one day we would come back to that area. >> and on american history tv we will visit the san bernardino history and railroad museum and talk about the importance of the railroad system with alan bone. >> construction was completed in 1918 that replaced a wooden structure that was approximately a hundred yards east of here that built in 1960. they decided to house the division head quarters that the location at this time. >> the c-span city's tour is working with cable affiliate and visiting cities across the country.

>> next a panel on pandemics featuring karen masterson and sonia shah who wrote "pandemic: tracking contagions, from cholera to ebola and beyond". >> welcome, everyone, can you hear me? i am from the uva center for global health and i am delighted to be moderating this panel with two outstanding journalist and authors who are currently living in baltimore and came down to share their stories with us. we are going to be on a tight schedule which i am responsible for keeping. we will look forward to about 15-20 minute presentation from each author and then ample time for questions.

i would like to remind/request that everyone silence their cellphone. i would also like to especially since i am so excited about this panel and all of the other events i would like to remind everyone that the virginia festival of the book is pleased to keep most events free. if you would like to help with that, please consider a donation. my third request is to please evaluate this session as the festival is always working to improving its offerings. finally, we will have books for sale here and in local bookstores throughout the festival and hope you are interested. i would like to introduce sonia shah to my far left. she has written the book under discussion, "pandemic," as well as other books. she is a prize-winning author, science journalist, and her work

has appeared in the new york times, "the wall street journal," foreign affairs, and she has an outstanding ted talk on eliminating malaria if you want to look at that. we also have karen masterson who is a former political reporter for the houston chronicle and the washington bureau of the houston chronicle. she actually left newspapers to pursue an interest close to my heart and the hearts of many in this room microbiology. she won a journalism scholar ship to study malaria in rural tan zina. she has a masters from the university of maryland and at

hopkins where she is new a teacher of science journalism. she lives in baltimore with her husband and twin daughters who i believe just joined us. we are delighted to have you here. again, welcome, please remember to keep those cellphones quite. i know we will have a fascinating discussion. i am turn the mike over to sonia. >> is this on? no? so, what i want to do with this latest book. this is my fourth book. i wanted to look at how it is that microbes, which are microscopic things that have no independent locomotion cause de deadly events we call "pandemic." we have had about 300 over the last years that newly aaemerged

or emerged in places we have not seen. we had ebola, zika washing over the americas and haven't been here, avian flus, mosquito-borne illness, tick-borne illness. i tried to track the origins of these things and what i found was a lot of them are coming out of the environment. about 60% of the pathogens that are coming up today come out of the bodies of animals. 70% are coming from wildlife. what is happening is as our population expand and industrial activities expand we are destroying a lot of wildlife habitat and lose lots of species but the ones that remain come

into closer contact with us. with this novel contact it allowed the microbes in their bodies to spill over into our bodies. bats gave us ebola and other viruses. from rodents monkey pot and lung disese. hiv and malaria from chimps and probably zika virus. birds are getting west nile a andave -- aviian flew as well. the process of urbanization that first started in the 19th century is really reaching its pe peak. by 2030, the majority of the human population will be urban and living in giant cities and they will not be cities like

charlottesberg but similar to slums and poor infrastructure. we have seen new pathogens take example of this. ebola is a great example. we have had outbreaks of ebola since the 1970s but they were small and self-limited and one reason why is they never affected places with more than a few hundred inhabitants. at the end of 2013, ebola virus emerged in guinea and within a few weeks was able to reach three capitol cities with a combined population of nearly three million. that is an important reason why it became such a huge issue where we lost 11,000 or more people. more people died in that outbreak than all previous ebola outbreaks combined. we have had zika virus around since 1940 possibly before that.

