them electricity or mechanization. thises will be for we had specific drugs to deal with malaria. added to develop the specific chemical cures penicillin, led ddt it became extremely potent to kill disease effectively and we gave public health over to the biomedical establishment. so now when we have an outbreak we'll look for social and political roots

then we hope we can throw sufficient drugs at it to make ago way. but it is insufficient to hear those almeida. summer to talk about the exponential growth one example of this is the operator can florida. in to be centered in key west generally. and to attack the insect and attack the virus.

but of course, those mosquitos have been present for a long time. and that's is into do. to attack that chemical onslaught. . .

>> it takes seven to ten dates to transmit the virus. it slows down if it is cool. it is quite possible that that is true, that there is less virus around. at the same time, we are living at a time of unstable weather patterns. so, all we would need is really a good rainstorm a a week and a half before people started to come for the olympics and some

of that water remain standing. these eggs can last for months. you just need a little bit of water and they will come alive again. i think it is a risky endeavor. at the same time, there's no stopping zika, it is going to come. it is probably here in far larger numbers that we know. 80% of people who get it do not have symptoms. so what we are counting is the tiniest above the iceberg. that is even counting a lot of people even have symptoms probably just thing gets rash or fever they don't notice in they get better. so what we are counting is this tiny fraction that is probably here more widespread way than we know. if we consider the fact that we have 15 or so suspected cases of

sexual transmission of the united states. if there is 100 introductions, supposedly 100 introductions of zika virus in the united states, 15 of those have transmitted sexually, those don't match up. sexual transmission sexual transmission is probably a pretty rare form of transmission. most likely there's many more cases of zika virus. olympics are not, it is coming, it is going to be here and is just a matter of time before we see it manifest itself in a more detectable way. >> it's hard not to talk about what our government is doing on these issues. for for 12 years i was one of the leaders in dealing with infectious disease, with your comment under clinton and bush there were large stats of the national security council focusing on bio security. , because they are 25 agencies and you have to have white house controller you have nothing. obama comes in, he wipes it out.

it's gone. it is not one of the 11 top priorities for the administration in terms of security. it is not even mentioned. and then under bush we had amazing efforts, tens of billions of dollars to figure out how to get development of vaccines, diagnostics and they were not very well designed, all of that has been dismantled by obama. and actually the explanation was that we heard why they quoted was they thought it was important and therefore we do not. that was why the quoted. what was your take on how it's possible given that these are existential threats where a billion people today will die of

an avian flu epidemic if it is roughly the same lethality as the previous. you can have quarantines, you cannot panic, how is it possible that this administration has essentially been zero interest in this? >> i think you have set it all. i'm not sure you really had a question so much as a comment which is fair enough, absolutely. but i do think we need to do even more than that really. what i'm tried tried to talk about in the book is not just that stockpile vaccines and have experts -- and we do need that as well, but to really get at the root causes of healthcare infrastructure and poor parts of the world and we have enough primary health services to people who are most vulnerable? what are we doing about

agriculture and the health of our animals and livestock? how are are we regulating the way we use land? we are breaking up tracts of land all over the place. there are a lot of reasons not to do that. and this is yet another reason. so i think we need in all of the above approach and we need the expertise you're talking about for sure. i would like it to be even more multifaceted defense strategy. >> so as you probably know, d.c. d.c. has the highest rate of hiv in the united states, so from a global perspective, what lesson do you think can be learned in approaching epidemics on a smaller scale? >> because d.c. has things like an epicenter of hiv? so how does that translate into -- or any correlation of what

you can learn from the global disease as it relates to a smaller population? >> i think we see it in the history of lots of contagions that it's when you have -- and this is an interesting aspect of the 1832 epidemic of cholera is that we had swells in the middle of the city and that was such a driver of the epidemic because there are these neglected communities right in the middle of new york city. that was something new at the time. in the past, the the poor people were put out on the periphery of communities. with urbanization they're starting up in the middle of the city, that became an app a center that would spark out to the rest of the city again and again. i think there are a lot of parallels right now, even ibo that is a great example. we didn't have anything on the ground, even soap and water could've helped the spread of

