY YOU NEED TO TAKE THAT KNOWLEDGE AND INTERVENE, AND THAT'S WHAT RESONATED WITH ME IN YOUR TALK, IS THAT BY THAT KNOWLEDGE, WE COULD GO IN THERE AND WE COULD INTENSIFY OUR SCREENING, COUNSELING, LINKAGE TO CARE, AND TREATMENT. SO I THINK COLLABORATION IS PROBABLY ONE OF THE MOST IMPORTANT ASPECTS OF MY CAREER, AND I HOPE THERE'S LESSONS IN THAT FOR EVERYONE ELSE, AND COLLABORATE WITH PEOPLE WITH GREAT SCIENTIFIC BACKGROUND AND KNOWLEDGE, AND WHO SHARE THAT SAME KIND OF END GAME THAT WE'RE GOING TO WORK TOWARDS INTERVENING WITH THE KNOWLEDGE THAT YOU GENERATE. IF YOU'RE AT OXFORD, I REALLY ENCOURAGE YOU TO SEEK OUT CHRISTOPHE FRASIER. HE'S A WONDERFUL COLLABORATOR, ONE OF THE BEST I'VE HAD IN MY CAREER. THANKS. >> WELL, I CAN TALK ABOUT SEQUENCING BUT I'M AN INSECT PERSON, SO I DON'T SEQUENCE HUMAN SAMPLES, BUT I DO SEQUENCE OTHER THINGS. I WOULD SAY WE FOUND THAT ONE OF THE REASONS MALARIA TRANSMISSION IS SO EFFECTIVE IS BECAUSE PLASMODIUM PARASITES HAVE A GENE THAT ALLOWS THESE PARASITES TO BECOME INVISIBLE TO THE MOS IMMUNE SYSTEM AND WE TOOK ADVANTAGE OF HUNDREDS, NOW THOUSANDS OF PLASMODIUM PARASITES FROM PEOPLE ALL OVER THE WORLD THAT HAVE BEEN SEQUENCED AND WHEN WE LOOK AT THIS GENE, WE REALIZED IT HAD A VERY STRONG GEOGRAPHIC STRUCTURE AND WHAT WE FOUND IS MALARIA IS TRANSMITTED FROM DIFFERENT STRAINS OF MOSS IN PLACES AROUND THE WORLD AND -- GIVEN IMMUNE SYSTEM OF A -- MOS CAN BE TRANSMITTED IN A GIVEN PLACE. SO BASICALLY THE MOSS IN DIFFERENT REGIONS OF THE WORLD DETERMINE WHAT KIND OF STRAINS OF PLASMODIUM ARE CIRCULATING. SO WE WENT FROM VERY BASIC TO HOW MALARIA BECAME GLOBAL, LOOKING AT THE SPREAD, HOW IT WENT FROM AFRICA TO AROUND THE WORLD AND DETERMINING WHAT COULD SPREAD TO A NEW CONTINENT OR NOT. SO I THINK CAN YOU GO FROM SOMETHING VERY BASIC IN THE LAB TO A GLOBAL PERSPECTIVE AND NOW WE'RE DEVELOPING A VACCINE BASED ON THIS GENE AND AGAIN, WE NEED TO UNDERSTAND HOW VARIABLE IS THE REGION THAT WE'RE GOING TO CHOOSE FOR THE VACCINE, IS THIS GOING TO BE A UNIVERSAL VACCINE, HOW POLYMORPHIC IS THIS GENE, SO AGAIN NOW WE'RE BEGINNING TO COLLABORATING MORE TRANSLATIONAL SETTINGS. AND I ALSO WOULD LIKE TO MENTION RECENTLY WE ALSO FOUND THAT THERE ARE SOME NATURALLY OCCURRING INFECTIONS OF MOSS WITH A BACTERIA THAT INFECTS MANY INSECTS. WE CHARACTERIZE A NEW STRAIN IN THE VILLAGE THAT APPEARS TO HAVE A STRONG EFFECT IN REDUCING PLASMODIUM TRANSMISSION SO NOW WE'RE DOING A LITTLE BIT OF RESEARCH, HUNTING, IN THE VILLAGES, WE'RE GOING TO SEE WHERE ARE THESE MOSS THAT HAVE THESE BACTERIA COMING FROM, WHAT DETERMINES WHETHER A MOS CAN CARRY THIS BACTERIA, BECAUSE IF THIS BACTERIA CAN BECOME ESTABLISHED AT A CERTAIN LEVEL, THOSE MOSQUITOES STOP TRANSMITTING MALARIA. SO THIS IS GOING TO BE A WONDERFUL PARTNERSHIP BECAUSE WE HAVE EXCELLENT PEOPLE IN THE FIELD, AND WE'RE BRINGING PEOPLE INTO THE LAB TRAINING TECHNIQUES SO THEY CAN DEVELOP IT, HOW IS WHICH VILLAGES IS IT IN, AND IF WE FIND THE RIGHT CONDITIONS, COULD ONE SPREAD MOSQUITOES WITH THIS BACTERIA TO OTHER VILLAGES AND CREATE NO TRANSMISSION ZONES, IS THAT SOMETHING WE COULD SEE IN THE FUTURE HAPPENING. SO I THINK GENOMICS IS GOING TO BE KEY, BECAUSE WE NEED TO TRACK WHERE THESE BACTERIA CAME FROM, HOW POLYMORPHIC ARE THEY, AND PUT ALL THIS GEOGRAPHIC INFORMATION IN THE CONTEXT OF MALARIA TRANSMISSION. SO I THINK THAT'S SOMETHING VERY EXCITING FOR US. >> I DO WANT TO ADD SOMETHING BRIEFLY BECAUSE THAT'S A REALLY INTERESTING QUESTION ABOUT ENGAGEMENT WITH BASIC SCIENCE, BECAUSE WHILE EPIDEMICS COME AND GO, SCIENCE NEEDS TO BE THERE EVERY DAY, AND WHILE YOU HAVE TO RAPIDLY MOBILIZE RESOURCES TO ADDRESS AN EPIDEMIC, YOU NEED A STRONG FOUNDATION TO DO SCIENCE AND IT'S ACTUALLY THERE'S A VERY IMPORTANT INTERACTION BETWEEN THOSE TWO WHEN A COMES TO INFRASTRUCTURE. AND THE COUPLE EXAMPLES THAT ARE REALLY IMPORTANT IN WEST AFRICA THAT I KNOW OF PERSONALLY, ONE OF MY CLASSMATES FROM OXFORD, WE STUDIED GENETICS TOGETHER, HER NAME IS PARDI SEBETTI, HER BASIC SCIENCE HAD LED HER TO IDENTIFY A GENE THAT SHE THOUGHT WAS PROTECTIVE AGAINST LASSA FEVER. SO IN ORDER TO PURSUE THIS, SHE GOT A BIG GRANT FROM NIAID TO SET UP A LASSA FEVER RESEARCH PROGRAM IN NIGERIA, AND SHE WAS ACTUALLY SEQUENCING BASICALLY META METAGENOMIC SEQUENCING OF EVERYTHING THAT SHOWED UP IN A FEBRILE PATIENT TO THIS HOSPITAL IN NIGERIA. AND SO SHE WAS VERY WELL POSITIONED TO SUPPORT STUDIES OF EBOLA WHEN IT BROKE OUT. BUT THAT WAS SOMETHING THAT WAS PUT IN PLACE WELL IN ADVANCE AND IT WAS FOR BASIC SCIENCE REASONS. LIKEWISE, IN MALI, WHERE NIAID HAS BEEN PARTNERING WITH THE UNIVERSITY FOR GOING ON 30 YEARS NOW, THEY HAVE THE ABILITY TO DO BASIC RTPCR AND THEY HAD THE PRIMERS TO IDENTIFY EBOLA CASES AND SO THEY DID SOME OF THE FIRST MOLECULAR DIAGNOSTICS AND WERE ABLE TO QUELL THE EPIDEMIC IN MALI IMMEDIATELY BEFORE IT SPREAD WITHIN THAT COUNTRY. SO IT'S A GREAT EXAMPLE OF WHY WE NEED BASIC SCIENCE TO GO ON EVERY DAY IN THESE PLACES SO THAT WHEN THE EPIDEMICS BREAK OUT, DR. SCHUCHAT AND HER COLLEAGUES HAVE LABORATORIES TO OPERATE IN. >> GREAT, THANK YOU. ANY QUESTIONS FROM THE AUDIENCE HERE? ANGELA WILL BRING A MIC. >> SO THIS IS A VERY DIFFERENT FIELD THAT I'M ASKING WITH THE POLITICAL CLIMATE, COUNTRIES AROUND THE WORLD CLOSING DOWN BORDERS AND DIFFERENT POLITICAL -- INTERNATIONAL IN THE WAY THEY'RE THINKING, HOW DO YOU THINK ABOUT DISEASE CONTROL IN REGARDS TO THAT IT MIGHT MAKE IT EASIER TO CLOSE DOWN THE BORDERS AND EASIER TO ELIMINATE DISEASES IN THAT WAY, BUT IT COULD ALSO BE MUCH MORE DIFFICULT TO COLLABORATE FROM COUNTRY TO COUNTRY. >> I THINK POLITICALLY THERE'S OFTEN A TEMPTATION TO JUST SHUT DOWN THE BORDERS AND THINK THAT THE DISEASES WILL STOP, BUT THE DISEASES DON'T REALLY CARE ABOUT THE BORDERS. SO THERE'S A LOT OF DATA THAT HAVE BEEN LOOKED AT FOR INFLUENZA BECAUSE IN PANDEMIC PLANNING AND PREPAREDNESS, PEOPLE WONDER CAN'T WE JUST LEAVE IT -- YOU KNOW, STOP ALL THE TRAVEL AND NOT HAVE PEOPLE COME IN TO OUR COUNTRY WHO MIGHT BE SPREADING THAT PATHOGEN. 