but it was in the forest of africa and asia carried by a mosquito that mostly bit animals so we didn't have a lot of infections in humans. but zika virus has arrived in the americas where we have massively expanding urban populations in the tropical areas and massively expanding territories of this mosquito that thrives in cities. it is an urban mosquito and lives in human garbage and can breed in a drop of water in a but bottle cap. this mosquito is a very efficient carrier of diseases because it only bites people. we are not only crowding our cities together we are also crowding our animals together. so it isn't just about people

but about our livestock. we have more animals under domestication than the last 10,000 years of domestication until 1960 combined. this is because populations are getting wealthier and bigger and we demand more protein. but a lot of these animals are living in the equivalent of slums. two million people will be living in slums by 2030 and we have millions of animals living in slums and those are factory farms. they are close to each other and exposed to fluids and excretement. this is an important reason we have increasing amounts of avian flus. they normally live in wild foul and don't make the animals sick at all. but when the viruses are able to

reach the factory farm they can replicate, spread faster and become more varient. we see them mostly coming from asia where most of the water foul is. these slides are advancing too fast. we are like five slides ahead. i am not sure why. that is where i want to be. thank you. the last one, just last year we had an avian flu hatched in the giant farms in asia reach north america and cause the biggest outbreak of animal disease in u.s. history. so we have the crowding of animals and -- how do we go back? okay.

so we still have a sanitary crisis of human waste in our planet now. 2.6 billion people around the world have no access to modern sanitation. they are living in the equivalent of 19th century slums. what we have now is a new sanitary crisis and that is where our livestock. they are producing seven billion tons of waste every year. this is far more than our croplands could possibly absorb. so what is happening is farmers are collecting in mineral lagoons that have essentially giant, unlined pit of untreated

animal waste. when it rains, or there is storms, all of this material leaks out into the environment. this is one reason why we have an increasing problem with forms of e.coli. there is one strain that about one half of all cattle in american feedlots are affected with it. doesn't make the cows sick but because cattle manure contaminates so much of our food and water we have about 70,000 americans coming down with this form of e.coli every year. we are driving the pathogens in the population and allowing them to amplify and we carry them around through the flight network. we don't have just a few airports but hundreds and

thousands of connections so when a pathogen breaks out in one part of the world it can rapidly spread to the rest of the world. this is the stimulation of a flu pandemic on a geographic map. if you plot that same pandemic on a map like this, which is all cities connected by direct flights, you can see when it comes up that the pandemic will resolve in a series of waves. but if you predict when and where a city will get infected by rook looking at the number of the direct flights between the infected and non-infected cities. in my book, i reported where emerging pathogensable coming

from going to haiti and south china and new deli but looked at the history of the most powerful pandemics and i focused on cholera. it has caused seven global pandemics since emerging. we think of cholera as a disease of poverty and it is that today. but when it first emerged -- this is a map ofdemic in 1832 of cholera in new york city. thousands of people died. this happened again and again over the course of the 19th-century. it wasn't just new york city but london, paris and other cities

were plagued during the 19th century. i wanted to look at how that happened, how we responded and how that could shed light on the challenges we face today with our own era of pandemics. back in 1832, doctors collected this data. it shows a pretty clear picture of cholera coming down the hudson river, down the eerie canal and toward new york city. but no one wanted to quarantine the water bay because it was the engine of growth and huge amounts of commerce were coming down the roadways so they refused to do it. my powerpoint wants to give you to talk all at once.

they didn't want to quarantine the waterways and they didn't. doctors went along with it and said, it looks like cholera is coming down the waterways but in fact it is not. in fact, cholera is caused by these stinky airs that rise up from decomposing vegetable matter. so they said, no, no, it isn't the waterway, just the bad smell. you know who is to blame for the bad smells? the poor, immigrants, and drunks. cholera came down the waterways and affected new york city again and again over most of the 19th-century. so there is actually companies that were making money selling cholera contaminated water. the epidemic of cholera was in a

slum called five points which is pictured here. this is a slum that, if anyone has seen the film "gangs of new york" that was about five points. crowded, dirty, and very crowded. 77,000 people per square kilometer and six times more crowded than tokyo today. it was on top of a pond that was filled with garbage. there was no sewer system in 19th hcentury new york. all of the human waste patience was allowed to still is in the streets, alleys, people's drinking water, into the wells and down into the ground water. in this area the ground water underneath the slum in particular would be extremely contaminated because the ground was low-lying, filled with

garbage and not bedrock like the rest of manhattan. the company that the state of new york chartered to deliver drinking water to the people of new york rather than tap up pm stream sources which they know at the time would be cleaner, fresher and taste better. they tapped a well right in the middle of that slum. and they delivered that water to one third of the residents of new york city. they did this over the course of a century through repeated epidemics of cholera. the company that did this as an interesting aside, they did this because they wanted to save money sort of like what happened in flint, michigan. they wanted to start a bank and it was called the bank of the manhattan company. anyone know what the bank of the manhattan company is called today?