virus like that. but we do do not have even the most rudimentary services for the remote communities and that puts everyone at risk. i think it's a big lesson on the history of contagion. >> my name is scott and i'm wondering if the government needs to focus on more of the developing world. i think it is not ridiculously hard when you take a given country and you know what is killing people in that country saying kenya were hiv and malaria are big killers, it's not ridiculously hard to figure out what investment you can make that will make the greatest difference of saving lives and have the greatest impact. but that gets harder when you're looking at pandemics when you don't know what the diseases are one it will emerge or where it will come from.

this question or priority setting is important because we're never going to have all the resources we want it so we really to set priorities and invest in strengthening, there's a ton of things that we could do to prevent pandemics, but i don't have a lot of ability to say which things are going to have the biggest bang for our buck so i'd like to hear you talk about it. >> i don't have the answer to, think you're right we need all of it. to me, the most glaring lack is primary health care and services for poor people in remote places. i was in haiti during that cholera epidemic. we traveled may be 50 miles from the capital but it took about eight hours because this place was so cut off, the thing thing that was so ironic is they were not so caught off that they

cannot get it cholera, but they were cut off enough that they cannot get any resources to help them. that just really struck me, in uneven development where they had one type of water coming down from the hills that the belgium's had built 20 years ago as an aid aids project. never give them any support for maintaining it, no services, no resources, no resources no know-how on how to maintain it. when i came there this pipe, they brought the sole drinking water to this remote community, was supposed to be on a cliff and because they're so much erosion in haiti it has slowly fallen all the way down to sea level. they had about 32 holes in it and nothing to patch it up. they were literally were literally using cloth and wrapping it around, so the water was

dripping out, they had this tiny trickle of fresh water coming into the town. that was all of the reason why they had cholera because everyone was getting buckets and leaping it out. when you only have a bucket of water you don't give up eating and cooking, you give up washing as much. to to me that was a really simple things like clean water and aid that is not -- that is sustainable over time. i think those are all vague rings, i'm not a policy person. i'm looking at how these things spread and what are the approaches we can take to empower communities to come up with their own solutions. do we ask them, what you think we should do? and they said what i think we should have bed nights, no they don't, we they say we would like better water into this town or whatever it is.

>> thank you. i'm from a part of this world where this has impacted me but nonetheless i'm talking about the care being and they have a huge problem because of the poverty and marginalization. i'm happy that you talked about the fact that public health issue and sanitation issue basically are more important than medical issues for stopping a lot of stuff from happening. two questions, the first, because we have not talked about that but i know both from europe and from the united states of america and other developed countries there are attempts to place people in the tropics in different places, africa for example, try to figure out potentially and how to

potentially track those things. that is the first thing maybe you want to talk about. the next thing is it zika that is starting to spread and care being. not my island but it's only a matter time before it gets there also. but it is a complex coming out of brazil the whole issue of consequences for kids. people are saying that yes potentially for sought people with genetic profiles you can suffer consequences. it was also seen as a problem no one is talking about that a lot of these neighborhoods where this is happening especially with kids, the consequence for kids are neighborhoods with a lot of pesticides and stuff like that. is it zika or is it zika plus these other things?

have you heard about that? i would like to hear from you. >> so that there has been lots of alternate theories about why we have had this rash of microcephaly in brazil. some of them are easy to say no that's not happening, the pesticide theory to me there is a lot of evidence, it's not the best pesticide. it's been used in other parts of the world but has not been a spike in microcephaly. could've it it been used differently in these places? could somehow because of cultural reasons could those people have gotten a higher dose? or something different happened? i do not know. i think it is a mistake to dismiss these alternative conspiracy theories. i think it's just to dismiss them and i think that is what and sort of the conventional response especially from the

global health establishment to say stop spreading these conspiracy theories, but there is a reason why these alternate theories come about. i think it's important to look at that. they come about because of a lack of trust in our biomedical establishment. where does that come from? if you trace that back and this is something i try to do in the book, look at why were health workers doing the treadmill and crisis west africa attacked and slaughtered? this happened during cholera epidemics too. there were burned down quarantine hospitals. if you walk it back, there are transgressions that have occurred between the biomedical establishment of local people.