2009, OF COURSE, WE LEARNED WE WERE THE FIRST PLACE THAT DETECTED THE INFLUENZA, SO THAT IDEA OF BORDERS WAS GOING TO IMPACT US INSTEAD SOMEBODY ELSE. BUT THERE'S BEEN A LOT OF MODELING TO SHOW THAT THE INFECTIONS LIKE INFLUENZA, WHERE THERE CAN BE TRANSMISSION BEFORE SYMPTOMS OR SUBCLINICAL INFECTION OR SO MANY OTHER THINGS THAT LOOK LIKE INFLUENZA THAT ARE NOT, THAT THERE'S JUST NO EFFECTIVENESS OR FEASIBILITY OF A BORDER CONTROL APPROACH. YOU WILL RECALL WITH EBOLA THAT WE DID EXIT SCREENING AND THAT WE DID ENTRY SCREENING FOR PEOPLE COMING FROM THE THREE WEST AFRICAN COUNTRIES, BUT THE NUMBERS OF PEOPLE WHO TRAVEL FROM THOSE THREE COUNTRIES TO THE U.S. WAS MINUSCULE COMPARED TO WHAT WOULD HAPPEN IF NIGERIA HAD BEEN INFECTED OR IF WE HAD SARS COMING FROM ASIA. THE OTHER THING THAT'S BEEN RECOGNIZED IS THAT A COST OF INTERVENING WITH TRAVEL AND TRADE IS ENORMOUS. IN SARS IN 2003, IT COST ABOUT $40 BILLION IN ONE QUARTER BECAUSE OF THE EFFECT IN ASIA OF PEOPLE -- YOU KNOW, THE AIRLINES STOPPED FLYING, THE MULTI-NATIONAL BUSINESS STOPPED. SO I THINK THAT IN THE MODERN ERA WHERE THERE IS A LOT OF TALK ABOUT BORDER ISSUES AND, YOU KNOW, ISOLATIONIST PERSPECTIVES ON A NUMBER OF COUNTRIES, THERE'S STILL COMMITMENT TO HEALTH SECURITY AND THE IDEA OF HEALTH SECURITY IS WE'RE REALLY IN THIS TOGETHER AND THAT THE BEST APPROACH IS EVERY COUNTRY HAVING BETTER CAPACITY AND US WORKING TOGETHER IN GOVERNANCE. SO EVEN THOUGH YOU MAY WONDER ABOUT THE POLITICAL COMMITMENT TO THE GLOBAL HEALTH SECURITY AGENDA THAT I MENTIONED, THE CURRENT ADMINISTRATION HAS PUBLICLY COMMITTED TO CONTINUE THAT INVESTMENT AND THAT COMMITMENT THAT WE DON'T WANT MANY COUNTRIES INCLUDING OUR OWN TO SUFFER BECAUSE WE STOP -- WE DETECT AND STOP OUTBREAKS LATER THAN WE NEED TO. >> THERE'S A SLIGHT DIFFERENT TAKE ON YOUR QUESTION, BUT IT'S AN IMPORTANT AREA FOR DISCUSSION. AND WE TALKED A LITTLE BIT ABOUT IT LAST NIGHT AND THAT'S POLITICAL WILL WITHIN THOSE COUNTRIES TO INVESTIGATING THE SPREAD OF THE DISEASES, AND THEN TRYING TO CONTROL THAT SPREAD. AND WHY WE AS SCIENTISTS WILL GO TO THESE COUNTRIES, AND INVEST IN BUILDING INFRASTRUCTURE, INVEST IN BUILDING COLLABORATIONS WITH THE FOREIGN SCIENTISTS, AND REALLY HAVEING A VERY PRODUCTIVE KIND OF ENVIRONMENT, THEN THE POLITICAL SITUATION CHANGES, AND IT CAN BRING THE WHOLE THING CRASHING DOWN, AND I HAD ONE EXPERIENCE WITH THAT, WHICH WAS IN ZAIRE, AND WE HAD STAFF BASED THERE, IT WAS WHERE OUR PROJECT WAS, AGAIN, HIV RELATED RESEARCH, AND THERE WAS CIVIL WAR THAT BROKE OUT. I HAD CDC COLLABORATORS THAT WERE THERE, AND WE HAD TO AIR-EVACUATE THEM. WE WERE VERY FAR AWAY, WE GOT THE BELGIAN PARATROOPERS TO GET IN THERE AND GET THEM OUT. WE ACTUALLY PUT BLOOD ON THE OUTSIDE OF OUR LABORATORY, SPELLING OUT THE FRENCH WORD FOR AIDS, AND THE LABS WERE PROTECTED BECAUSE NONE OF THE RIOTERS WOULD GO NEAR THAT BUILDING. YOU HAVE TO THINK OF THOSE KIND OF ATTRIBUTES AND SO FORTH. WE LATER ACTUALLY, AS THINGS SUBSIDED, WANTED TO CONTINUE THOSE COLLABORATIONS. WE TOOK THOSE SCIENTISTS THAT WE WERE WORKING WITH, BROUGHT SOME BACK TO THE STATES, GOT THEM EDUCATED, THEY RETURNED, AND THAT'S VERY IMPORTANT, GETTING THEM EMPOWERED TO GO BACK TO WORK IN THOSE COUNTRIES, AND NOW WE HAVE AN ONGOING COLLABORATION IN THE DEMOCRATIC REPUBLIC OF CONGO. ACTUALLY THEY WERE INVOLVED IN THE EBOLA OUTBREAK AND ACTUALLY HAD LABORATORIES AND EFFORT. SO IT DID CLOSE DOWN. WE DID HAVE TO PULL PEOPLE OUT. THAT'S VERY IMPORTANT. SAFETY HAS TO BE THE NUMBER ONE PRIORITY FOR ANY OF YOUR TEAM ANYWHRE. WE'RE TALKING ABOUT GLOBAL HEALTH AND WORKING IN VERY UNUSUAL PLACES AT TIMES, BECAUSE WHERE THERE'S POLITICAL UNREST, THERE'S OFTEN THE EMERGENCE OF THESE DISEASES. BECAUSE THERE'S ABSOLUTELY NO CONTROL GOING ON. EVEN THE REFUGEE CAMPS, THERE'S A NEED AND AN EFFORT TO GET INVESTED IN THAT. SO ONE IS PATIENCE, ONE IS WORKING THROUGH YOUR GOVERNMENT, WHETHER IT'S U.K., U.S., OR WHEREVER, TO TRY AND MEDIATE AND TRY TO CREATE A SEA CHANGE AGAIN TO GO BACK IN AND TO CONTINUE THE COLLABORATIONS THAT YOU WORKED SO HARD TO SET UP, BECAUSE WE TALKED ABOUT INFRASTRUCTURE DEVELOPMENT AND SO FORTH. THINGS CHANGE. THE POLITICAL WINDS CHANGE. SOUTH AFRICA, I'LL JUST GIVE ONE EXAMPLE, HAD APARTHEID. THE BORDERS WERE SHUT DOWN. THIS WAS A COUNTRY NO ONE WANTED TO DEAL WITH. THEN THAT ALL CAME DOWN, BACK AND FORTH, LOTS OF MIGRATION. GUESS WHAT HAPPENED? AIDS EXPANDED. IT ACTUALLY DIDN'T GO DOWN, IT ACTUALLY -- AND CREATED AN EVEN MORE NEED TO GET IN THERE AND TO WORK WITH THOSE INDIVIDUALS. AND THEY HAVE GREAT SCIENTISTS AND GREAT PUBLIC HEALTH PEOPLE THAT WE HAVE ONGOING STUDIES WITH. SO THERE'S TWO WAYS THIS CAN GO. WHEN THE BORDERS OPEN UP, SOMETIMES DISEASES FLOW MORE ACTIVELY BECAUSE OF MIGRATION, BUT REMEMBER SAFETY. WHEN YOU'RE WORKING OVERSEAS, WHETHER IT'S YOU OR YOUR COLLABORATORS, OTHER INDIVIDUALS INDIVIDUALS, YOU HAVE TO MONITOR THAT VERY CAREFULLY. >> YES, I JUST WANTED TO MENTION THAT IN MALI ALSO, THERE'S BEEN A LONG ONGOING PROGRAM AND THERE'S TIMES OF, OF COURSE, POLITICAL