jp morgan chase, yes, thank ymo. i will end the story telling you how cholera vanished from new york city. eventually new yorkers moved the well from there to up there. but they didn't do it because they wanted to uplift the public health. they didn't do it because the people of new york were screaming for better water which they know would make them more healthy. they did it because the local brewers wanted better tasting water for their beers.

they felt like the stinky water was putting the beers at a disadvantage especially with lot brewers in philadelphia. they moved the water well and cholera vanished after that. a century of cholera pandemics ended and spread throughout the country and throughout europe as well. so the question i have is of course we can do a lot better today in our era of emerging pathogens. but as this story to me says it is not necessarily about our technology. it is really about whether we have the political will to do it. thank you so much for listening. [applause] >> okay. now we are going to welcome karen masterson the author of the malaria project and i am going to switch with you sonia so i can manage the pc.

okay. >> so i came to global health issues and microbes by accident. i was a political reporter and an environmental reporter for the philadelphia inquire before that. i was looking for something different and stumbled upon research of infecting state hospital patients with malaria so they could trust drugs on them. this was shocking to me and i could not a lot of the historical treatment of this. i kept pulling threads and searching through boxes in the

archives and i realized i was in unchartered territory and had to tell the story. i didn't know much about world war ii, malaria, or bioethics but got up to speed because it was a fascinating story i wanted to tell. i wanted these slides to be deleted because i have 60 but the boxes look like this. they were stamped top secret because it was a secret project. the world was at war and nobody had a good malaria drug. before normandy most of the fighting happened in highly malaria areas so if you had a weapon against the disease you would have a leg up on the battles. so the roosevelt administration opened the spigot for this project and hired 400 scientist, 50 universities, most of the american drug companies, to come together and find a bomb.

it was funded under the same umbrella including the manhattan projects. the reports were in black out and couldn't be published. they were written by the lead investigators and sent to a central clearing house at john hopkins university and the scientist met ever month. i figured out how to not be judgmental of the scientist. i learned from this man at the cdc and listened to his stories and dissected mosquitos. we had been around along where he infected the hospital patients with the disease. the problem was you could not grow malaria in a petri dish. you had to have live infections and as malaria dried up in

northern europe and the united states it was hard to come by. if you infected people you could study it. he called those the good old days and i said you know you are talking to a reporter and i will write this. he was sincere. those were the good ole days. now the cdc had to infect monkeys and they were difficult and expensive and tried to bite him and monkey malaria didn't extrapolate to humans that well and they had to run the vaccine studies on the monkey. he had a room full of archives nobody had seen before from world war ii and here immediately following world war ii and used the data collected from these infected patients to inform today's vaccine researchers. the data they had on live infections remains valuable to this day. he and one of his colleagues. so he got me thinking like a

malaria expert and i feel like i came to the story with more objectivety and not as much judgment. this is a blood slide from an american solder during world war ii and this is the blood stage of malaria. what the parasite does is enters through the mosquito might, this is a shape-shifting parasite, it immediately gets into your liver and from there with incubates and hides from your immune system until it is ready to launch an attack on your red cells and your red cells end up looking like this and when you have trillions of the parasite in the body you get sicker than over. it is a terrible week long infection. at some point when you are feeling the most sick, some of these parasites mature and become sexually distinct and

they emit a chemical that attracts mosquitos, the mosquitos drink them in and fuse into an egg sack and a week or two later they burst with these stick-like into saliva and infect again. i chose to tell the world war ii story through this man for several reasons. i liked him and didn't want to spend time researching on one of the scientist who i felt had their biological thinking dialled up too much without having enough empathy for their patients. after the war, he was the dean of the university of chicago medical school, vice president there, and adviceed the eisenhower administration on medication school and said we are teaching them to focus on

the body parts and that is not safe. we should focus on the whole body and was called a communist for it. before the war, he was a malaria expert. he started out as a graduate student at the rock feller foundation as part of a large network of american researchers trying to get a handle on the u.s. terrible malaria pandemic. this is leesburg, george where the infection reached 80%. he worked in places where the cypress trees were being ripped up to keep up with the development in the northern states and the southerners were left with gaping wholes of larva producing swamps that filled with mosquitos that carried malaria. so throughout the course of the 1920s and '30s, he worked with -- this is samuel darling.

