with human urban expansion. it loved living near people. it will breed in a, drop of water and bottle cap. so all of our plastic garbage provides perfect breeding sites for the mosquito. unlike mosquitoes carried zika in the past, this only bites humans. in addition to crowding our people together we're also crowding our animals together. we have more animals under

domestication right now than in the last 10,000 years of domestication until 1960 combined. huge numbers of livestock that we're keeping right now, and many of them live in these factory farms. we have a million or more individuals crowded together. so they're basically, the animal equivalent of urban slums. this similarly allows pathogens to amplify and change to make them more virulent. one example of that avian influenza virus, normally live in waterfowl. but when the viruses drop into these factory farms where captive animals are come together, they start to change and replicate and mutate. that is what viruses do. they become more virulent. we have problems with more virulent forms of avian influenza. some involve ways that can

infleck humans. they started carrying these pathogens found in more efficient way. that is something cholera took advantage of. that was steam travel. we started streaming across the atlantic. also with clipper ships, steaming up and down all of our rivers and our waterways and then we used steam engines to build canals. this connected our waterways together. this international network of waterways, perfect for a water-born pathogen cholera to take advantage of which it did again and again. eerie canal opened right at time to lead cholera into new york city at the beginning of century. we do it better today not just with our flight network. we don't have a couple of airports in capital cities, hundreds of airports, tens of thousands of connections between them all. so when a pathogen emerges in

one part of the world it very rapidly can spread across the rest of the planet. in fact our flight network is so influential in shaping epidemics you can actually calculate where and when an epidemic will strike next just by measuring the number of direct flights between infected and uninfected cities. this is map done by dirk brothman plotted same virulent flu epidemic on that map. this is map of cities connected by direct flights. you can see the flu epidemic evolved into perfect series of waves. these are just some of the ways, in which the way we live allows microbes to turn into pathogenic causing organisms. the rest of the story is how we response. we just don't take these things lying down. we put up political defenses and

medical defends. only when the defenses fail that pandemics occur. so in 1832 doctors in new york state collected this data that we mapped. it shows a pretty clear picture to us today. cholera is coming down the hudson river and erie canal and heading into new york city. the obvious response was considered a quarantine. close down traffic on the waterways to protect the city. nobody wants to do that. quarantine is considered too disruptive to trade. so instead they said, well the cholera might look like it is coming down the rivers but actually cholera is being carried by -- based on 2,000-year-old theory, medical paradigm for many years that diseases like cholera spread through the smelly air that rose up from decomposing organic

material. and zoo they said the cholera is being called by the mi asthmas, and blamed them on the drunks, the poor and immigrants. those people were actually violently scapegoated during cholera epidemics in the 19th century. there was a company making money selling cholera contaminated water to 19th century new yorkers. the epicenter of epidemicses in cholera in new york was a place called five points which is pictured here. it is subject of movie, "gangs of new york," the martin scorsese movie. this place was built on a pond, the pond was collected with goor badge and slum was built up on top of that. ground underneath the slum was low-lying and unstable.

the groundwater was easily contaminated by leaky privies and out houses of slum on top of it. the company that the state of new york chartered to deliver drinking water to the people of new york, instead of tapping clean, upstream sources of water which they knew would be taste better and cleaner. they sank their well in the middle of that slum. and they delivered that water to 1/3 of the people of new york. and the reason they did that is the same reason that people in flint, michigan decided to change their water intake, they wanted to save money. they wanted to save money because they wanted to build a bank. does anyone know the maim of the bank of the manhattan company today? jpmorgan chase. that's right. biggest bank in the country. so eventually, new york did move their well from the slum of five points up to westchester county

and crescent river and cholera ended for good then. but what is interesting is why they did it. they didn't do it to protect the public health. they didn't do it because they threw out the fear of miasma, decided cholera is carried in contaminated water. they did it because the city's brewers demanded better tasting water for their beers, because put crappy tasting water is putting their beers at competitive disadvantage. so i think there is a lot of modern parallels to this story today but we can do a lot better and the question is will we find the political will? that is something i hope we can talk about more during our panel and our q&a today. thank you so much for listening. [applause] so we have a great panel of speakers today our first speaker

will be dr. ian lipkin. center of infection and immunity at columbia university. if anyone seen the film "contagion" i will add the scientist in that film is modeled on him. >> thank you. >> i'm all for the john snow professor which is particularly apt, given so much of this book concerns cholera. i was told about this meeting and i generally accept these limited invitations, and i was told by assistant that i could skim the book. i began with that intent. but in fact i read it cover to cover. i thought it was a beautiful book. for those of you who haven't looked at it yet, you saw a bit of an example. you have burr versus hamilton.

you have a whole description of sort of the london underground and where the plumbing. you have, it is very, very, it is an elegant book. so i have decided to do today is something a little bit different although i hope during the q&a we can talk about some of the interesting aspects of west nile virus and mersa and sars that may be of interest to you and talk about what i hope will be sonia's next book. that is the future really of infectious diseases. because the emphasis in it particular book is on acute diseases, ones associated with severe illness, pneumonia, hemorraghic fevers, things that kill us or make us at least quite ill. we have other disorders typically thought of as non-communicable. there are parts of the book, sonia, where you talk a little

bit abouthis and the ways in which microbes modeled us through evolution. they have contributed to our ability, for example, to become mammals by having impact on whether or not a mother will reject the fetus. because in fact what is a fetus but a tumor growing inside of us. how do we -- there are retroviral elements that have been integrated in the placenta that prevent rejection of the s. if you look at the genomes of our genomes, they're riddled with retroviral sequences and other sequences as well. these have important impacts but in addition to the more basic sense when you actually look at the microbes and cells which are really doing is examining the ability of the body to recognize something as self or not self because essentially we are always dealing with an onslaught

of things that may represent nutrients, may represent microbes. the way we develop, the way we grow is a function of this relationship that we've had with microbes. now there are a wide variety of these quote-unquote, non-communicable diseases which as i show you shortly may in fact in some instances have an infectious trigger. these range from coronary artery disease and stroke to met billionic disorders like diabetes, psychiatric disorders like autism, autoimmune disorders things like rheumatoid arthritis and such as well as many forms of cancer. now the number of canners that are attributable to infectious agents may not be fully appreciated by many of yous particularly when you look in sub-saharan africa, represents up to a third of these cancers. frequently people who have

cancers under 50 years of age. hepatitis-b and c, human papillomaviruses and here are some examples. hepatitis see causes sar cono, ma'am ma. we have burkitt's lymphoma. human papillomavirus only described recently as yesterday largely eradicated largely of vaccines. hiv, sarcoma, as you look back and these and so forth. all the other infectious causes of cancer we're thinking more broadly about infectious diseases may be possible for us to eradicate these as well. we know we can already do this with hepatitis-b and with human pap home virus papillomaviruses and other vaccines as well.

these are vaccine preventable illnesses. this is journal of pediatrics, the description we can literallier rad cat human papillomaviruses through vaccination programs. which means we can eradicate cervical carcinoma and form other forms of carcinoma as well. many diseases sonia alluded to, ebola, marburg, can probably be prevented by using variety of vaccines. these are diseases fairly straightforward to approach. infection is likely to be implicated in a wide range of diseases of the cardiovascular system including stroke and coronary artery disease. inflammation is the leading contributor to these. we now know, for example, simply, something as simple as bad parry done -- perry done tal

disease can result in a stroke. some of you may have read this article that appeared. i tried to sell to donald macneil several months ago we started talking about autism and neurodevelopmental disorders and such, we started talking about micro ensevenly a couple weeks ago, i said this is probably just the tip of the iceberg. as we began to discuss this i presented him with some of the data i will show you now. this is a disorder we tried to model in mice called sidnum korea's. this is associated with streptococcus and traumatic heart disease, described in 1500s by a british internist named of the john sidnu. there were a group of children who thought to have schizophrenia.