mabel threw the best of intentions but it is still there. it needs to be addressed. that lack of lack of trust needs to be addressed. it is real. when we dismiss people's alternate theories we are dismissing the altar line feeling that they do not trust and i think it makes it worse. and it's the same thing with the anti- vaccine argument where people say these people are so stupid and ignorant they do not get the vaccine of course it doesn't cause autism and of course we do, but where does that mistrust come from? people are frightened about industrial contaminants. about chemical contaminants and corporate secrecy. all of these things, corporate control control of medicine, these are all issues worth of dressing and why people feel they cannot trust these messages. we need that, we, we need to do that work now because when some big pandemic comes we really need to do trust our authority. we need to be on the same page, we, we are not there yet, we have a lot of pockets of

miss trust and conspiracy theories that come up almost immediately. within days of the zika virus there is the monsanto, all kinds of theories about why this is happening. >> i'm studying public health at george washington university and environmental health and policy. i'm taking a a class called the social determinants of health and my question is how would we work toward creating policy that would be effective in investing addressing environmental issues and social issues as you mentioned earlier? >> that's a huge issue. how do people experience disease and what does that mean about what kind of intervention is going to make sense in their lives. this is a huge issue in malaria which was the topic of my last book where we are

hatching a lot to plans to help people in countries that did not necessarily match up with their own priority. bed nets were a good example of that where we created insecticide treated bed nets it was a great idea because it was cheap, easy, no, no refrigeration, no hospitals, no roads, no anything. these people can be in a poor, deprived setting and we can give them this intervention and it will save them from malaria. well, okay we did that. spent a lot of money and sent the nets around and it was a good effort and a lot of resources were spent doing that. then they were not used right away. 20% were being used, a very low percent. then they they sent the anthropologist and see what was happening. people do not consider malaria consider disease in their lives, they consider it a normal part of their lives.

the nets are hot and square, it's the nicest material that they've had in their huts of their sameness for their honored guest, all kinds of reasons that were not considered. it is because people on the ground who have the most malaria, they think of it in a different way than we think of it. part of it is immunity. they have immunity to it, if you survive the gauntlets of the first two years of life and have your 12 episode of malaria and survive it you have immunity to it. malaria comes and goes. it is the way you and i think of the flu. if we had a bunch a bunch of african scientists come over to the united states and say you people will lose 40,000,000,000 dollars a year from cold and flu all you need to do is where this mask when you go to school or work, it's so simple. we don't need don't need anything fancy, we'll just give you all of these were free. would we do it? >> we don't even wash her hands during flu season.

>> i have sort of a question a contrast between this book in ted koppel's book about doomsday vents like massive power outages. what are your personal actions that you have done to prepare for pandemics or what are you doing your daily life to avoid epidemic disease? >> i do things, keep up with my vaccinations, wash my hands, i tried to stay informed because each pathogen is different. i do. i do believe we live in a microbial world. disease is part of our relationship with nature. this idea that we should live in some kind of germ-free environment and never have this is really anomalous if you think about through the long history of humankind battle with microbes.

we had the first antibiotic in the 19 forties, by 1980s we started having hiv and lyme disease, all of these new pathogens came out that we cannot really treat that well anymore. so that. of time when we had this sense, and this is a. of time when i grow up and i'm the daughter to dr. so so i grew up with that feeling that infection, who cares, i'll take anabiotic's it simple. i don't need to live with that, that's not going to be part of my life. well, maybe that was wrong. i think were going to have to adjust to the new reality as anabiotic stop working one by one which is already happening. >> thank you so much [applause]. >> thank you all.