he was the brains behind the panama canal which almost was shutdown. and next to him is paul russell and if you know about malaria you know him. he is one of malaria's most favorite sons. through the new deal, anti poverty programs, building dams in a way that eliminated mosquito larva instead of producing mosquito larva, bringing electricity to the south and attracted industries so people had jobs and could get into homes with tight eves and screens and by 1940 most of america's malaria had been completely dried up. while we were working on malaria this way, this man won a noble prize because he figured out how

to give malaria to neuro syphilitics and cure them of insanity. he ran a noble prize because syphilis was ramped and it causes erratic and insane behavior with people ending up in state hospitals and dying a year or two. he figured out you could save 30% if you gave them malaria fevers. if you control them with quinine, it would increase the body's immune system to a point where it could fight off that difficult stage of syphilis which is when the virus gets in the brain. but because you cannot grow parasites in a petri dish he kept the strains of malaria going by taking blood from infected patients and giving them to new patients. this became the new way of

treatment for neuro syphilitic. state hospitals all over the year, if they could afford it, picked this up. if you were lucky, you could take malaria if you are neuro syphilis and be cured of it potentially. this was a major breakthrough. he is only one of two psychiatrist to win the noble prize in history. the germans were trying to come up with a synthetic drug for malaria and were clever saying we don't need to do studies in africa and in places where malaria is endemic we will run them on the patients who are undergoing malaria therapy. it is a win-win. we get to study the disease, test the drug, and they came up with two potential drugs, one was

>> with guns and planes was shutdown because of the malaria in west africa. so that supply started and were flown out of miami book fair down to the hump of africa and boom they are stopped because the air fields there, the workers are all completely infected with malaria. the u.s. air command asked if they will go over there and clean it up. he got there and found this. air fields were being carved out of the jungle and creating massive mosquito production, massive mosquito breeding and this was the reason why the

pilots and the mechanics and the construction people were all getting malaria. he had quinine but he realized under these conditions it didn't work. he had the german drug and under these conditions it didn't work. he tried screen and said we will screen up the barracks and you will role down pants and sleeves and wear netting over your helmets and to the best of your ability you will wear bug spray. he had sessions every day. he made education the most important part of what he did. he said if you are going to go to the sex villages if you have to go during the day not at night because the malaria-ca malaria-carrying mosquito is out at night. and the infection rate in liberia in six months were

brought down to one percent. the quinine was a backup to save them from this african form of malaria that can turn into cerebral malaria which can kill you in a day. he brought it back to the u.s. military and the war department said it isn't just drugs. you need a multi-tongue approach. and he said we don't have time for you. we will talk to you later. then came baton. the troops were forced out of manilla and within a month, 80% of them had malaria at the time of surrender. commander said we had bullets and ammunition but nobody could lift their heads and everybody was sick with malaria and we had

no quinine. that woke up the war department and they opened up the spigot for the plan and a lot of scientist came together to argue for. while, 10,000 marines were landing, the first meetings of the malaria project took place and were recruiting top scientist in their field. many of these men had never learned about malaria but were needed for the project. it was the number one medical priority of the war department. they started working on drugs as the marines lifted up the landscape, the water pooled, mosquitos bread, camps turned into manholes. a medical person said to a staff member we have to do something about all of the mosquitos that are breeding in this landscape because we will have terrible malaria. and the commander said we are

here to kill the japs and the hell with mosquitos. that was reported and sent to head quarters and everybody in malaria knows this quote but that week the first cases of malaria landed in the field hospitals. by january of 1943, the infection rate on the canal, and on new guinea and other islands was 3,000 infections per 1,000 man. they were getting three times in a year. so the war department said we don't have a drug yet. the malaria project, the scientist are doing their best and screening drugs using bird malaria which doesn't extrapolate, they are doing toxicity on dogs, they are fighting a lot with each other. and they said stop and make this drug work. and they did.