UNREST, WE'RE FORBIDDEN FROM FLYING THERE, IT'S BEEN SHUT DOWN, BUT WHAT'S BEEN A SAVING GRACE FOR US, THERE'S SUCH A GOOD LOCAL INVESTMENT IN TRAINING, WE HAVE SKYPE TALKS TO COORDINATE, BUT THEY HAVE A VERY GOOD -- THEY HAVE PH.D. PROGRAM, THEY HAVE PROFESSORS WITH A LOT OF EXPERIENCE, AND SO YOU CAN KEEP A PROGRAM GOING FOR SIX MONTHS WITHOUT ANYONE BASICALLY BEING THERE. COMMUNICATING VIA SKYPE AND HAVING THEN LOCAL PEOPLE THAT CAN FOLLOW. SO I THINK THAT'S THE OTHER BIG ADVANTAGE. ONCE YOU HAVE A CRITICAL MASS OF WELL TRAINED PERSONNEL, A LOT OF PEOPLE AT ALL LEVELS OF EDUCATION, BUT PIs, NOW THEY'RE WRITING THEIR OWN GRANTS, THEY REALLY HAVE -- SO THEY'RE REALLY TRUE INVESTIGATORS AND COLLEAGUES. THEN THINGS CAN SUSTAIN MUCH BETTER. SO IT SHOULD NOT BE DEPENDING ON US BEING THERE FOR SHOULD REALLY BEGIN TO HAVE SOME INDEPENDENCE. >> JUST ONE MORE COMMENT -- I MEAN, I COULD MAKE LIKE 10 MORE COMMENTS BUT ONE THING I DON'T THINK I'VE MENTIONED YET IN MY REMARKS, YOU KNOW, WHEN WE THINK ABOUT THE POLITICAL CLIMATE, MANY GOVERNMENTS ARE GOING THROUGH CHANGES AND POLICIES ARE COMPLEX RIGHT NOW AND RELATIONSHIPS THAT WERE GOOD A YEAR AGO MIGHT NOT BE GOOD NEXT YEAR. THERE ARE ALSO MULTILATERAL ORGNIZATIONS THAT ARE PRETTY IMPORTANT IN GLOBAL HEALTH. THE WORLD HEALTH ORGANIZATION OR SOME OF THE OTHER U.N. ORGANIZATIONS, THE WORLD FOOD PROGRAM, THE ANIMAL HEALTH ORGANIZATION, THOSE CAN BE IMPORTANT. THERE ARE TIMES -- WE HAD AN H5N1 AVIAN INFLUENZA IN NORTH KOREA. THERE WAS NO WAY THE U.S. HAD ANY WAY THAT WE COULD DO ANYTHING WITH THAT, BUT THE WHO WAS ABLE TO ADDRESS IT. AND SO EVEN WITH CDC, SOMETIMES WE ARE WORKING BILATERALLY, OUR GOVERNMENT, TO ANOTHER GOVERNMENT, SOMETIMES WE ARE WORKING AS PART OF AN INTERNATIONAL WHO EFFORT WITH DIFFERENT ACCESS. SO YOU KNOW, THERE'S POLITICAL CONCERN ABOUT, YOU KNOW, SOME OF THESE ORGANIZATIONS AND SHOULD WE BE PAYING OUR DUES OR NOT, BUT THEY CAN ACTUALLY PLAY A REALLY IMPORTANT ROLE IN TIMES WHERE THE ACCESS IS LIMITED. YOU CAN LOOK AT WHAT'S GOING ON WITH POLIO ERADICATION NOW. WHERE DO WE STILL HAVE POLIO TRANSMISSION, THIS YEAR IT'S ONLY BEEN IN AFGHANISTAN AND PAKISTAN THE BORDER AREA IN VERY, VERY DIFFICULT AREAS OF ACCESS AND SECURITY, BUT THERE ARE SOME GROUPS THAT CAN GET IN THERE OR SOMETIMES IT'S NOT EVEN INTERNATIONAL GROUPS BUT THERE ARE AREAS WHERE THE VETERINARIANS CAN STILL GET IN BECAUSE CARING FOR YOUR ANIMALS IS IMPORTANT IN SOME OF THESE COMMUNITIES. SO YOU KNOW, WE HAVE TO BE PRETTY CREATIVE AND FLEXIBLE. >> CAN I HAD ONE MORE THING? >> YES. >> I ALSO WANT TO SAY IN THIS TIME WHEN MAYBE HEADS OF STATE ARE REALLY RACHETING UP THE TENSIONS BETWEEN COUNTRY, OUR ROLES ARE REALLY IMPORTANT IN TERMS OF DIPLOMACY. AND YOU'RE PART OF AN EXCHANGE PROGRAM WITH BRITAIN, MANY OF YOU HAVE CONNECTIONS TO OTHER SITES MAYBE IN SOUTHEAST ASIA, IN AFRICA, AND DON'T FORGET WHAT DR. SCHUCHAT TOLD US, CONNECT, LISTEN, MAKE FRIENDS, THOSE THINGS ACTUALLY MAKE A DIFFERENCE. AND I KEEP UP WITH COLLEAGUES IN AREAS WHERE THERE'S A LOT OF UNREST RIGHT NOW, AND JUST CHECKING IN, SEEING HOW THEY'RE DOING, I THINK HELPS US TO KEEP THOSE CONNECTIONS AND FOR THEM TO HAVE ANOTHER FACE FOR AMERICA THAT'S NOT JUST, YOU KNOW, OUR HIGHEST LEADERS BUT THE INDIVIDUALS WHO ARE PART OF AMERICA. SO KEEP BUILDING THOSE INTERPERSONAL CONNECTIONS, ALL THE MORE IMPORTANT NOW THAN EVER. >> IN MY VIEW, POLITICS TAKES THE SHORT TERM VIEW, MANY TIMES THEY'RE THINKING DOWN THE LINE TO THE NEXT ELECTION. WHEN WE'RE IN SCIENCE, WE'RE HERE FOR A LIFETIME. SO OUR RELATIONSHIPS ARE BUILT IN A LIFETIME OF COLLABORATORS. YOUR NAME AND YOUR REPUTATION HAS TREMENDOUS VALUE. IF PEOPLE TRUST YOU, THEY KNOW YOU'RE HONEST AND YOU DO GOOD WORK, YOU CAN ESTABLISH LIFETIME RELATIONSHIPS THAT WILL WITHSTAND ALL THE POLITICAL UPS AND DOWNS AND UNREST, SO I WOULD AGAIN THINK, LIKE ANNE MENTIONED, THINK IN THE LONG TERM, POLITICIANS COME AND GO, AND SCIENCE IS STILL THERE, AND WE'LL BE THERE FOR MANY DECADES HOPEFULLY. >> I WOULD ADD THE KEY TO SUCCESS IN DOING GLOBAL HEALTH, SINCE THAT'S THE TEAM OF THIS SESSION, IS COLLABORATION. REACHING OUT, SHARING THE SCIENTIFIC ACHIEVEMENTS AND THE FAILURES AND THE INTERVENTIONS, THESE ARE -- IT'S MAKING FRIENDS, AND WHEN YOU'RE IN THE FIELD, THAT'S THE MOST IMPORTANT THING YOU CAN DO, IS ESTABLISH THOSE FRIENDSHIPS, WHICH LEAD TO COLLABORATIONS, AND SHARING ALL ASPECTS OF THE SCIENTIFIC ENDEAVOR. THAT'S VERY IMPORTANT. >> LET ME TELL ONE MORE -- GIVE YOU ONE MORE RECOMMENDATION. THERE'S A BOOK CALLED "HOUSE ON FIRE" WRITTEN BY FORMER CDC DIRECTOR AND ADVISER TO THE GATES FOUNDATION JUST AT ITS FORMING, AND HE WAS VERY INVOLVED IN SMALLPOX ERADICATION AND THE BOOK IS ABOUT HOW INDIA ERADICATED SMALLPOX, BUT HE TELLS A STORY IN THERE ABOUT SOME OF THE CHALLENGES WITH THE POLITICAL CONTEXT AND THE ENVIRONMENT AND THEN HE TELLS HIS PERSONAL STORY OF THE INTRAINDIA AIRPLANES JUST TERRIFIED HIM, AT A CERTAIN POINT HE SAID I'M NOT FLYING ANY PLACE ELSE, WE'RE TAKING THE TRAIN, IT MIGHT BE OVERNIGHT BUT I'M JUST TAKING THE TRAIN. SO HE AND HIS COUNTERPART WERE DOING VERY LONG TRAIN RIDES WHERE THEY MET ALL THEIR INDIAN GOVERNMENT COUNTERPARTS. SO THESE TRAIN RIDES TURNED INTO RELATIONSHIP BUILDING, AND WHEN THEY GOT INTO THIS PINCH OF WHY THEY COULDN'T BE MAKING THE PROGRESS THAT ME THE WERE MAKING, THEY JUST COMPLETELY WERE AUTOMOBILE TO OVERCOME THE BARRIERS BECAUSE NOW THEY WERE PARTNERS AND THEY WERE FRIENDS WITH THE KEY GOVERNMENT OFFICIALS WHO HAD TO MAKE THINGS HAPPEN. SO IT MIGHT HAVE