they did not have schizophrenia. what they had was obsessive compulsive disorder with a set of repetitive behaviors as you see here. they were treated with plasma to remove anti-bodies or intravenous glob you lynn you could remove the disorders. we were unable to identify the trigger. we replicated it by injecting these mice with group a, a,shthreptocci, went back to the children and found the same antigens were implicated. other thing we decided to approach in similar way done by our group in new york and done by paul patterson who died a couple of years ago, who was at that point at caltech, to look at historical associations between influenza viruses and other pandemics and stressful

environments and later occurrences of schizophrenia and autism, other neurodevelopmental disorders and what we found, if you looked at the association of these disorders, it made sense. that is to say, you would see outbreaks of, what looked like outbreaks of schizophrenias 20 years downstream following out breaks of influenza and other viruses. if you look some four to seven years of age, four to seven years out with autism you would find examples there too. we were able to model this with mice and we demonstrated that if you examine mice, there were so -- [inaudible]. to a virus or a virus or bacterial infection, really doesn't matter, the animals would be withdrawn in corner of cage as opposed to animals would show off some sort of norm

vehicle like -- something like that. did that 2/3 of way through gestation, instead of being withdrawn like these animals, they become hyperactive running all over the cage. indicating what was important here, not so much infectious agent per se you about the host response to something like that. the other thing we've begun to learn a great deal more about, is the microbiom there is excellent exhibit presently at the, at the, just literally across the park at the museum of natural history and here we tried to cover through the course of this to understand something about the gi micro buy open, vaginal micro biome, implication of the disease. we understand that the micro biome is tuning in immune system, probably important in

thinking about allergy, role in colon cancer, obesity, cardiovascular disease, other immunodisorders and even depression. the flip side, sort of contagion hypothesis sonia is talking about introduction of cholera and other things we've seen as we begun to clean up the environment as a reciprocal relationship we seem, as we no longer have those sorts of risks we're beginning to see increased risk of asthma and wide range of other disorders, so it is becoming clear that we can't only think about pathogens. we have to think about balance between microbes and humans and it will become very, very complex. if we look at the the micro bome look at different types of bacteria and normal progress we see here has become subverted by this modern life where we

formula-feed babies, we treat ourselves with antibiotics, we have obesity, we have wide a variety of other sorts of interventions which led to all sorts of outcomes which haven't tremendous impact right now on the way we live, and the way types of diseases that we begin to see. if you look at the composition of the gut microbome in italian city where we have what we consider ideal western diet, mediterranean diet, it is still very different from the fiber-rich diet that you see in africa. and there are consequences of this. we have begun to see, for example, the appearance of diseases associated with some of these antibiotic resistant bacteria like diffocil which are killing people, which are wages of modern life.

we have been unable to eradicate these now with modern antibiotics and we're beginning to use microbome transplants as a way to address these problems. because there has been so much success with treatment of clostridium difficile with micro biota transplantses people use them for wide variety of other applications as well. i'm not advocating this by any means. pointing out that people believe they can reverse autoimmune disorders like crohn's disease, ulcer a tiff colitis, irriddable bowel syndrome, multiple sclerosis and autoimmune diseases as well as some forms of colon cancer. so moving forward, sonia, as you begin to think about your next

book, not to say that we resolve all of these issues with respect to acute infectious diseases, you hear how we predict them in following shortly, important to think about ways which we can bring microbes back into balance and we can begin to understand the role of microbes and response to them in genesis of wide range of disorders from autism to cancer. [applause] >> thank you for that, dr. lipkin. so glad my work for the next book is already, he has done the outline and everything. so, i want to introduce dr. daszak, president of equal health alliance. dr. daszak was one of the great

sources of my book, "pandemic." if you pick up the book there is bunch of pages about him and his fabulous work he will share with us. >> thanks very much. you know, what i like about this book, other authors haven't touched on it repeated cycles throughout history that we've gone through with pandemics we're still in. you make the point today, we're still doing things that led to cholera around the world. we sort of think about these issues of overcrowded lives and, non-sterile conditions as being over there. we're absolutely connected less everywhere on the planet less than a day's flight away. that is exactly what microbes do. they exploit new niches we put up and adapt. so we create ad perfect system really for microbial invasion.

i think we're in the middle of the age of pandemic and i would like to think we're at the end of it. i would like to talk briefly in more positive and optimistic day in 50 years or 100 years time future generations will look back on this, those guys really did have a lot of problem with infectious diseases we got rid of now. let's think of ways we can work together to get rid of this pandemic threat and deal with other issues dr. lipkin is discovering as we speak. what i do, i'm in a organization called eco health alliance, non-profit here in new york, signs based. we work on emerging diseases to understand what drives them, what are the underlying causes of pandemics? what is the science behind it? can we prove something is attached to the driver of a pandemic that leads to the spread and can we do something about that driver? so first of all, we need to know

if these really are a big issue. the book lace it out very clearly. of course the science behind that, what is the real evidence that emerging diseases are on the rise? that we're in an age of increasing pandemics? so a few years ago, probably about a decade now, a group of us sat around and started talking about this i was working -- i just finished working at cdc i was working on wildlife diseases, including a global disease offing froms which seems off topic but actually is emerging disease of frogs that spread globally that wiped out species. even more significant than 1918 flu or cholera it caused a extinction of species. it caused me to see something going on in the planet what is happening with in terms of wildlife with rise of new diseases in those populations, what is happening in domestic animals and livestock and

poultry and others and what is happening in our own communities. we realize these things are connected of course. this is one health movement, we call it ecohealth. we involve the environment, ecology, ecosystem that drives these problems. of course as we're seeing from the talk about the human micro bome completely disrupted by modern life so our ecosystems. we need to take a trip out to the black forest up there in harman state park say where are the wolves, you know? where are the passenger pigeons? where are the chestnut trees? completely disrupted ecosystem. so what happens when we disrupt ecosystems? we also disrupt the microbebota where animals live in them. big question a decade ago, are emerging diseases on the rise? we sat around, take every single example of emerging diseases,

one that are pandemic, one that causes a small cluster of cases. get a database. this is what you do in science, you build a database and you analyze it. we start this project, we thought we were very clever, we'll do it in a few weeks and crank out a paper. it actually took two years, because it turns out it is not straightforward. the data on where and when a disease first emerged, where the first case of a new disease is are very hard to get ahold of. eventually after couple years we got this database of something like 450 emerging disease events, new pathogens, new to science but moved into our populations for the first time or were already there and began to spread sore some reason. we plotted them out. this is plot of that decade from 1940s to the 1990s when we published it. as you can see it is clearly rising. so is our effort to find those. you have to correct that.

so we have to build a database of every single author of every paper in journal of infectious disease working on infectious diseases to see how that is rising. 14,000 data points later, logged in every, gis coordinates of any every office's work we could correct the rise, show there is still a significant increase over time, statistically significant in number of new diseases emerging in people. so this is a problem that is increasing. not only that, the really big ones, ones that go pandemic as sonia points out over and over again in the book, are ones that come from animals usually. they're zoonotoc. usually come from ebola, emerged probably from bats and hiv which emerged from chimpanzees. so those viruses, the ones that go pandemic are almost exclusive i from wildlife with some

intermingling with domestic animals like avian flu. they're the yellow bars on this graph. they're increasing disproportionately dramatically compared to the rest of them. pandemics are on the rise. emerging disease are on the rise. really big ones, hivs, ebola, 1918 flu are decreasing. we can see how many eye merging diseases we can predict next year, there are about five and these predictions are showing to be true. three of those will emerge around animals. that is the bad news. what are we going to do about it is the question. so we set about to look at what are the big questions to try to deal with this problem. first of all we don't really know how many viruses there are on the planet. really to get a handle on can we ever deal with this problem we need to work that out. and it took us a few years to come up with a strategy.