and the american drug companies started making it. we ended up overdosing troops on the pacific and atlantic side. they were soiling their pants, vomiting, some of them had psychological episodes because it is a neuro tropic drug and affects people that way, and the men refused to take it. the war department turned on their propaganda machine and we had dr. suess and he draw cartoons and posters. these posters were so ubickitous they started calling the mosquito and. they learned if they roll down their pants, wore the repellent and protected themselves they

would not get this disease malaria. the war department was encouraging the men to take the drug. they lowered the doze and learned it could be a prophylactic. they thought sex would help get the message out clearly. [laughter] >> they trained about 10,000 men in new orleans to form malaria units that attached to combat units. instead of learning how to use rifles they learned how to use dip sticks so they could catch the laufsh larva and study it. once they were attached to their combat units they hired thousands of local men to clear the waterways. running water kills larva, stagment water breeds malaria.

they sprayed the area with kerosene to kill the larva. they studied the problem in their tents. they had their own locations and they would take blood from local people and figure out how seeded it was and how large the malaria problem they would have. the doctors had to go to malaria school and learn the difference between the kind that julius used in his malaria therapy -- the one you can control easily with quinine and it not deadly versus the kind you get in africa which is quite deadly. they had to know the difference between gangi and malaria. the army air command had to spray the flooded areas in italy

after the germans discovered this they thought they could slow it done. the malaria project at home had a major breakthrough around this time. again, they had made almost 7,000 compounds, nothing had been produced that was worth anything. they were fighting, and they ended up with a report on their desk that had been captured in tanesia and showed reports in the adobe villages using a drug from bear who was best advanced at coming up with the synthetic quini

quinine. it showed it worked as a prophylactic but also a cure. they had used up all of the state hospital patients because there were not that many so they didn't have clinical material. many of them just referred to patients as clinical material including james shannon who was in the 1950s the head of the nih. they decided they should go into the prisons. they could have plenty of men to do research on in the prisons. so in goldwater memorial hospital, this was on welfare island, and they grew the parasites captured in the men coming home at hospitals.

the blood from them, from these different kinds of parasites we needed to build bombs against, were sent to this man, ralph alvin who ran the most successful project in figure out how to use the drug in stateville prison. he said i don't need to use those people. i have plenty of prisoners who will volunteer to be part of my project. he grew his malaria in prison n and tested the drugs on those prisoners and used them as technicians even. among the most famous was nathan lee and i don't know if anyone remembers the murder case? in the foreground is clarence darryl who saved lepolld from

hanging -- these two boys were brilliant and from healthy families. they picked up a neighbor off their mansion line street and killed them to see if they could get away with it because they were so smart and they didn't. one was killed in a shower stall and the other went on to be a ring leader and was brilliant and helped in the lab and turned this drug into the one that was used like aspirin after the war in the tropics. before the war, the approach to eliminating malaria was multi-prong, long term, hard, it cost money, it meant creating jobs and putting screens on home after the drug because he had this and ddt which is another product coming from the war, and the policymakers said we can use

these. and the world health organization used them in a global effort. in 1967, resistance developed in the malaria parasite so cor quin stopped working. you could change the dates and replace the drug and the same route would hold true. every drug that has been made since cor quin to fight malaria suffered the same fight and the last remaining drugs that we have, in fact the only drug we use that wasn't created, during or at least apparent molecule wasn't created during this war time project and that is going down the same route, resistant to this development in asia and it is spreading. the reason why i find this story so important and why i want to

tell it is because it is instructive. i think we have these global health programs that focus on drugs. we need drugs and vaccines but we need to do the harder work, too. thank you. i think i have gone over my time. [applause] >> thank you both so much for a fantastic presentation. i will ask one question and open it up for questions. so, be ready with your questions. so, your final words there, and that pink and green map that shows the development of resistance almost as soon as the magic bullet is developed. sonia in your book you talk about the development and resistance to multiple different kinds of pathogens and that is

the pattern these pathogens evolved with and around us. i am wondering, political year, what would you recommend in terms of the paradigm shift necessary to move between this dominate paradigm of searching for a magic bullet in the context of the germ theory to waiting into the complex intersections of commerce, politics, and war and the environment that actually lead to the emergence of these pathogens to their spread and to their success. so, how should we be thinking about that? >> i think that is a great question and there is a big sort of elephant in the room that we never get to when we talk about this problem which is that -- if

we aim our public health goals toward furthering biomedical invention that pails with economic interest, right? there is powerful private interests that benefit from that. drug companies and others. we are talking about public health interventions that are about social and political changes they are going to be in conflict with those same private interests; right? we have seen and this is something i have been writing about now and that is how a lot of our public health agencies have become really beholden to private interests and it is partially because they are underfinan underfinanced and we have a movement with public and private partnerships which i think is a good idea but when companies are telling the the cdc how to earmark their money and look