BEEN HIS FEAR OF FLYING THAT GOT HIM ON TO THE TRAIN, BUT SLOGGING IT OUT ON THE TRAIN WITH HIS COUNTERPARTS WAS REALLY PART OF THE SECRET THERE. IT'S A GREAT BOOK, THOUGH, FOR FOLKS INTERESTED IN GLOBAL HEALTH IN TERMS OF BOTH THE SCIENCE AND PUBLIC HEALTH STRATEGY THAT WORKED BUT ALSO THE PERSONAL STORIES OF HIS FAMILY IN BOTH WEST AFRICA AND THEN IN INDIA. >> THANK YOU. WE HAVE A COUPLE MORE QUESTIONS COMING IN FROM THE U.K. THIS IS FROM CHARLES. HE SAYS OFTEN IN EPIDEMICS, LOW RESOURCE AND LOW EDUCATION POPULATIONS ARE HIT THE HARDEST IN TERMS OF MORBIDITY AND MORTALITY. WHEN WE TARGET THESE POPULATIONS, WE SOMETIMES FACE SKEPTICISM TOWARDS NEW INTERVENTIONS. CAN YOU COMMENT ON HOW TO OVERCOME THESE OBSTACLES? >> THIS IS REALLY CLOSE TO MY HEART RIGHT NOW FROM THE EBOLA ACTIVITY. NIH AND CDC AND WHO WILL WERE INVOLVED IN LARGE FIELD TRIALS OF EBOLA CANDIDATE VACCINES IN WEST AFRICA. I'D BEEN WORKING IN VACCINES IN THE UNITED STATES WHERE VACCINES WE'VE BEEN USING FOR YEARS WERE RAISING QUESTIONS FOR PARENTS ABOUT IS THIS SAFE TO GIVE TO MY CHILD. THE CANDIDATE EBOLA VACCINES THAT WERE PROPOSED FOR THESE FIELD TRIALS HAD NOT EVEN REALLY BEEN IN PEOPLE WHEN WE STARTED TALKING ABOUT IT, AND THE COMPRESSED TIMELINE FROM PHASE ONE STUDIES OF THE DOSING AND TOLERABILITY TO THE -- TRYING TO GET THOUSANDS OF PEOPLE VACCINE WAS EXTRAORDINARY PEOPLE WERE BEING ASKED TO STEP UP AND VOLUNTEER FOR THESE, WHERE THERE WERE LANGUAGE AND CULTURE ISSUES AND WE REALLY COULDN'T SAY WITH HUGE CONFIDENCE THE SAFETY RECORD. AT THE TIME WE PICKED THE DOSING FOR THE SIERRA LEONE STUDY, LESS THAN 100 PEOPLE IN THE WORLD HAD GOTTEN THAT DOSE OF VACCINE, AND WE WERE PROPOSING WHAT ENDED UP BEING AN 8,000-PERSON TRIAL. WE DID AN ENORMOUS AMOUNT OF COMMUNITY ENGAGEMENT OF LEADERS OF COMMUNITY MEMBERS, OF MEDICAL HEALTH BUT ALSO TRIBAL LEADERS TO ACTUALLY LISTEN AS WE WERE DESIGNING THE STUDY TO UNDERSTAND WHAT WAS GOING TO BE IMPORTANT. WE LEARNED THINGS LIKE WE COULDN'T CALL IT AN EBOLA VACCINE BECAUSE TO THE COMMUNITY AND THE LEADERS, THAT MEANT A VACCINE THAT HAS EBOLA IN IT AND THAT WILL CAUSE EBOLA. SO IT HAD TO BE CALLED AN EBOLA PREVENTION SACK SEEN. JUST TO THE LEVEL OF WHAT WAS THE NAME OF THE VACCINE. WAS AGAINST -- THE PLATFORM WAS THE VA ANIMAL VIRUS, THE IDEA THAT'S NOT A HARMFUL THING FOR PEOPLE WAS LESS IMPORTANT TO THEM THAN WHAT'S THAT GOING TO DO TO OUR ANIMALS? ARE THEY GOING TO GET THAT VSV DISEASE? WE HAD TO RUN AROUND TRYING TO FIND ANSWERS TO THAT. SO WE REALLY HAD TO LISTEN AND ENGAGE. WE LEARNED THAT RANDOMIZATION WAS OKAY. WHICH NEEDED TO PARTICIPATE IN IT. THEY WERE FAMILIAR WITH A LOTTERY, BUT THE WAY LOTTERIES WORK, YOU PULLED THE TICKET OUT YOURSELF, SOMEBODY DIDN'T GIVE YOU THE TICKET. SO HAVING A LITTLE BASKET WHERE YOU PULLED YOUR OWN NUMBER OUT RATHER THAN WHERE WE' SIGNED YOU A NUMBER MEANT THAT WE TRUSTED THE WAY THE PROJECT WAS BEING DONE. SO THERE WERE JUST ENORMOUS DESIGN ELEMENTS THAT WENT INTO HOW WE MESSAGE AND AND ACTUALLY SETED AND ACTUALLY SET UP THE STUDY THAT WAS BASED ON LISTENING. >> SO I'LL GIVE ONE EXAMPLE, IT'S A VERY IMPORTANT QUESTION, ONE THAT I THINK OUR MODERATOR COULD EASILY ANSWER HERSELF FROM WHAT I LEARNED LAST NIGHT. WHEN WE FIRST STARTED WORKING IN UGANDA, IT WAS TRUE THAT HIV WAS JUST SPREADING VERY RAPIDLY AND HAD ITS GREATEST IMPACT IN THE POOREST POPULATIONS, IN THE RURAL FAR TO REACH GROUPS, SO IN COMES THE SCIENTISTS AND PUBLIC HEALTH PEOPLE, AND WE SET UP A PROGRAM THAT'S CALLED THE RIKAI HEALTH SCIENCES PROGRAM. AND THE MOTTO IS "HEALTH THROUGH SCIENCE." WE STARTED DOING OUR STUDIES, BUT ALWAYS WE HAD A COMMUNITY ADVISORY GROUP MADE UP OF THE INDIVIDUALS FROM THE COMMUNITY. EVERY STEP ALONG THE WAY, THEY WERE ALWAYS BEING INFORMED WHEN WE CAME UP WITH FINDINGS, WE WOULD THEN PULL THEM IN AND THEY WOULD HELP US IN EACH OF THE VILLE VILLAGES, WE WOULD TALK TO THE TRIBAL LEADERS, AND WE WOULD HAVE THESE SIT AROUND MEETINGS WHERE WE EDUCATED THE POPULATION. THIS IS WHAT WE'RE DOING, THIS IS THIS WORK, IT DIDN'T WORK, WHATEVER THOSE EFFORTS WERE. WHEN WE WERE READY TO PUBLISH, WE ACTUALLY HAD OUR COLLABORATORS THAT ARE FROM UGANDA ACTUALLY MEET WITH ALL THE COMMUNITYIES, TALK IN THEIR LANGUAGE, TELL THEM WHAT WE HAD DONE. THAT SEEMS TO BE WORKING PRETTY WELL, AND IT'S A REAL GIVE AND TAKE AND DISCUSSION. WHY I THOUGHT YOU MIGHT BE ABLE TO ANSWER THAT QUESTION IS THAT SHE'S BEEN WORKING ON A NEW DIAGNOSTIC TEST FOR MALARIA AND THE DRUGS FOR TREATING MALARIA. WELL, THAT'S VERY IMPORTANT, IN A PLACE LIKE UGANDA, IF YOU HAD A FEVER, YOU WERE TREATED FOR MALARIA. WHETHER YOU THIS OR NOT, IT WAS JUST THE WAY IT WAS DONE, BECAUSE THEY DIDN'T WANT TO MISS THAT. WELL, WITH THESE NEW DIAGNOSTICS NOW, YOU KNOW, 20, 30% OF THOSE PEOPLE WITH FEVER MAY HAVE MALARIA, THEY GET APPROPRIATELY TREATED, AND OTHERS DO NOT. IS THAT GOING TO BE PERTINENT TO THE UNITED STATES? NO. THAT'S REALLY HELPING THE PEOPLE OF THAT COUNTRY WHERE THE STUDY WAS DONE. SO I DO THINK IT'S COMMUNITY ENGAGEMENT IS WHAT NEEDS TO HAPPEN, AND WHAT DO THEY NEED, IT'S NOT WHAT ALWAYS THE U.S. NEEDS, ALTHOUGH WE MAY BENEFIT FROM IT. IT'S WHAT DO THOSE PEOPLE NEED. AND NOT STARTING THE STUDIES UNTIL YOU REALLY HAVE A GOOD FEEL FOR THAT. >> YEAH, IT SOUNDS LIKE WE'RE HEARING THAT IT'S REALLY WORTHWHILE TO PUT IN THE INVESTMENT TO HAVE OPEN COMMUNICATION AND COLLECT FEEDBACK EARLY AND OFTEN, NOT JUST ONCE YOU HAVE A FINISHED PRODUCT OR A FINISHED TOOL OR WHATEVER IT MIGHT BE. THANK YOU. QUESTION IN THE AUDIENCE. ANGELA WILL