this what we did, commonly used in conservation biology. if you're trying to count the tigers in the bangladesh, it is really difficult to count every tiger. they don't particularly want to come out to say hello. what scientists do or conservationists do, you find a tiger, you trap it. you tag it. and you release it. then you try to catch more. eventually you start recatching some of those tigers. there is simple equation you can use to work out the whole, the size of the whole population including the unknown tigers based on the number of recaptures against the number of captures. so we did that with viruses. working with the group at columbia university and our global network and our ecoalliance around the world we started catching animals we knew carried zoonotic virus, pandemic

type viruses. if we repeatedly caught same species over and over again and discovered as many as viruses possible we could do this. first graph is just one viral family looking at the number of samples we collected. this is about 1,000 individual fruit bats from bangladesh. these are giant tropical fruit bats with a wingspan about this bid. their bodies are about this big. they're really cute animals. they are like puppies with wings. but the problem is they have big teeth and a bunch of lethal viruses. that is unfortunate. they're really good and do a lot of good in the world. they pollinate tropical trees, especially fruit trees. they're very important pollinate tores. we have to catch each bat individually. we have to an necessary size them individually. skilled biologists do the work.

put samples on liquid nitrogen, put them on the filed in bangladesh and get them cultured back in the lab here in columbia university. then we repeatedly did the very best type of pathogen discovery, something the lab is world famous for and started discovering new viruses. after a while, after a few samples we started seeing the same viruses. our discovery curve was saturated and use that saturation point to predict how many unknown viruses there are. we repeated this for about 12 different viral families all of the ones that cause, nasty emerging pandemics in people and came up with a predicted number of unknown virus. in this bat it is about 58. if you multiply, very simple extrapolation. it is not rocket science, mult by that by 320,000 known, sorry, the 6,000 odd known mammal species on the planet you come

up with a figure of about 320,000 unknown viruses. sound like a lot. we only know of about 4,000 virus so far. so there is a lot of work to do. but it is not millions. and it is not tens of millions. if you look at the rates of viral discovery and increaseed speed and decreased cost of technology to discover these virus we can easily achieve this we candies cover all the potential pandemics out there. i think this is great. and i, we came up with a figure because we know how much it cost to do this work. to find 100% of these viruses, is about 6.8 billion. it's a lot of money. you don't need many samples you can get 85% of the them for 1.4 billion. spread that over a 10-year billion. a $140 million a year. still a lot but how much does an outbreak of one of these new unknown viruses cost?

the cost of sars has been calculated, if you look at the drop in gdp for southeast asian country during the sars outbreak, against the market fluctuations that you would expect, you get a figure of something between 10 and $50 billion for one single outbreak. absolutely mind-boggling. this is one single person in market in china who brought bats in, it is a bat origin virus, put them in a cage and they infected other animals and people and led to a global pandemic. real cost, it disrupted trade networks we rely on for our globalized pattern of travel and trade. these things cost so much if we wait for them to emerge. i think we're missing the point. what i'm calling for now is a global viral race to the moon approach to find as many of these new viruses as we can, using the very best technology we've got and let's save ourselves some money as well as

many, many thousands of lives. now the other big question we have is, well, where will these viruses originate? where will the next pandemic emerge from? again 10 years ago that wasn't known. everybody kind of knew. there were lots of maps out there at that people drew where they put pins on, ebola, hiv, sars, all the rest of it but we didn't have science to back that up. so we set about trying to dot science. we had a big problem. we had a database of every known emerging disease. we knew where and when the people who worked on them were so we could correct for the reporting biases in the database. so we know there is a lot of people in europe looking for infectious diseases. so if a disease emerges in europe it will be recorded. when you look at raw data, you see a lot of european outbreaks and a lot of north american

outbreaks. we have to correct for that so we did that in our analysis. the other big issue we knew these pandemics turned to originate in wildlife but at that time we had no idea whether one species of wildlife carries the same number of viruses as another. we made the assumption overall most animals will have roughly the same number of viruses as another species. we have incredible data on every single ma'am ma'am species on -- mammal species on, range of that species. we knew where every mammal species was. we made the assumption we don't need to know how many viruses it has got but which need to know relatively how many. we need to know relatively where the risk is highist. we got around the problem. we were able to show convincingly there is correlation between two things that drives emerging diseases. where people are on the planet. not just where the population is

the most dense. where we do most to the environment. land use change is correlation of emerging diseases. changes in population density. disruption to the environment is drivers. the other big issue where wildlife are on the planets. when you look at hot spots for emerging diseases which this map shows, where the next pandemic will originate of the, high biodiversity and huge population bases expanding into the areas, hunting wildlife, farming animals next to them, bringing wildlife into markets, trading them and generally disup aring that ecosystem balance. so this is where we work now. we work only in hot spot countries. we focus on communities who are at risk on the edge of the forest. people hot work with wildlife and markets. people who work in farms. we interview them about their hash bits.

take samples from them. look for evidence of viruses we find in wildlife from samples of people. we work with other countries to work to find what those new viruses are and what the rick of those becoming pandemic is and recently we were able to show really clear in parts of southern china there are still bats present that still carry viruses almost identical to sars. there are still people there who hunt bats. who live near bats. who eat bats, which is how sars originated. we're able to show the clear and present danger and work with those populations to try and change wife i don't remember and make the things they do a bit lower risk, stop sparking off the next pandemic. i think all of this is positive and great. i think we will crack this pandemic problem but it will not be straightforward. we will have to deal, as sonia

says in the week we have to deal with underlying issues very hard to deal with. globe equity, poverty, food supplies, clean water, really simple, not simple but not high-tech issues. and yet we in the west tend to look for high-tech solutions, a vaccine, a drug a new test kit whereas perhaps what we really need is to reassess the way ian is with our own microbome our relationship with our ecosystem and bring the balance back where it should be. thanks very much. [applause] >> thank you very much. next we have carl gierstorfer. did i say that right, carl? >> no. >> i'm sorry you have to say it again to get it right. carl is back from south sudan.

he is going to talk about his work with ebola and some, shot some great film he has done, sorry, on hiv too, right. >> yeah, like the last couple years doing two films. my last film was the ebola outbreak in liberia. i was there for two months. i looked how the community experienced that outbreak. and previously i did a documentary on the origin of hiv. in this documentary i tried to piece together where this virus came from and how this virus actually managed to cause a global pandemic. and in that talk i will touch a lot upon what peter has been saying, about the geographic origin of a virus that caused the pandemic, hiv, and what conditions there were. so i will, it is a bit like looking through a magnifying glass, how it feels to have life there and what conditions are

there on the ground. hiv as you know is one of the worst pandemics we have experienced in recent history. hiv is a virus that comes from chimpanzees. so the pandemic form, hiv-1-m is virus similar form found in chimpanzees. since the 19 80's we've been knowing it is coming from chimpanzees and science is trying to figure out where exactly this virus originated? where did it jump from chimpanzees into humans and how did it subsequently spread? you have to know a little bit about chimpanzees. chimpanzees live in rainforest areas in west and central africa. the good thing about chimpanzees, they don't move a lot. they don't like water. they don't cross rivers. for many generations they stay in the same place. so what scientists did is, they basically looked for chimpanzee populations. they collected their fecal

samples. they looked at whether they were infected with the chimp version of hiv and they compared it to the human version that caused the global pandemic and by measuring the genetic distance they could figure out where this virus must have originated and that search brought them to central africa, to cameroon which is here. and more specifically to an area in southeastern cameroon bordering three countries, central african republic, republic of the congo to the south and here cameroon. this is a very, very remote area and we went there for our film to document the work of the scientists there but also there is a lot of science going on looking at what, what peter has been talking about, looking at emerging of new viruses transmissions, because of a lot of the factors and drivers that drive these viruses into human