into this and this is how we will sell more products or divert research away from things that interfere with our economic interest. two 3rds of the money is from private donors and those are agencies that are getting money from people that can buy control at our premier health in institutions. we will do the best interest as long as private interests are such a huge influence on our public health factors. if you look at the 19th century, sanitary movement, which they didn't know that clean water would make us that much healthier. they had these ideas and none of it was true. their theories were wrong but they thought for clean water and better housing and sanitation and you know in the face of a lot of scientific uncertainty.

they said this is what we need. we need to reform our public health to protect ourselves and it doesn't matter if it disrupts congress. there was a social move lt that did this and i feel that is the big missing factor. as a public, we are very quick to say new disease? okay, let's throw money at the drug companies and get scientist to come up with the magic pill or drug that will fix the problem and we have finding that is not going to be enough. >> i think it is what sonia is saying. it is a matter of perception. we have a certain perception about how to handing anything doing with disease. i am a swimmer and i have a shoulder thing going on. it is bugging me and i went to the doctor and the doctor said you have bursitis and you should

get a cortisone shot. i went to see my accupuncturist and he fixed it so i didn't need the shot. needles are going to take longer to get me back in the pool swimming but it is going to be longer and more permanent and i will not have side effects. if you feel like this is what we as consumers are fed in our personal lives. when we take our perception to global health and these matters of pandemics like ebola we think the only thing we can do is come up with a drug or vaccine when what we really need to do is think about poverty, surveillance, think about health systems and they all need to be in countries where they are

non-existent and need to be built. if we have going to be protected from things coming across our borders we need to care about how well the surveillance systems are in these other countries. if we took a percentage of the money we spend on global health much of it comes back to western labs and to scientist's salaries and it is decided we should spend this on different ways of creating a better surveillance system. the products we actually produce in those labs will last longer and they will work better. our perception is off. the solution is always a medicalized one. it is -- the germ theory led us there. we came to understand germs as the, you know, the devices that caused illness and our first

response was to come up with ways to prevent those illnesses using vaccines, then stuff from chemistry labs. but it is more than that. we need to take a broader view. >> thank you very much. i would like to open up -- does someone have a microphone for question? i will repeat the question in case anyone doesn't hear it. >> hi, thank you for the presentation. i have a question. i have noticed that every time there is an outbreak, whether it is ebola or zika virus, there seems to be a fringe group where there is conspiracy theorist. i was amazed by the number that popped up on by social media feed with people saying zika is caused by gmo mosquitos or crops.

you have a public who is one, not even taking the threat seriously and claiming it is a big conspiracy and saying, you know, any vaccine that might be prevented it out of the question and even preventive measures. my question is what are public health organizations, ngo's and governments, doing to try to combat this? this is a very fringe group but with the power of the internet the theories are spreading like a virus. >> i think you are right and yog into this in a chapter in the book and that is why is there so little trust of our public health authorities that when we have good evidence zika is being carried by mosquitos, came from this place and is a virus. we have good evidence for this. so why do groups of people believe otherwise and come up

with alternative theories? i think our traditional response is to say they are not literate and the same thing we are with people who don't want to take vaccines. they are dumb or selfish erowhatever. i think that is a mistake. where does that mistrust come from if we trace it back? it does come from something real. that people are mistrustful of the corporate influence on medicine, mistrustful of transgressions in medical science. karen told us about a great example. mistrustful of contaminant from needles. they are real concerns that need to be addressed in a honest way. we cannot just dismiss the alternative theories as

conspiracies coming from muddled minds. i think they come from somewhere real and need to be addressed in a real way and i don't think we have done that yet. >> yeah, i agree. i think it is the other side of the coin where probably the majority of people would assume that a medical response to, you know, a health problem is the most appropriate when perhaps it is not. there is a pushback on that because the pharmaceutical industries have no much influence on how we perceive things. there is a pushback and why should i trust you when your xhurn interest are not in line with my personal interest. it is what sonia said. i view it as the extremes that are coming from, you know, a public that is too trusting of the medicalized approach to our

own health. >> you were talking about basically, i guess, between the public and private interests getting all mixed in. i am wondering if you find that -- i know ag gag laws are usually based on the way animals are treated but do you find that those same laws are hindering getting accurate information about how much waste is on these factory farms and how big those -- i think you called them lagoons. >> manure lagoons. >> yeah. where they are. looking at that side from an animal rights perspective i never put it together with learning where these pathogens come from. >> i am not that familiar with the laws around disclosures about these things. these are estimates that other

people put together that i am sinathizing in the book and research. i really don't know how. but of course in all of these areas there is a great deal of proprietary secrets. i dig in the gray matter and put it together into a larger story. >> i think you had a question. >> on the issue of bacterial resistance. ... blap blap