BRING YOU A MIC SO THE PEOPLE IN THE U.K. CAN HEAR. >> HI THERE. MY QUESTION KIND OF DOVETAILS WITH THE PREVIOUS ONES, IN GLOBAL HEALTH AND PUBLIC HEALTH, OFTENTIMES THERE ARE PEAKS OF MEDIA ATTENTION TO CERTAIN OUTBREAKS, AND IN BETWEEN THOSE OUTBREAKS, MAYBE NOT SO MUCH ATTENTION IS BEING PAID TO WHAT'S GOING ON IN THE FIELD. I WANT TO ASK ABOUT WHAT STRATEGIES HAVE YOU FOUND USEFUL IN TERMS OF COMMUNICATING TO THE PUBLIC HERE IN THE U.S., BOTH TO, I GUESS, BUILD SUPPORT AND UNDERSTANDING OF THE WORK YOU'RE DOING WHEN MAYBE IT'S NOT MAKING THE "NIGHTLY NEWS" AND ALSO TO PROVIDE, I GUESS, A SCIENTIFIC VIEWVIEW POINT WHEN THERE IS A LOT OF HYSTERIA AND MEDIA REPORTING AROUND, SAY, A SPECIFIC OUTBREAK? >> I CAN START WITH THAT. YOU THINK ESSENTIALLY YOU DON'T GET ATTENTION WHEN YOU WANT IT AND YOU GET TOO MUCH ATTENTION WHEN YOU RELE DON'T WANT IT. ATTENTION SPAN DOESN'T LAST AS LONG AS IT NEEDS TO BECAUSE THE MEDIA RATINGS AND SO FORTH, AFTER A WEEK OR TWO, THEY MOVE ON. SO IT'S PRETTY CHALLENGING. I WANT TO MENTION A COUPLE THINGS. IN MY LIFETIME IN PUBLIC HEALTH, IT WENT FROM BEING LIKE WHO'S EVER HEARD OF IT TO BEING THE MOST POP LAT -- ONE OF THE MOST POPULAR GRADUATE MAJORS IN THE U.S., SO I THINK YOUNGER PEOPLE ARE SORT OF GETTING EXCITED ABOUT PUBLIC HEALTH AND THE SORT OF SCIENTIFIC CAREERS THAT SURROUND IT, WHICH WILL HELP WITH OUR INFORMED PUBLIC. AND JUST A LITTLE HIGHLIGHT ABOUT THAT IS THAT THE SMITHSONIAN IS LAUNCHING AN EXHIBIT, I BELIEVE, TODAY ON OUTBREAKS. AND THE CDC ACTUALLY HAS A MUSEUM THAT'S PART OF THE SMITHSONIAN IN ATLANTA WHICH CURRENTLY HAS AN EBOLA EXHIBIT THAT'S SHOWING UNTIL MAY, SO IF YOU COME TO ATLANTA, COME SEE OUR EXHIBIT, IT'S REALLY, REALLY PRETTY COOL. WE ALSO RUN A DISEASE DETECTIVE CAMP FOR HIGH SCHOOL STUDENTS, IT'S PRETTY COMPETITIVE NOW BUT IT'S TWO DIFFERENT WEEKS, I THINK, IN THE SUMMER THAT KIDS CAN COME IN AND INVESTIGATE AN OUTBREAK, THEY NOT ONLY DO THE -- LEARN THE BASIC STATS OF HOW TO DO THE EPI, BUT THEY ALSO DO A LITTLE BIT OF A LAB PIECE AND A PRESS CONFERENCE THAT THEY PUT ON WHICH IS USUALLY THE HIGH POINT, BECAUSE SOMEBODY GETS TO HOLD THE CAMERA BUT SOMEBODY ELSE GETS TO BE THE REPORTER, THAT'S THE MOST POPULAR JOB, AND THEN THE INTERVIEWEES THERE'S TRAINING THAT MAYBE YOU ALL WILL BE ABLE TO HAVE ACCESS TO CALLED RISK COMMUNICATION, WHICH IS A REALLY HELPFUL APPROACH TO DEALING WITH THE MEDIA OR THE PUBLIC IN TERMS OF CONCERN. AND IT IS AN EFFECTIVE STRATEGY TO GET THROUGH EVEN WHEN PEOPLE ARE REALLY SCARED, SO THAT THEY KNOW WHAT THEY NEED TO KNOW, AND ALSO SO THAT THEY KIND OF DIGEST YOUR MESSAGES. IT TURNS OUT IN NORMAL TIMES, BEING A PROFESSOR, BEING AN EXPERT IS THE MOST IMPORTANT THING IN CONVEYING MESSAGES, BUT IN EMERGENCIES OR WHAT'S PERCEIVED AS AN EMERGENCY WHICH JUST MIGHT MEAN THAT SOMETHING COULD HAPPEN TO MY FAMILY, THE MOST IMPORTANT FEATURES ARE HONESTY AND EMPATHY, THAT IF PEOPLE KNOW THAT YOU CARE, THEY'LL CARE WHAT YOU KNOW, BUT IF YOU JUST SOUND LIKE THE SMART PROFESSOR, IT CAN LOOK LIKE YOU'RE COVERING SOMETHING UP OR THAT YOU JUST TURN PEOPLE OFF, SO THAT WAY THAT YOU DELIVER MESSAGES IS REALLY IMPORTANT IN TERMS OF THE CONTEXT. BUT HOW DO YOU OVERCOME THE COMPLACENCY OF THE MEDIA AND THE PUBLIC WHEN YOU REALLY NEED SUSTAINED INTEREST IS A BIG CHALLENGE. FOR SOMETHING LIKE AIDS THAT'S GONE ON FOR DECADES, OH, WE FIXED THAT. POLE YO, IS THERE STILL POLIO, ISN'T THAT GONE? SO IT'S REALLY TRICKY BECAUSE YOU TRY TO THREAD THE NEEDLE BETWEEN CRYING WOLF AND BEING CREDIBLE. AND FOR CDC, OUR MOTTO IS WE WANT TO BE FIRST, WE WANT TO BE RIGHT, BUT WE WANT TO BE CREDIBLE, AND YOU CAN BE FIRST SOMETIMES AND WRONG AND THEN YOU'VE SHOT YOUR CREDIBILITY. SO YOU'VE GOT TO BE COMFORTABLE GOING OUT THERE AND SAYING WE DON'T KNOW. SOMETHING IS HAPPENING, HERE'S WHAT WE KNOW, HERE'S WHAT WE DON'T KNOW, HERE'S WHAT WE'RE DOING, HERE'S WHAT YOU CAN DO IN THE MEANTIME, AND SUSTAIN THAT EMPATHY AND CREDIBILITY SO THAT WHEN YOU DO KNOW MORE, PEOPLE WILL RECEIVE THE INFORMATION. >> I JUST WANTED TO MENTION THAT I WAS IN A WORKSHOP ABOUT A WEEK AGO IN THE NATIONAL ACADEMY OF SCIENCES ON THE SCIENCE OF SCIENCE COMMUNICATION, SO I THINK THERE IS REALLY A NEED TO COMMUNICATE SCIENCE BETTER TO THE GENERAL PUBLIC, SO IF SOME OF YOU ARE INTERESTED, THERE'S THE ALAN ALDA, MAYBE SOME OF YOU ARE TOO YOUNG TO KNOW WHO THAT IS BUT MANY OF US SAW MASH. HE'S AN ACTOR, HE STARTED THIS PROGRAM AND IT'S TO HELP SCIENTISTS COMMUNICATE BETTER WITH THE PUBLIC. SO YOU CAN SIGN AND THEY HAVE WORKSHOPS AND IF YOU HAVE ENOUGH PEOPLE, THEY CAN COME TO YOUR INSTITUTION. THEY DO A LOT OF TECHNIQUES IN PERFORMING ARTS, SO BASICALLY YOU HAVE TO PUT YOURSELF IN THE SHOES OF PERSON YOU'RE TRYING TO COMMUNICATE TO, LIKE AN ACTOR WOULD, AND THEN TRY TO CONVEY THE COMMUNICATION CLEARLY, BECAUSE, I MEAN, OUR WORST ENEMIES THAT WE KNOW TOO MUCH AND UNDERSTAND TOO MUCH WHAT WE'RE DOING, SO WE ASSUME THAT OTHER PERSON IS GETTING IT, AND MANY TIMES THAT IS -- WE'RE NOT DOING IT CLEARLY. ALSO WE USE A LOT OF TECHNICAL NAMES THAT MAKE IT -- ONCE THE PEOPLE -- IF I TELL YOU THAT THE INVISIBILITY GENE IS CALLED PFS47, YOU WILL BE LIKE, WHAT? BUT IT'S NOT IMPORTANT WHAT THE NAME OF THE GENE IS, IT'S WHAT THE GENE DOES. SO I THINK THAT BY REMOVING A LOT OF THE TECHNICAL SLANG, YOU CAN REALLY MAKE SOMETHING MORE APPROACHABLE, AND THEY SAY, WELL WELL, THERE ARE VERY FEW STORIES AS INTERESTING AS SCIENCE, RIGHT? IT IS THIS AMAZING PROBLEMS THAT SEEM INTRACTABLE, AND THEN HOW YOU GO ABOUT FINDING SOLUTIONS