populations are at work there. i take you from there, fourdais in the car to get there. it is a long journey. then you end up at this place. it is the songa river. it is a river network that flows south to the congo. congo flows to the big capital of the congo. this area has been an area that has always been remote but since the colonial opening up in the 18 '50s, there was a -- 1850s, there has been input of a lot of people and we know from yen net tick dating estimates hiv originated in that area around 100 years ago, between 1880s and the 1920s. now if you look at the history of the place, if you look at all the geography of the place, you think why there, why then? but then only then looking at the historical developments then

everything starts to make sense. all the major colonial powers were operating in the area. they went in there mainly for rubber but also timber. so there was a huge disruption on off the original lifestyle, a huge movement of people going on because they had enormous demand for workers. then of course over the decades there were networks being built, riverine networks and also railway networks and growing cities like kincasa exploding in the 1930s. all the factors, once hiv jumped from chimpanzees to humans and could expand and then finally make the leap out of africa and into the rest of the world. we also know by now, by the 19 of 0 in kinshasa there was

epidemic of hiv aids. there were hundreds of thousand of people infected. because of the post colonial chaos in the 1960s and '70s, health infrastructure collapsed, there was civil war going on. nobody noticed. it wasn't until the 1980s that we took notice of hiv here in new york and of course on the west coast. so cameroon was the place where hiv-1 originated. as i said we went there because, we wanted to understand whether this place still today has the potential to basically breed another virus or facilitate another zoo necessary notoc emergence of the -- zoonotic emergence of virus. this is scientists gathering

samples for the laboratory in philadelphia for hiv analysis. this is very remote area. it takes fourdais to get there and there is rainforest area. but there are huge logging operations going on. it is not going on funny enough at edges of the forest but going on the middle of the forest. so the cameroon government is auctioning off to international companies certain areas in the rainforest where they log. this is an italian company. they're logging for timber there. so you have networks of course where they have to bring out these timber to the next port. and the next port is more than 1000 miles away to the west. so you have all the roads where there is constant stream of trucks bringing out this hardwood and timber to the coast. so you have networks again. secondly, you have a lot of people coming into that area to work for the logging companies, first of all. but also to provide services for all these truckers. mind you there are no

supermarkets or anything there. it is just bush tracks and little settlements like these. and the people live exclusively of bush mead. these are pigmy hunters. this is a woman slaughtering a daca. we were there almost three weeks and you couldn't get any protein except from bush meat. so we were eating monkeys. we were eating snakes. we were eating porcupines. so the whole range of animals you had in the forest you were eating. all of these people were eating them there. all of these people were, in one way or the other coming in close contact with wildlife, either through slaughtering it. here's a preparation after monkey over a fire. so you had constant exposure to wildlife. and constant opportunities for viruses and pathogens infecting these wildlife to jump over into

humans now there are doctors, we went there with a cameroonian army medic. he is working with a team of scientists in southern france and also here in philadelphia and they are actually monitoring these populations. first of all, what do you see is you have very high hiv rates because the truckers, they, hiv spreads along the trucking routes. the truckers of course have lots of you know relationships with the population there. so that is one way of hiv to spread. it is up to 25%, almost every fourth person has hiv there. they're also analyzing blood samples. what they're seeing they have indirect evidence of transfer of pathogens that normally only infect monkeys and apes and related to hiv but other than than hiv, direct evidence these populations have viruses through

antibodies and some of the people are infected with known pathogens. they don't make them sick. they don't pass them on yet. we don't know if that happens, but the first steps are already taken. so, in a nutshell this one of the areas which peter pointed out in central africa where you have all the drivers there. you have mobility of population. you have a population growth through an input of population, working there. you have a very close and intimate contact with wildlife. and also you have networks that can bring these pathogens to the big cities in west and central africa. now, i'm a biologist, what i realized with chimpanzees, almost if you look at, evolution and the effect of the solution and also the less effects going on this hiv, it was likes hiv

found itself in a chimpanzee population that was dwindling. any virus at the moment in chimpanzees has a population of, maybe 250,000 chimpanzees left. of course for any virus that makes or manages the jump into humans, it has ever expanding population of 7 billion people. so the selective pressures are there for viruses to adapt to its new host and go into a human host and to survive in a human host. listening to peter i find it very interesting some of the efforts are going on there to understand which viruses are circulating, which viruses can make the jump into humans. and of course if you can prepare ourself, if we have genome or genetic sequences of virus it will be huge advantage to have these things in the future and these areas, as remote as they may be have to be on our map.

so that is where we can react early enough or we can actually act preventatively before it is too late. finally i just want to say with ebola it was basically the same thing. ebola, the present outbreak in west africa originated in guinea. they call this forest region of guinea. this is not for rested region. there has been a lot of deforestation going on. from evolutionary perspective if this virus finds itself in bats and habitat of bats is being destroyed. for the bats there to, two-ways to go. either the bat population dies out or the bat population manages to live next to human populations. bats are mammals. they're very adaptive in that sense and that is probably what

happened to ebola. you had bats living in very close proximity with humans and that made it very easy for this ebola virus to jump from bats into humans. and then of course it was in an area where the next capitol cities were never very far. the way with ebola, everything was at play, as with hiv everything was at play. we know these factors around it is probably a matter of looking very closely and thinking very hard how we interact with nature. thinking also how we can use our knowledge to prevent it in the future. thank you. [applause] >> thank you, carl. amy maxmen is going to share some of her reporting on ebola. amy is science journalist and has been supported by the

pulitzer center. >> hi. so, i, i am a science journalist, and i going to talk, my talk is a little bit different. it will be a lot less sciencey actually. i talk about our, our being the u.s. to response to epidemic ins that happen in the developing world. what we respond to and what we don't respond to. so i had gone to sierra leone to cover the ebola outbreak. i was just going to cover science. that is what i do. i have a background in science. i wanted to cover urology and treatments to it and anthropologie but what i was really stung by there the large distance between the response as we see it, through a google image search, versus what you see on the ground. i was very intrigued by that. so that is what i really spent a couple of months there reporting

on. so there is what we maybe think about, white tents, bio hazard suits. where i spent a lot of time was the hospitals where people go when they're sick, if they go seek medical care. that is before the international response shows up. so this is a photo of exhausted nurses. if you go to public hospitals what you will find, are underpaid, overworked staff. often there is no electricity, there is no running water. and, so, specifically i spent a lot of time in the west of sierra leone. there is large western district on the border of guinea, an in september of 2014 "doctors without borders" was shouting a lot there was terrible ebola outbreak. at that time it wasn't huge. this was a bit different than what they were seeing before. they were worried. at that point, dr. kahn, you might have heard of him, leading

virologist in west africa, he was in this big hospital in western sierra leone. sorry. loud enough? sorry. so he was at this hospital in western sierra leone. he is worried because they're on the border with guinea. he calls all of the young doctors he trained in the country to come there. he convinced a lost nurses to come for training on what should they do should ebola show up in sierra leone. they came but within a few weeks there was woman who was pregnant who came to the hospital. she miscarried and she couldn't stop bleeding. she kept bleeding, moved her to the surgical ward. that there was possible a hemorraghic fever that is in that area but also ebola. she died and tested positive for ebola. at this point it blows up in the region. ebola is spreading rapidly.

nurses have to take care of them. they don't have gloves and protective gear. commercial shippers stopped flying. hard to get protective gear in the country. they are using tarps to protect themselves. this is walls of one of the hospitals, placerred with memorial services for nurses, ambulance driverrers and technicianses who have died and they don't have protective gear and they're working hard to do what they can. may, june, july, it keeps tesla indicating. this is -- escalating. this is one the morticians from the hospital. he convinced me to come into the morgue. ebola was not as strong when i was there. during the peak of the outbreak during july and september of 2014, there was more than 3,000 ebola tests done at this hospital and he just slept, he slept on other side, he slept on the ground because around the clock he needed to prepare bodies.