>> and. >> then i think more importantly for in animals there are tons n tons of antibiotics to use in animals that are a greater threat potentially to us and we have seen strong data in european countries that have been sent prescription antibiotics as a growth enhancer a hand to the appropriate use of antibiotics is incredibly important to preserve those

that we do have to function again of the most dangerous pathogens. >> thanks for coming and it interesting topic. with that last question and it is interesting that that specific issue of patient compliance is directly informed our approach to tuberculosis and now is a world standard. with drug-resistant its of the mosquito born illness the new use of genetically modified mosquitos and i have not heard of since recently of the new disease control approach.

>> we have talked to the entomologist they come up with the of wonderful technology and it is exciting high you can genetically modify a mosquito to prevent the pregnancy and the female mosquito but then they stop and everybody else's truck bleeds -- extrapolates as a natural habitat but then they say we did not say you could do that it is hard we're pretty sure that you can't the we have the technology and we're working with it. >> can there has been so much press and yet to is a

delicate thing to do if you look at malaria you look only at female infected mosquitos who are the problem. on top of which way to between five then seven days before they are infected to another person's we're talking about the grandmother. so that as of you need to tell. the old ladies. [laughter] and though whole way we approach mosquito control is a very delicate task with the blunt tool we don't even know how much mosquito control you have to do doesn't have to me 99% control to reduce transmission? who knows maybe those grandmother mosquitos are resilient.

>> so there is a of big push as huge questions if it will work. all the mosquito control they have been doing has not worked handed effort to make sure is set number of villages which is now properly it is an intense effort if you know, anything then in many parts of africa with those outcomes have developed because of that.

but in these villages the entomologist found that when there was 100 percent bed net coverage they change their buying habits and in a bit earlier. they find a way and they are adaptable they can change habits pretty quickly. so the main malaria carrier is a rural mosquito and as africa urbanizes there are projections that malaria lot be as much of a problem then in india is an urban mosquito they adapt. as africa urbanizes there is no reason to believe that it will not adapt to become an urban mosquito.

the frustrating part of reading the news is a simplistic representation i know just enough to be dangerous but this is a lot harder said than done. and that's carried for mosquito elevation but what we can do is work on the conditions but that is politically difficult so now we try to eliminate the species. >>. >> of those sexually transmitted diseases.

>> comedy these emerging viruses are sexually transmitted in addition through transmission through factors? >> as far as i now it is still the most quito board fires that is transmitted sexually so that is beyond where they are present. so that will be interesting development how it flows but that is the only one that i know of that could do that. >> there is an interesting project going on in south africa right now looking at the by role population of the prostate so i very interested to see because so we may learn more.

>> this has been fascinating we just keep running from one part to the other and everybody in brazil but when you look at the world will get the next run and what he think is coming up? >> that is what the book is about. [laughter] >> so can we track this to look at the driver rather than waiting until they wrapped exponentially growing al breaks and then

come up with drugs, and and vaccines. maybe if we didn't have so many passages in the emerging but we will have to go backwards and access to health care import communities. with the livestock way sand all these things and go on our drivers. it to also predict where it intellectually come up with the map of where there was likely to either merge. we cannot track every single micro but we can do active surveillance to see where it is changing you rather have the opportunities and to detect these things before

they start to cause disease. >> is a technological approach that we learned about those underlying conditions to have a huge opportunity to address those >> they give some much. [applause] >> thanks your attention and fill out your evaluation. [inaudible conversations]

>> she was still the person who thought this was possible. and so the people had no expectations so that idea he was a little crazy you have to be crazy to take this on and the right kind of crazy. >> i help with the constitution in the influence is considerable and i am very anxious to meet with you.