AND THE IMPLICATIONS THAT THIS HAS, SO I THINK THAT THE WAY HE PUT IT, I HEARD ALLAN ALDA TALK ONCE AND HE SAID THE PUBLIC DESERVES, NEEDS, TO UNDERSTAND SCIENCE, BECAUSE THEY WILL BE ALL FOR IF THEY UNDERSTOOD WHAT IT IS AND WHAT IMPORTANCE IT HAS. SO I THINK IT'S UP TO US TO DO A BETTER JOB. I THINK IN THE NEXT GENERATION, YOU'RE GOING TO BE MUCH MORE -- THERE'S MUCH MORE COMMUNICATION, MEDIA, TWEETS, VIDEOS, INSTAGRAM, I CAN BARELY FOLLOW WHAT MY 13-YEAR-OLD IS -- THERE'S A NEW MEDIA EVERY DAY. I THINK THE NEW GENERATION IS GOING TO BE DIFFERENT, BUT I THINK COMMUNICATION IS GOING TO BE KEY. MEANING GETTING TO THE PUBLIC AND, AGAIN, FACTS AND WHAT IS OPINION AND WHAT IS FACT. I THINK AS SCIENTISTS, WE'RE GOING TO BE -- AND AS CITIZENS, I THINK WE HAVE TO FIGHT THIS BATTLE OF WHAT IS TRUTH, AND TRUTH IS NOT WHAT YOU WANT TO BE TRUE, TRUTH IS TRUTH. AND WHAT YOU KNOW IS WHAT YOU KNOW. AND THE BOUNDARIES OF WHAT YOU KNOW AND YOU DON'T SHOULD BE CLEAR, SO I THINK NOT ONLY AS SCIENTISTS BUT AS CITIZENS, WE HAVE TO DEFEND TRUTH AND FACTS. >> THANK YOU. STEWART? >> HI, EVERYONE. THANKS SO MUCH TO THE PANELISTS FOR THEIR COMMENTS SO FAR. THIS PIGGY BACKS OFF OF COMMUNICATION AND SORT OF THIS TOPIC THAT WE'RE TALKING ABOUT. DR. SCHUCHAT ILLUSTRATED MAKING THE WORLD A SMALLER PLACE. I THINK PART OF THAT HAS TO DO WITH TECHNOLOGY AND SORT OF THE ADVANCEMENTS IN COMMUNICATION AND HAVEING VERY NICELY LAID OUT A VERY LONG CAREER, A VERY AMAZING CAREER THAT SORT OF DISPLAYS HOW THINGS HAVE TRANSFORMED OVER THAT TIME. SO MY QUESTION IS, HOW DO YOU THINK THESE CHANGES IN TECHNOLOGY AND COMMUNICATION HAVE SORT OF AFFECTED YOUR ABILITY TO OVERCOME THE CHALLENGES IN INFRASTRUCTURE THAT ALL OF YOU GUYS HAVE. I CAN SEE NOW DAYS, WE CAN GET ON OUR PHONES SORT OF ANYWHERE IN THE WORLD, SATELLITE COMMUNICATION, ALL OF THIS STUFF AND BRIDGE THOSE IMRAPS THAT PREVIOUSLY WE MIGHT NOT HAVE BEEN, AND ALSO SORT OF OVERCOMING IN THE SAME LIGHT MAKING THE WORLD A SMALLER PLACE, BUT THEN ON THE FLIP SIDE OF THAT, HOW SOME OF THIS CAN BE PERHAPS MISCOMMUNICATION. YOU'RE LOOKING AT THE INTERNET, YOU KNOW, WE ALL KNOW HERE THAT IF IT'S ON THE INTERNET, IT MUST BE TRUE, RIGHT? SO LIKE HOW DOES THAT CONNECT TO, PERHAPS, PUBLIC HEALTH PROBLEMS RIGHT NOW IN THE COUNTRY, WHERE CHILDREN AREN'T GETTING THEIR IMMUNIZATIONS AND THAT SORT OF TOPIC. SO THAT WAS SORT OF MY QUESTION. THANK YOU. >> IT'S THE BEST OF TIMES AND THE WORST OF TIMES. THE EASE OF DOING INTERNATIONAL COLLABORATIONS, GLOBAL HEALTH, IS JUST WONDERFUL COMPARED WITH 20, 30 YEARS AGO, BUT THE MISINFORMATION IS PRETTY RAMPANT TOO. I THINK YOUR GENERATION IS SO MUCH MORE COMFORTABLE WITH THE TECHNOLOGY. YOU'RE ESTABLISHING FRIENDSHIPS BY NEVER EVEN HAVING MET THE PEOPLE, YOU KNOW, YOU HAVE SOME WAY THAT YOU'RE FIGURING OUT WHO TO TRUST AND WHO NOT TO TRUST, MY GENERATION, WE'RE PRETTY CLUELESS ABOUT THAT. BUT I DO THINK THAT ONE OF THE REASONS ARE MANTRA HAS BEEN BE FIRST, BE RIGHT, BE CREDIBLE IS BECAUSE THE BAD INFORMATION GETTING OUT FIRST DOES NOT HELP. IN THE 2001 ANTHRAX ATTACKS, THERE WERE REASONS THAT THE COMMUNICATION WAS -- I MEAN, PERHAPS THERE'S -- THERE WERE POOR REASONS WE WERE OUT THERE NOT COMMUNICATING VERY WELL AND IN THE ABSENCE OF A CLEAR COMMUNICATION STRATEGY, THERE WERE JUST LOTS OF RUMORS, MYTHS, BAD INFORMATION THAT WAS COMPETEING WITH EACH OTHER, AND WE LEARNED FROM THAT THAT WE HAD TO INVEST IN COMMUNICATION AT C DC AND ACROSS HEALTH TO BE BETTER PREPARED AND HAVE REASONABLE STRATEGIES. SO ONE OF THOSE STRATEGIES THAT WE USE ANYWAY IN TERMS OF THE TRUST AND CREDIBILITY RECOGNIZING THAT CTC CAN HAVE THE BEST INFORMATION IN THE WORLD BUT SOME PEOPLE DON'T TRUST THE GOVERNMENT, SO WHAT'S OUR STRATEGY? WE WORK WITH PARTNERS. IT MAY BE THAT FOR HEALTH ISSUES, YOUR PEDIATRICIAN IS THE MOST TRUSTED PERSON. OR YOUR DOCTOR OR NURSE, THE PERSON THAT KNOWS YOU AS AN INDIVIDUAL AND CARES ABOUT YOU AND ISN'T A FACELESS BUREAUCRAT IN ATLANTA OR WASHINGTON. SO WE DO A LOT OF WORK WITH PARTNERS SO THAT THEY -- YOU KNOW, IT MAY BE THE FAITH-BASED COMMUNITY, IT MAY BE NON-PROFITS, IT MAY BE THE LOCAL MAYOR, BUT SOMEBODY WHO'S CLOSER TO YOU IS USUALLY MORE TRUSTED. I GUESS IN THE INTERNET ERA OR THE SOCIAL MEDIA ERA, WHAT'S CLOSER TO ME, WILL SOMEBODY LIKE YOU, MIGHT BE A BETTER MESSENGER. SO EVEN WE DO A LOT WITH MOMMY BLOGGERS NOW ON CHILDHOOD IMMUNIZATION TO GET THEM THE FACTS, THEY DECIDE WHAT THEY WANT TO DO WITH THEM, BUT TO GIVE THEM ACCESS TO US SO THEY CAN DISSEMINATE WHAT THEIR TAKE ON THAT IS. SO INTERMEDIARIES, PARTNER, CHANNELS CAN BE REALLY IMPORTANT TO GET PEOPLE WHEREVER THEY ARE. THAT SAID, THERE ARE CERTAIN FOLKS THAT YOU'RE NOT GOING TO BE ABLE TO INFLUENCE, THEY ARE WHERE THEY ARE, AND WITH THE VACCINE ISSUE, WE REALLY TRY TO GET THE CONVERSATION GOING, WE'VE BEEN TRYING TO GET TOOLS TO CLINICIANS TO HAVE GOOD CONVERSATIONS SO THEY LISTEN, AND DEVELOP THAT TRUST AND HAVE THE FACTS AT THEIR FINGERTIPS SO THAT THEY CAN -- ONCE THEY HAVE THAT TRUST, DELIVER WHAT THEIR EXPERIENCE AND KNOWLEDGE IS. >> YOU HAD ASKED A LITTLE BIT OF TWO PARTS TO YOUR QUESTION. ONE OF THE PARTS UTILIZING TECHNOLOGICAL IMPROVEMENTS AND COMMUNICATION, IN CONVEYING YOUR MESSAGES, BUT ALSO WE CAN USE THOSE COMMUNICATION DEVICES TO ACTUALLY IMPROVE HEALTH. AND SO WE TAKE THE IPHONE OR ANDROIDS VERY SERIOUSLY AS TO HELPING WITH DIAGNOSTICS, HELPING WITH A PASSAGE OF MESSAGES, IT'S TIME TO TAKE YOUR MEDICINE, TO IT'S TIME TO YOUR CLINIC APPOINTMENT, SENDING THESE LITTLE APPS AND SO FORTH. IN UGANDA, THERE