there were piles of corps corpses. by the time i got there, if you think august in august, and this is in the west dealing with expanding -- 1000 people had died by august of 2014. that is when the world health organization decided there was international health crisis. that is when fund-raising begins. countries start donating lots of money. that even takes a lot of time because countries decide how much they're donating. they decide how will they implement it. will they get the u.s. army to do something? what will they do? this all takes time. the whole time the virus is multiplying and spreading and hits the capital. by october there are 3,000 people dead and still there is not a lot of international effort. all the white tents and bio hazard suits you're seeing, they're starting to show up around then. late november, early december, when finally mid-december they decide there is enough ambulances and these white

tents, ebola treatment centers for people. by early december there are 6,000 people dead. when i come there, when i come the plane is full of aide workers. at that point when you go to public hospitals what you see strikes across the country in sierra leone and liberia and guinea. this is some of the graffiti. please pay my day. problem with all the staff they were workinger this going to be paid 50 to $90 a week for risking their lives going through this tremendous thing. either, some people were paid but a lot of people were not paid or were paid half or paid extremely late. there were protesters before we arrived. somebody dumped three corpses on the ground just in protest. part of the anger was also headlines are reading obama donates 100 million. so there is huge donations. it is clear people are donating a lot of money.

there should be a lot of money. why aren't they getting it? you can see there is money too, in december what i'm there. united nations helicopters flying back and forth. parking lots in the capitol cities are full of new cars donated. they have plastic wrap still on them. there are things happening. there are ebola treatment centers being put up. and there is lots of donations. and it is clear. some things are going to very good purposes. other things are questionable. what people keep asking me as i visit various public hospitals who is hiding all the money because we're still not getting paid. so that sort of became my question too. this is chart from may 2015. these are donations. these are not promises. actual donations to made to west africa. u.s. was biggest donor with 1.5 billion. you can see the u.k. has 30 million. so on. but here's the thing for how donations are made.

you might, i didn't know this until i looked into it because i have a science background. when these, bilateral donors like the u.s., u.k., governments make donation, they make donations, their money goes to the united nations agencies, to their own agencies like the cdc or to big ngos like international red cross, like save the children, like "doctors without borders," big ngos. there they might hire contracts to hire next level of people that need to be hired, other ngos. there is a whole hierarchy. where it does not go is like, to the public hospitals or to nurses who are within the system. doesn't go to the government of the country. it goes outside of the system. however, the government of sierra leone is one of extremely poorest countries. . .

>> so i won't go into it. what they did is asked the un agencies unit undp to implement this kind of awesome way of paying people through mobile phone because the cash economy, very few people have bank accounts, you get a text message, you go to a vendor and pick up $90 in cash. super-smart idea because you need administrator department that keeps track of who goes

where and things like that. so i went about trying to make at least at the one hospital in the west who works there who was owed which money. i don't think anyone really cared if the system worked or not because i don't know if there's a lot -- if is system doesn't work, i don't know if it ever comes back to the people who are told to implement the system. that's sort of the end of that. why should we care? i think the reason why it bothers me now is because it's sort of a question put out, so that was we hear, there's definitely going to be other epidemic that are happening, what would have happened had in april when dr. con new that ebola might cross over the border, what if there was hospital with running water, electricity and gloves and

protective gear and nurses supported and paid a living wage, what would have happened then if they were prepared to take care of the outbreak itself. we had the case in dallas, the cdc might have dropped the ball for a minute but there wasn't spread in the u.s. this is a photo -- this was woman in the -- with the hair cap, she was the head of the ebola treatment area at the hospital. so they built a new nurse's corridors for her. the isolation unit for fevers. it's the rainy season. all 15 of them have to huddle in there when it rains. their files are completely covered in water.

that's the public system that's there. it may be a question of before and after crises, is there way to support systems in place as opposed to just outside of it. along with that i have an e-book that tells more of the story i talked about, but you can download or sort of a shorter version on my website and other stuff too. thanks so much. [applause] >> thank you to all our speakers. now that we have time for discussion, what i'm going to ask people to go, obviously she gets to start. but if you're interesting in asking the questions, the mic is just here, please, everyone, because we have limited time, if you can make your questions as brief as possible and indicate

who on the panel there indicated if that's appropriate. thank you. [inaudible] >> i don't think it's on. concerning trying to identify the million viruses, as we know there are many viruses that are nonpathogenic. also we know that there are million viruses that can cause disease and does it make sense and the second question, the shock concerning the water thing in lower manhattan in 19th century. that was started.

it wasn't that they were interested in supplying water. they were interested to build a bank. aron burr was one of the people and the in order to get a charter for the bank they had to build a water system. that's how it happened. they weren't interested in water at all. it's the profit motive that bring people here and i don't see a solution to that unless we change our whole society in the way culturally we do it. i think it's so driven by the profit. winston churchill said, eventually americans try everything first and then eventually do the right thing. i don't know how long it's going to take for us to get there. i'm somewhat cynical. >> you go first. it's your book.

[laughter] >> i think it is a huge political challenge to try to -- thank you for pointing that out. and i go into some detail in the book, if anyone is interested. it's a great story. certainly -- okay. the other one. that's the problem. there we go. >> we will leave this discussion here to go live to the white house briefing. here is josh earnest. >> nice to see you all. i do not have any announcements at the top so we can go straight to questions. darlyne, do you want to kick us off? [inaudible] >> well, obviously, yeah, the administration has been enthusiastic that democrats and republicans can work together on

common sense criminal justice reform legislation, and the white house officials have been involved in the process both on the house and senate side, and we've -- our role has been to try to furniture bipartisan cooperation and in the era of divided government that we are operating in, that kind of bipartisan cooperation in capitol hill particularly in something like this important is pretty rare, and so we want to continue to encourage them in those efforts. the -- the commutation reflects the authority invested in the office of the presidency and represents case-by-case review of people coming forward seeking clemency. the process is quite different

and the issues are somewhat different but if the announcement of 61commutations by the president is a reminder why criminal justice is important and serve greater cooperation and progress on a broader criminal justice reform package on capitol hill, then we would obviously welcome the development. >> but it's stalled -- [inaudible] >> yeah. >> working together to try to move legislation. >> yeah. >> seems like -- [inaudible] >> sometimes the legislative process on capitol hill doesn't move nearly as quickly as we would like or even quickly as one could expect but at this

point we continue to be encouraged by the fact that there are advocates of this legislation in both parties in both houses of congress. one recent example is that in the speech that speaker ryan delivered last week, i believe it was wednesday or thursday of last week, his comments about the many problems plaguing the republican party got a lot of attention and understandably so. he also had some comments that indicate continued support for criminal justice reform, and look, there are not to many situations where i would say this, but speaker ryan's description of why criminal reform is a priority for him, i think it's something that many people at the white house would -- would strangely agree with. he talked pretty powerfully i thought about the importance of

redemption and how speaker ryan's faith informed his view of this -- of this issue. i don't think it was a coincidence that he chose to deliver the remarks during holy week. it's a priority that they share at the white house. my guess is if you get into the elements of competing legislative proposals that there might be some differences that emerge that will only just require republicans and democrats to cooperate and work through agreements to arrive at the kind of solution everyone can support. i continue to be optimist that i can we we will be able to get that done even in election year. >> i wanted to ask about syria, there's an interview where president asaad is rejecting

calls, is there any reaction? >> i didn't see the interview and i don't know whether he envisioned himself as being part of union government. we raised concerns of president assad's leadership. the manner in which he has used the nation's military to attack innocent civilians isn't just completely immoral, it has turned the large majority of the country against him. it's impossible to imagine a scenario where the political turmoil and violence inside of syria comes to an end, while president assad is still there, and by there, in a -- in the president's office in syria. so that's why we have been clear for years that the successful

resolution of the political chaos inside of syria isn't just critical to solving the many problems plaguing that nation in the broader region, it also will require president assad stepping aside. >> syrian reports recently took report from isil, i know that the u.s. -- [inaudible] >> but how does the white house feel about -- [inaudible] >> well, a couple of things about that. the first is obviously isil -- the actions that isil undertook while palmero under their control were terrible, they plundered precious historical artifacts that actually illustrate the common heritage

that -- that we all have. they also carried out terrible acts of violence against the individuals who are responsible for protecting that heritage. so seeing them driven out of that vocation, seeing isil driven out is obviously a welcomed development, but that doesn't change the basic calculus that i just described, which is that the political turmoil inside of syria will not recede as long as president assad is in office. and, you know, that's why we continue to believe that he must go. okay. roberta. >> in the two weeks since president putin said he was partially withdraw russian military from syria, there seems to have been a buildup in moscow shipping more equipment to syria

according to announcement of shipping data and patterns. i'm wondering how closely the united states is tracking that partial withdrawal and whether the white house has concerns about what's happening in terms of the withdrawal or the shipping of military? >> i haven't seen the analysis you just cited. i can tell you more generally that the united states and coalition partners and intelligence agencies are clairefully -- carefully watching the situation inside of syria. earlier indications making the announcement of military withdrawal at least a large portion of syria, that the russians were following through on that commitment. i haven't gotten an updated assessment on that but i haven't been alerted to any sort of change in that assessment. you know, our case to the russians has been for frankly --

was the case that we were making prior to their military buildup. you recall russia had a military presence in syria for a long time and were using the military presence to sure up president assad's grip on power. we were concerned of the military buildup. and our view is that by holding to assad's power would be higher for us to reach a diplomatic agreement among the party who is are concerned about syria because president assad wouldn't have nearly same kind of incenttoif negotiate. he certainly wouldn't have the incentive to consider leading the clear and we have made clear that that's what will be required to reach a political

agreement. so what's notable about that is that the russians understood publicly and privately that a political transition inside of syria was required to try to bring in the chaos and violence there. they were in the military strategy that hindered those negotiations. so what we are hopeful of is that russia will continue to engage in that political process constructively and bring about the kind of transition that is so clearly in the interest of not just the united states and russia but a variety of countries in the region and certainly in the interest of the opposition parties, many of whom are representing civilians that

have been innocently slaughtered by bashar al-assad. >> can you tell us a little bit more about what exactly president obama hopes to establish when he meets leaders this week on the summit specifically? >> well, there are more than 50 world lead thears are coming to the united states, they are coming to washington tomorrow who will be participating in the nuclear security summit and many of them are countries who are making important contributions to our counterisil campaign, and the president felt it was important while all in town all in one place talking about national security that they should have a discussion about what the president's identified as his top priority. this should be a useful session to review progress that coalition has made. there's been notable progress in iraq and syria just in the last

couple of weeks, particularly as it relates to isil leaders that have been taken off the battlefields. there's also been important progress made in the strategy to and reviewing that process and building on that moment eem will -- momentum will be part of the agenda. you'll have an opportunity to talk to him in more detail about why the president believes that that discussion was important to have. okay. justin. [inaudible] >> i'm wondering if you guys share that assessment of the

drafts and wanting to look back on federal -- >> yeah. well, look, let me start by saying that at the end of last year speaker ryan made a commitment to try to advance legislation that would help the puerto rican government and the puerto rican people deal with their financial challenges. and the fact that we have seen this discussion draft put forward, i think reflects continued good faith in trying to fulfill that commitment. and so obviously we appreciate the constructed efforts by chairman bishop and other members of the house natural resources committee. this is an example where democrats and republicans have been able to at least coordinate their efforts with regard to this legislation, like leader pelosi, the white house believes that benefits from improvement.

you know, we have been pretty clear of what we believe is the the crux for addressing the challenging and giving restructuring authorities that the municipalities across the united states have and that will allow them to deal with financial challenges. at the same time, we also believe that the puerto rican government needs to be held accountable for implementing reforms that they have committed to make, and so having a mechanism for independent oversight to confirm that those reforms are being effectively implemented is also important, how exactly to do that, i recognize as a subject of extensive negotiation and there can be a lot of back and forth on that. but, you know, we would view that as another area of where this bill can be improved.

now, there are a couple of other proposals that we have supported that we continue to advocate and that is that the reimbursement rates under medicaid that are given to the government of puerto rico should be increased consistent with the kind of reimbursement rates that are given to states all across the country. we also have advocated for the expansion of the earned income tax credit so that u.s. taxpayers in puerto rico would benefit from it. the eitc is a proven strategy for combating poverty while continuing to incentivize a taxpayer to pursue gainful employment. you know, currently u.s. taxpayers in puerto rico don't have access to earned income tax credit. we believe it should be changed because it would improve the financial standing of the puerto rican government but also

improve economic outlook for the cuban people -- i'm sorry, for the puerto rican people, but also for the broader economy in puerto rico. [inaudible] >> i'm wonder if you have a reaction and if you can talk about how this law comes under the administration -- [inaudible] >> right. i'm not going to react to the specific decision. i think the treasury department has done that and you can cite their statement on the matter. but you do raise something that i think it's worthy of discussion in here which is one component that was passed early in president obama's presidency included giving regulators the

tools that they need to regulate nonbank financial institutions. this is one of the lessons that we learned from the great recession, it's not just banks on wall street that could potentially shake the foundation of our financial system, if they make a bunch of risky bets that go bad without proper oversight, worst yet, could put taxpayers on the hook for bailing them out, and if we are serious and the president certainly is about falling through on a commitment to making sure taxpayers are not in a position again, we need to make sure that regulators can have -- can exercise at least some authority over nonbank institutions because we know that nonbank institutions in the financial crisis precipitated in 2008 made risky bets, they went south, shook our financial institutions and our financial system and put taxpayers in a position where we had to offer

them some assistance to bail them out. that wasn't good for our economy and we can't ever let that happen again. that's why giving financial regulators in the united states greater authority for nonbank institutions was so important and the president believes strongly in that principle and, you know, that's why wall street reform created the fsoc in the first place and it's taking a look at the systemically important financial institutions, so this principle is one the president believes in and obvious one and based on the experience that we all went through in the mist of the financial crisis in 2008 and it's why the president worked so hard to pass legislation to address it. let me say one other thing andly let you follow up, many of the critics warned that passing wall street reform that would give

regulators additional authority including around bank institutions, that passing these kinds of regulations would be overly burdensome and that they would throw a cold wet blank over innovation and the dynamism. they were wrong. we can evaluate this and look at the numbers and see -- this would sound familiar to you, every month since president obama has signed into law the wall street reform bill, our economy has created private-sector jobs. every single month. we have seen the growth in the stock market be rather dramatic over that time period. so it is clear that we can effectively regulate financial institutions to protect taxpayers without stifling

economic innovation, we can do both. we have to be smart about it. i think the results over the last five years speak for themselves and i think they speak loud and clear. >> just last quick one. >> okay. >> i think i was interested in the idea of having bilateral with china and trilateral with south korea and japan. i'm wondering if that sparked any renewed concern among china, they've expressed directly or that you have seen motivate d on actions in the region and balance going forward? >> the united states has invested quite a bit of time and diplomatic energy into encouraging and promoting

reconciliation between two closest allies, south korea and japan. and we have welcomed the steps they have taken over the last year or so to strength the relations between those two countries. the interest of the united states are enhanced when two closest allies can coordinate together. we obviously welcome those developments and we -- will certainly be the subject of discussion when leaders meet in washington tomorrow. as it relates to china, one thing that we have been quite clear about is we understand that even our close allies are going to have their own independent relationship with china. there's nothing wrong with that. in fact, i think you can make a strong case that the right kind of relationship building between china and some of our allies would actually be good for our interests in the same way that the ability of china and the united states to work together

can have a positive impact on south korea and japan. the most obvious example of this is inner dealings with north korea. it's only because the united states and china have been effectively work together that the united nations imposed the toughest sanctions that have been imposed on north korea. that will pressure the north korea regime and isolate over the nuclear weapon's program in the way it has positive benefits for our ally south korea and japan. there's nothing inherent in the alliance of those two countries that affect our ability to work effectively with the chinese to promote the interest of our countries. mark. >> josh, a number of the recipients had gun possession charges, was that not troubling

to the president in search of nonviolent offenders? >> well, the president and his team review individual cases, individually and so they're looking at individual cases to determine how appropriate it is to offer them some clemency. what's important about these cases is that many of them are low-level drug oh -- offenders, and many had they been sentenced under the rules of today, they would have served sentence. that's what made them particularly strong candidates to receive clemency from the commander in chief. >> on the fight against isis, in the aftermath of bomb negotiation brussels, has anybody raised the idea of the article 5 in the nato?