WERE NO PHONE LINES. THEY MADE THIS JUMP IN COMMUNICATION AND WENT STRAIGHT TO IPHONES AND THE TOWERS ALL WENT UP WITH CELLULAR NETWORKS AND EVERYTHING, SO WE DECIDED WE'RE GOING TO USE THAT IN THE AIDS CRISIS TO GETTING PEOPLE TO TAKE THEIR MEDICINES, COMING IN AND ACTUALLY WE DID A CONTROLLED TRIAL THAT ACTUALLY SHOWED THESE THEN CAME ALONG OCICB, WHICH IS OUR OFFICE OF CYBER INFRASTRUCTURE AND SO FORTH, AND THEY SET UP -- THIS IS ALL IN A VERY REMOTE AREA. CATHY HAS BEEN THERE. AND WE CAN COMMUNICATE VERY EASILY, THE SAME IN MALI AS WE HEARD, AND BLG ABLE TO TALK TO OUR PARTNERS, CONVEYING WHATEVER MESSAGES NEED TO HAPPEN, SO IT CAN BE DONE FOR THE PATIENTS AND IT CAN BE DONE WITH YOUR PARTNERS. HOW DO YOU AVOID THE MISMESSAGING AND SO FORTH. WE DO THE SAME THING, WE RELY ON OUR COLLABORATORS AND OUR FOREIGN PARTNERS TO DO THE MESSAGING TO THEIR PEOPLE. SO THEY'RE NOT GOING TO TRUST SOME AMERICAN WHO'S BACK SOMEWHERE ELSE, I WON'T GET INTO IT. IN ANY EVENT, THEY WILL TRUST THEIR OWN PEOPLE, SO WE TALKED LAST NIGHT, WE HAVE THIS REPORT THAT CAME OUT, A LOT OF FANFARE ABOUT IT OUT HERE IN THE STATES FOR WORLD AIDS DAY, WE HAVEN'T SAID IT WORD, WE, THE AMERICANS, TO OUR UGANDAS. THE UGANDANS HAVE TAKEN IT OVER. 100%. THEY CONVENED MEETING, THEY BROUGHT IN THE MINISTRY OF HEALTH, THEY BROUGHT IN ALL THE MAJOR PLAYERS AS TO HOW THIS WORKS, THIS FINDING, SO FORTH, AND I SAW THIS MORNING THEIR LOCAL PAPER, BIG HEADLINES, AND IT'S DAVID SERWATA, ONE SINGLE MENTION OF THE AMERICAN WHO'S THE FIRST AUTHOR OR THE AMERICAN WHO'S THE LAST AUTHOR. IT WAS THEM, IT WAS THEIR STUDY, AND THEY PASSED IT ON TO THEIR PEOPLE. IT'S IMPORTANT TO AVOID THAT POLITICAL KIND OF MISCOMMUNICATION. >> I WAS GOING TO MENTION ONE OTHER ASPECT AND THIS MAY BE LESS RELEVANT FOR SORT OF THE LABORATORY SCIENTISTS BUT FOR THOSE BIG PROJECTS OR PROGRAMS, SOME OF THE TECHNOLOGY HAS REALLY BEEN TRANSFORMATIVE FOR THE MANAGEMENT OF LARGE PROGRAMS. IN THE POLIO ERADICATION PROGRAM IN A PARTICULAR COUNTRY, THERE WAS AN ISSUE WITH MIDDLE MANAGERS SORT OF TAKING A CUT OFF THE RESOURCES AND THE ACTUAL FRONT LINE VAX NAY TORS NOT GETTING PAID FOR THEIR WORK, AND WITH THE ABILITY FOR PEOPLE TO GET PAID DIRECTLY ON THEIR PHONES WITH MINUTES OR WITH WHATEVER WAS GOING ON IN THAT PARTICULAR COUNTRY, THERE WAS THIS ABILITY TO REALLY KIND OF DEAL WITH THE CORRUPTION THAT WAS A PROBLEM FOR A PARTICULAR PUBLIC HEALTH PROGRAM. THE FLIEP SIDE IS THERE WERE FOLKS WHO WERE SORT OF SUPPOSED TO BE MAKING THE ROUNDS HOUSE TO HOUSE, VISITING EVERYBODY, MAKING SURE EVERYBODY HAD GOTTEN THEIR DOSES, THE GPS ASPECT OF THE PHONES WAS ALSO KIND OF USEFUL FOR THE SUPERVISORS OF WELL, YOU KNOW, FOR SEVERAL HOURS, THEY WERE OVER HERE INSTEAD OF IN THE COMMUNITY THEY WERE SUPPOSED TO BE CANVASSING, SO IN TERMS OF THE QUALITY OF WORK AND MANAGEMENT AND ACCOUNTABILITY, IT CAN BE -- SOME OF YOU WILL BE SUPERVISING LARGE WORKFORCES IN YOUR FUTURES, AND IT'S REALLY -- YOU MIGHT THINK OH, THE POOR WORKERS, THEY HAVE NOTHING, BUT IT'S SO DEMOTE VAITING FOR GOOD WORKERS TO HAVE OTHER PEOPLE SLACKING OFF AND IGNORING THEIR DUTIES, AND AS GOOD SUPERVISORS OR MANAGERS, HOLDING YOUR STAFF ACCOUNTABLE REALLY ELEVATES YOUR MOTIVATED STAFF TO TRUST THE SYSTEM THAT IT'S FAIR AND SO FORTH. SO IN THOSE TWO INSTANCES, BETTER SUPPORT FOR THE FRONT LINE WORKERS AS WELL AS BETTER ACCOUNTABILITY, BOTH IMPROVE THE QUALITY OF THE PROGRAM AND THE ABILITY TO REDUCE TRANSMISSION. >> I JUST WANTED TO MAKE A COMMENT THAT SOMETIMES THERE'S A LITTLE BIT OF A DISCONNECT BETWEEN WHAT YOU KNOW AND THE DECISIONS YOU TAKE. I'M A SCIENTIST, I'M A MEDICAL DOCTOR, I'M ALL PRO VACCINATION, BUT WHEN THE TIME CAME TO VACCINATE MY DAUGHTER, WAYS HAVING SECOND THOUGHTS. SECOND THOUGHTS I MEAN I SAW THE NUMBER OF VACCINES SHE WAS GOING TO RECEIVE IN ONE DAY, I SAY IT'S CRAZY, IT'S LIKE SIX DIFFERENT ANTIGENS ALL AT ONCE IN ONE INJECTION, AND WHAT IF THIS COMBINES AND WHAT IF SHE HAS SOME GENETIC POLYMORPHISM AND SHE DEVELOPS AN AUTOIMMUNE DISEASE, SO WE HAD AN APPOINTMENT WITH THE PEDIATRICIAN AND AT THE END, SHE WAS GREAT, I MEAN SHE SAID, YEAH, YOU KNOW, MAYBE PUTTING ALL OF THESE VACCINATIONS AT ONCE ARE THE BEST STRATEGY FROM A PUBLIC HEALTH PERSPECTIVE, BUT IF YOU'RE WILLING TO BRING HER MORE TIMES, WE DON'T HAVE TO PUT THEM ALL AT ONCE, SO WHY DON'T WE GO -- SHE ASKED ABOUT OUR TRAVELING PLAN, WHICH ONES WERE ESSENTIAL AND WHAT TIMELINE WE SHOULD DO IT, SO THEN WE BROUGHT HER MORE TIMES, BUT WE HAD A LITTLE MORE, YOU KNOW, NOT SO MANY VACCINATIONS AT ONCE. AND FOR US, THAT'S -- YOU KNOW, BUT IT WAS ALL INTERACTION WITH THE PEDIATRICIAN. SO ONE THING IS WHAT YOU KNOW THEORETICALLY, BUT WHEN IT'S YOUR OWN CHILD, THEN IT'S A DIFFERENT PERSPECTIVE. BECAUSE YOU THINK I'M HER MOTHER AND I TOOK HER TO BE VACCINATED. WHAT IF SHE DEVELOPS A HORRIBLE AUTOIMMUNE DISEASE OUT OF THESE, WOULD I BE ALWAYS WONDERING. SO I SAID OKAY, I HAVE TO FIND A BALANCE BETWEEN PROTECTING HER AND DOING WHAT I THINK IS THE SAFEST WAY TO PREVENT SOME POTENTIAL INTERACTIONS. WE JUST WORRY ABOUT SO MANY ANTIGENS ALL AT ONCE, COULD THEY HAVE SOME EFFECT. SO I THINK IT'S INTERESTING, I WAS SURPRISED WITH MYSELF ABOUT THE WORRIES AND HESITATIONS I HAD WHEN I'VE NEVER QUESTIONED WHEN IT WAS NOT MY CHILD, IT'S A NO-BRAINER, OF COURSE YOU HAVE OH VACCINATE, BUT WHEN IT'S YOUR CHILD, THEN IT'S A LITTLE BIT DIFFERENT. >> MAYBE I'LL JUST EXPAND A LITTLE BIT ON THAT. OIR HEAD OF COMMUNICATION IN OUR IMMUNIZATION CENTER TELLS KIND OF A SIMILAR STORY THAT, YOU