>> that's a good question. no one has raised it with me, at least. at least part of the reason for that is that there's no denying that the united states of america stands squarely with our allies in belgium and we do that rhetorically in comments you've seen from the president of the united states but we also do as practical matter as well that there's expertise when it comes to law enforcement and intelligence community and other national security assets that we can offer to belgiums to protect the country. so -- so i haven't heard a discussion about this but i don't know frankly how it would impact the way in which we have offered our assistance to our allies in belgium as they confront this threat.

>> why not require all nato nations to step up fight against isis, an attack on all is an attack on one? >> yeah, we have been pleased with the kind of response that we have seen from our european allies and the con transcribe -- contributions to coalition. we believe that there's certainly they can, one example that we frequently cite, we believe that allies could share intelligence with one another and the united states in a way that would enhance the security of all of our citizens and we continue to make that case. i don't know whether or not invoking article 5 of the nato charter would enhance that or not but we continue to make that case. i don't think it is an overstatement to suggest that particularly right now this is a case that we are making through law enforcement national

security channels with our european allies every single day and, you know, we are going to continue to make that case because, again, we believe that it would be valuable in enhancing the national security of our allies that are under a lot of pressure right now, but we also believe it would be helpful in strengthening security of the united states. >> one last item, president obama said that once he leaves office he's looking to three to four months of sleep. [laughter] >> does he not sleep late some days? >> i don't know the answer to that. [laughter] presumably he does maybe on the weekends. look, i think the president is making reference to the fact that after serving as president for eight years that anybody -- >> he's tired? >> anybody would do a little

r&r. >> he didn't say r&r. he said sleep. >> i think the president is prepared to spend the next nine months losing a little sleep as he thinks through how he can maximize opportunity while in office. >> thanks. [inaudible] >> we know the nuclear cooperation will be the major topic. and other than that, what are those major issues in your mind will be at the top of the agenda? >> well, that's a good question. there are obviously a wide range of issues that the united states and china are able to effectively coordinate on. the most example of that recently is the to work together to isolate and apply further pressure on the north korean regime for destabilizing activities on the korean

peninsula, but there are other areas where the united states and china through their coordination can make progress in countries. i'm confident that they'll be discussion of the global economic climate. this is an issue that's gotten a lot of attention in china and that has consequences for the u.s. economy, i would anticipate that they'll be a discussion of that. cybersecurity is an issue that often comes up with the united states and china. we were pleased with the progress that we were able to make in those discussions when president xi voted the white house last fall. i'm confident that they'll be additional discussion of that. as we say, the president often regularly brings the issue of human rights and i would anticipate that he'll bring up that issue once again in his conversation with president xi. once the meeting is concluded, we will try to get you a more detailed read of the agenda that they followed and try to give

you some better insight into exactly what was accomplished in the conversation. obviously respects president xi and is appreciative of those areas where they have been able to effectively coordinate to advance the interest of citizens -- where they have been able to advance the interest of both of our country citizens. >> we know this would be the eighth meeting actually between the two leaders since 2013. this is a quite high engagements. what is the significance bilateral relationship with china and the united states and how do you describe their relationship? >> i think what i would say frankly that the frequency of the meetings is an indication of how many issues our countries are able to coordinate on.

i let -- left out on important one which is climate one. ability of the united states and china to work effectively on the issue was critical to completion of the un climate change agreement in paris at the end of last year and the president observed when that agreement was reached in paris that that wasn't the end of our work to coordinate on issues related to climate change, it actually was the beginning and i would anticipate that president obama and president xi will talk about how we can advance the global advancement to fight climate change. michelle. >> do you think whether it is the case -- [inaudible] >> and he declines that. >> well, i don't know what sort of request put forward. you can check with his office. what is true that president

obama has met frequently in the last six months or so, twice at tend of last year both in turkey and in paris, there have been phone calls between the two leaders. vice president biden was in turkey just in the last six weeks and had an opportunity to sit down for a one-on-one meeting. and i certainly wouldn't rule out a conversation between president edugeon and president obama. that certainly includes turkey's efforts to fight terrorism inside of turkey but also to continue to enhance the military pressure that's being applied against isil. >> why not a bilateral since they are an important piece of

the puzzle and have asked for a more formal meeting. can you just once and for all say why not a bilateral? >> because the world leaders are only here for two dais and there -- days and there are 50 of them and that's obviously going to prevent president obama meeting from each of the world leaders that are here. again, it also presumably would rule out vice president meeting with each of the world leaders but he is going to make time for president erdegoun and i'm confident that president obama will make little time with some kind of conversation while he's here too. >> do other world leaders do that? >> i'm sure there are. >> europe as a who has failed to address the significance of the terror threat that they face and belgium in particularly, but he's talking about negligence on

europe as a whole. what do you think of this comment? >> europe is in a year neek -- unique situation. the president has been focused on the issue of foreign fighters since the very emergence of isil on the global scene. you recall he convened united nations council meeting a session focused specifically on shutting down the foreign fighters to iraq and syria and the concerned that we've had all along that individuals that travel to iraq and syria will get training and could use potentially their passport to return home and carry out acts of violence in their home country. that is apparently what -- what

happened with the attacks that we have seen in europe recently. what's unique about europe is they have a relatively significant individuals that fit the description that i just offered, fought along side isil and returned home. europe is also geographically closer to that region than the united states. again, that puts europe in a particularly difficult situation in mitigating this threat. that's why the united states continues to support them as they undertake these efforts. the europeans themselves have also acknowledged that there's more that they can and should do to protect their citizens and protect their individual countries. and we are obviously going stand

with them and encourage them as they do that. i mentioned to -- to justin, i believe, that one example of how they could do that would be to improve their intelligence sharing, both among european countries but also with the united states. that would be one example of how they could plug some of the gaps that have emerged. >> when you have a situation where turkey is warning them about a particular individual that's now back in belgium and belgium -- obviously what happened what happened. >> the belgiums have acknowledged that that was an error and a mistake and there needs to be reform of the methods of transmitting information so that they could better protect their people and better account for those potential risks and, you know, obviously they're right about that. >> talked about russia not attending attending the summit

tomorrow and acknowledged that there's still cooperation and ongoing dialogue and all of that, but what message does that send to the white house that they're not attending this? what's your take on that? >> the fact is that the russianians have have been able to cooperate which is iran from obtaining a nuclear weapon. talks were critical to longer-term success both in reaching the agreement but implementing it and we have been pleased that iran has followed through on the steps they commit today take to ship a bunch of the uranium stock file, 98%, out of the country that. was a key commitment that iran made and russia was instrumental in facilitating iran's

commitment. russia has effectively coordinated with us when it comes to north korea and they supported at the security council level the imposition of sanctions that went i don't the sanction that is were previously in place to apply additional pressure to the north korea regime and to further isolate them because of their continued development of their nuclear programs. so on those areas where we have high priorities, obviously the russians have been effective partners but at the same time we would welcome russian participation in the security summit. >> is there not a problem, no significance that they are no-shows? >> obviously we would welcome them doing so and they are going to miss out on an opportunity to coordinate with the international community on important issues. i do think that it serves to

further illustrate the degree to which russia is isolated from the international community, for whatever reason they've chosen not to engage in this conversation. i think -- and this is yit -- yet another consequence of russia's involvement in that particular matter. >> do we expect to see many, many of those? >> i wouldn't rule that to additional individuals. that would only be done after a careful review of individual cases by department of justice but i certainly wouldn't rule it out. >> is there a target number? >> no, there's not a target number simply because the cases are reviewed individually. so there's not a target number. there's just a commitment to try

to review as many cases and offer clemency to individuals that are deserving on it. >> april. >> just to follow on michelle, she asked the question, but when it comes to the commutation, do you have a large number that you're going to just pay from different states, how are these lists compiled, what happens? >> there's a formal application process that individuals who are incarcerated want to seek clemency can undertake with attorneys but this is a process that resides with the department of justice and can give you details and how many individuals are currently going through it. >> okay, so you don't know exactly how many are sitting there to be reviewed? >> be reviewed. i don't know but the department of justice may give you an idea. >> do you have the number of those, as you said many people have low-level drug charge

sentences and -- finish their time, do you have the numbers of the people who actually are in prison in the country now on those charges? >> i don'thave those numbers in front of me. i think one of the statistics notable, april, about a third of the individuals who received clemency today were serving life sentences. that's why the president, i made this a priority. [inaudible] >> when president obama was

senator the black caucus was trying to address the issue. how much work or how important was it when he was then senator in chicago? >> look, there are a variety of questions that have been raised about the fairness in criminal justice system. that was only possible because republicans recognized disparity . we are hopeful that will prevail. [laughter] >> yeah. >> i turn to the section that has outlines of criminal justice proposal and what we would like

to see included in the measure. >> lastly, going back to the numbers. typically the last day or before the last day or last week or within the last month the president had -- [inaudible] >> well, the part and process is similar in that individual cases are reviewed individually by the department of justice and, you know, they find deserving individuals, then send those over to the white house to the president's consideration and that process will continue and i certainly wouldn't rule out additional pardons granted. >> the north carolina governor cast a law as state authority over localities of its state including charlotte.

does the for think the federal government should assert authority? >> well, i have to admit that i'm not familiar with sort of the legal consequences of applying municipal, state or federal law in this kind of scenario. i'm hesitant to weigh in the legal argument. i think that what is true is that governor has chosen to use the state authority in a rather meanspirited way. it certainly does not promote the kind of fairness and justice our country has long stood for and that's why i think you've seen the president speak out when other states have pursued similar measures and we are going to continue to do that as i observed in, i guess, in the

gaggle that i did yesterday. the president was quite pleased with the supreme court decision last summer that guarantied the freedom to marry and the president recognized while a decision worth celebrating and process, that was far from the end of the struggle and we are going to continue to engage in these debates and the president is always going to be on the side of fairness and justice. [inaudible] >> isn't that something that has a consequence -- a positive consequence? >> let me check with our attorneys in terms of how, what specific impact federal laws

could have on the situation. i'm just -- i'm not steeped in the legal details of this particular matters. let us follow up with you on this matter. i think i can speak about the principal clearly at stake here and one principle is one the president holds dear and that's why you hear strong comments from me. [laughter] >> margaret. >> president obama back in 2009 -- that was before the rise of isis which is the best-funded, best-network terror group out there. so are we now in nuclear threat energy? >> well, there's no denying that

it would be very dangerous and deeply troubling if isis could get a handle on nuclear material or nuclear device, and it does underscore why the president has made securing nuclear material around the globe a top priority. and since the president took office we have made a lot of important progress in that regard. the iran deal, the international agreement to prevent iran from obtaining nuclear weapon is probably the best example of that. a large percentage, 98% of stockpile of highly enriched uranium was shipped out of the country. >> are you concerned about iran selling to isis? >> the concern was just that when you have this dangerous material in such large quantities it ens -- enhances

the risk, iran supports terrorism, there's no denying that. also to ensure that iran had the appropriate protocols in place to protect the nuclear material that they retained. you recall that that was also a key component of the international agreement, was putting in protocols and standards related to nuclear security, some of which involved the united states lending our expertise. what's also true that since the president initiated series of nuclear security summit, 13 countries plus taiwan have eliminated their stockpile of high le -- highly enriched

uranium, that's another tangle example of the progress that we have made. there also has been important progress in establishing essentially a nuclear-security architecture, a set of standards that country around the world abide by in shipping and storing nuclear material but also in terms of deploying equipment at their borders that could detect the attempted shipment of nuclear material. all of that enhances the national security of the united states, all of that makes the world a safer place and all of that is a result of the president making this issue a top diplomatic priority. >> so do you think that -- [inaudible] >> well, i think there's no denying that the rift of the united states has been reduced

because of the progress we've head in the context of the nuclear security summit and the series in the last several years. we continue to be very mindful at the threat that is posed by a terrorist organizationlike isil getting hands on nuclear material and that's an important motivator who are all participating in the summit this week that they recognize the dire consequences of that happening and they're taking the responsible steps in participating in the summit in a responsible way to ensure that the security of the world. >> when you talk about the summit and you mentioned that coalition of isis meeting, it sounds like you're describing it --

[inaudible] >> versus the level of threat that many feel and many intelligence analysts would say isis poses and reflecting those concerns that the white house has specifically about nuclear terror. we do expect to have any kind of action plan coming out of this focus meeting on the threat from nuclear terrorist? >> well, it is true that if the president envisions a much broader discussion about our counterisil efforts beyond just preventing isil from getting on nuclear materials, given the fact that all the leaders are here to participate in a nuclear summit i'm cflt that will be discussion. but again, you'll have an opportunity to talk to the president. >> you mentioned iran.

were not that i'm aware of. primarily because the most important business that we had to do with the iranians as it relates to the nuclear program and the nuclear material that they retained, is something that we are able to resolve and so i'm not aware of a bunch of series of considerations including iranians. >> is it your concern of nuclear agreement? >> the united states now -- i'm not aware of the consequences. what i can tell you that the united states now for the first time is able to verify iran's handling of their nuclear material. we can verify that they are not building a nuclear weapon, that their program is focused only on peaceful and we also know that

iran has followed through on applying many of the safety and security protocols that other countries with nuclear programs respect and we believe that's important as well. >> you did bring up the point that you believe iran is sponsor of terrorism. you have to talk about elicit nuclear trades, are you saying that the nuclear deal that this country along with allies came to agreement on this summer ends that concern about iran is trading nuclear material with other groups? >> well, it's going to be a lot harder for iran to do that if they choose to do so because of access to iran's nuclear program. we are able to detect if they begin to take steps that are either in violation of the iran

agreement or if they take steps in violation of other un regulations that could potentially be used for a nuclear program. there's a whole set of prohibitions that certainly apply to north korea but also apply to iran when it comes to things like their missile program or other technology they could be used to weponized nuclear material. so if iran were to see to enhance their coordination with north korea on something like that, as a result of the international agreement to prevent iran from obtaining a nuclear weapon, we would have more insight into their activities than we have ever had before. ..

>> there are a lot of things we prefer the russians do that they don't do. that has led a situation where russia is more isolated than they been quite some time. dataset consequences for their broader economy but at the same time it has not prevent us to coordinate on some areas including nuclear security with the russians in the way it enhances both our countries national security. the iran's agreement and the recently imposed sanctions against north korea are the two best examples of that. those things could not have happened without russia's couc