KNOW, SHE WAS LIKE DOING ALL THE MESSAGING OF IMMUNIZATION AND VACCINE SAFETY AND SO FORTH, AND WITH HER, SHE TALKS ABOUT BEING HOME ON MATERNITY LEAVE AND RELAXING AND HER HUSBAND TOOK THE KIDS FOR A LITTLE BIT AND SHE TELLS THE STORY, SHE WAS ALL RELAXED AND JUST SETTLING IN AND TURNS ON THE TV AND IT'S OPRAH ON THE TV WITH JENNY MCCARTHY, AND SHE'S -- YOU KNOW, JUST AS A NEW MOM, HEARING HER TALK ABOUT WHAT HAPPENED TO HER SON AND SO FORTH, AND SHE REALIZES, YOU KNOW, I KNOW? MY HEAD BUT I'M LISTENING TO JENNY MCCARTHY, I LIKE HER. THEN SHE TELLS THE STORY OF GOING TO HER PEDIATRICIAN AND FEELING LIKE I KNOW ALL THIS STUFF BUT IT'S MY BABY. AND JUST THE ANGST. AND WHAT SHE DESCRIBED WAS THE WAY HER PEDIATRICIAN TALKED TO HER MADE A HUGE DIFFERENCE. YOU KNOW, JUST LIKE, WELL, WHAT ARE YOU WORRIED ABOUT? LET'S TALK ABOUT THAT. HAVE YOU BEEN NOTICING THINGS, REALLY PUTTING THE CONTROL INTO THE PARENTS TO WORK THROUGH WHAT AM I THINKING ABOUT, WHAT DO I KNOW, WHAT DO I NOT KNOW. WE DO TRY TO LET PEOPLE KNOW YOU KNOW, THAT IF YOU'RE -- FEEN TWEEN WHEN YOU WANT TO GET THEM VACCINATED AND WHEN YOU EVENTUALLY DO, IT'S NOT WITHOUT RISK TO NOT VACCINATE, JUST AS THE QUESTIONS OF ARE THERE RISKS OR BENEFITS OR WHAT ARE THE ACTUAL RISKS. BUT I THINK THAT SENSE OF EMPOWERED CONSUMERS AND SOMEBODY IN CONTROL CAN REALLY HELP A BIT. I HAVE ALSO A SIMILAR STORY WITH -- MY MOM IS 89 YEARS OLD RIGHT NOW AND HAD FIVE KIDS, AND WE ALL HAD ALL THOSE DISEASES, AND SHE HAD FAMILY MEMBERS LOSE LOSE -- REALLY IMPACTED BY VACCINE-PREVENTABLE DISEASES, SO ONE TIME SHE SAID TO ME, HOW COULD ANYBODY BE AGAINST VACCINES? I JUST DON'T UNDERSTAND T THEY'VE BEEN SO TRANSFORMATIVE. I SAID, WELL, MOM, THERE'S CERTAIN VISITS WHERE YOU GET A NUMBER OF SHOT AND SHE'S LIKE, WELL, HOW MANY? WELL, IT COULD BE FIVE OR SIX. SHE'S LIKE, OH, MY GOD, THAT'S RIDICULOUS. YOU KNOW, SHE'S LIKE -- YOU KNOW, I THINK IT'S A VERY NATURAL REACTION THAT YOU'VE HAD. WHEN YOU LOOK AT IT, THOUGH, IN TERMS OF THE SCIENCE, YOU GUYS WHO ARE MORE SCIENTIFIC THAN ME, YOU KNOW, THE NUMBER OF ANTIGENS EVEN WITH A LOT OF SHOTS IS FEWER THAN WE USED TO GET, BECAUSE THE OLDER VACCINES, LIKE THE SMALLPOX VACCINE, WERE INCREDIBLY COMPLEX. THE WHOLESALE PERTUSSIS VACCINE, YOU WERE GETTING A SILL YOB ANTIGENS ZILLION ANTIGENS VERSUS THE SMALLER PURE ANTIGENS YOU'RE GETTING NOW. SO WHATEVER THE THEE RET CAMS ARE, THE VACCINES ARE MUCH, MUCH SAFER NOW THAN THE DISEASES THAT YOU COULD GET OR THE OLDER ANTIGEN EXPOSURES. BUT CLEARLY FEELING IN CONTROL AS A PARENT IS VERY, VERY IMPORTANT. >> I SEE CLAIRE POINTING TO ME SO I'LL SPEAK UP ABOUT COMMUNICATION TECHNOLOGY AND N. A BASIC SCIENCE CONTEXT. I LEARNED A LOT FROM MY VEN TORE AT OXFORD, DOMINIC KWIATKOWSKI. I DON'T KNOW IF ANYBODY IS WORKING IN HIS LAB. BUT WE BEGAN BY TRYING TO IDENTIFY GENES THAT CONFER RESISTANCE AGAINST MALARIA IN HUMAN POPULATIONS. WHEN I WAS THERE, WE WERE LOOKING AT ONE GENE AT A TIME. RUN THOUSANDS OF PCRs IN A JAY, RUN THEM OUT ON A GEL, COUNT UP THE GENOTYPES, BUT AS THE LAB WAS FRAN SITIONING TO LOOKING AT GENOME WIDE ASSOCIATION STUDY, DOMINIC WAS ONE OF THE FIRST PEOPLE TO REALLY REALIZE WHAT IMPLICATIONS THAT HAD FOR SAMPLE SIZE, AND THAT YOU DIDN'T JUST NEED HUNDREDS AND THOUSANDS OF PATIENTS PARTICIPATING IN THESE STUDY, YOU NEEDED TENS OF THOUSANDS IN ORDER TO GET THE RIGHT ANSWER FROM THE GENETICS. AND THE NUMBER MAY ACTUALLY BE HUNDREDS OF THOUSANDS, WE'RE LEARNING NOW. SO HOW IS HE GOING TO ENROLL 100,000 MALARIA PATIENTS? WELL, THIS TO BE THROUGH CREATING A NETWORK. AND HOW DO YOU GET PEOPLE ENGAGED IN PARTICIPATING IN YOUR NETWORK? WHAT HE REALIZED IS THAT HE NEEDED TO HAVE A PLATFORM FOR COMMUNICATING WITH ALL OF THE PARTIES THAT WERE SHARING THEIR DNA RESOURCES WITH THEM, SO WHILE HIS LAB WAS SET UP TO DO THE SEQUENCING AND THE GENOTYPING, THEY PULLED TOGETHER ABOUT, I THINK, 23 INSTITUTIONS AROUND THE WORLD TO CREATE THE MALARIA GENOMIC EPIDEMIOLOGY NETWORK, AND ONE OF THE REASONS THAT THIS WAS SUCCESSFUL IS THAT WHEN YOU SUBMIT YOUR SAMPLES AND YOUR OWN DATA ASSOCIATED WITH IT, MAYBE IT'S A VACCINE RESPONSE, MAYBE IT'S VITAL SIGNS OR FEVER CURVES, THEY BUILT TRANSLATORS SO THAT THE DATA YOU SUBMITTED COULD BE PUT INTO A UNIVERSAL FORMAT RATHER THAN MAKING EVERYBODY USE THE SAME DATABASE, WHICH NEVER WOULD HAVE WORKED, AND THEN THEY DEVELOPED TOOLS WHEREAS A COLLABORATOR, YOU COULD ACTUALLY SEE YOUR DATA WHEN IT CAME OUT OF THE PIPELINE, YOU COULD ANALYZE IT ONLINE, AND YOU'RE A PART OF THE PROCESS. SO I THINK THAT'S A GREAT EXAMPLE OF USING THIS TECHNOLOGY TO ACHIEVE SOMETHING YOU NEVER WOULD HAVE ACHIEVED BEFORE, AND IT MAKES HIS LABORATORY AN INTERESTING PLACE BECAUSE IF YOU GO THERE, IT LOOKS MORE LIKE A BAY OWE TECH STARTUP AND IT'S MOSTLY PROGRAMMERS AND SEQUENCERS, BUT THEY REALLY ACCOMPLISHED SOMETHING UNIQUE THROUGH THAT. >> GREAT, THANKS. UNFORTUNATELY WE'RE OUT OF TIME, SO I WANT TO THANK OUR SPEAKERS VERY MUCH FOR TAKING THE TIME TO SHARE THEIR THOUGHTS AND EXPERIENCES WITH US TODAY. [APPLAUSE] THANK YOU. AND NOW WE'RE GOING TO MOVE TO THE ROUNDTABLES AT THE BACK OF THE ROOM. AND IF YOU NEED TO TAKE A QUICK BREAK, THAT'S OKAY. >> WE'RE GOING TO TAKE A -- SORRY. WE'RE GOING TO TAKE A REALLY QUICK BREAK, AND THEN WE'RE GOING TO GET STARTED PROMPTLY AT 11:00. STUDENTS ARE ASSIGNED TO TABLES. WE WILL HAVE OUR PANELISTS JOINED BY DR. SCHILLER AND DR. PIERSON AS WELL, WHO WILL BE ROW TAIGHT OUR TABLES ROTATING OUR TABLES ALSO SO TAKE A BREAK, GRAB A COFFEE AND WE'LL SEE YOU AT THE SMALL TABLES.