so i think that is the change that is going on. is entering a lot of people because that system that we support cancer research there would be a clinical trial program and now they do very well in those and make major discoveries but that was the big point so therefore we we should not restrict the grants. [applause]

>> thanks

>> >> [inaudible conversations] we'll come. i am from the university of virginia and i am absolutelyighd delighted to be moderating his panel today.

lazore currently sherry where stories with us. we're going to be on a tight schedule and i am responsible for keeping with ford to 50 to 20 minutesple time than there is time for questions please silence your cellphone especiallysi since i am so excited about this panel the virginia festival the book is placed to keep most even 3n if you like to help with that the please evaluate this session as the festival is always working to improve offerings

and we hope you will be interested. writing the book under discussion entitled pandemic she is a science journalist and author as her work has appeared in "the new york times" and we will be discussing her new book today. and the former politicalouston reporter said she left in

newspapers to pursue microbiology and in 2005 she had a journalism fellowship to study malaria in intent and tanzania dash she has a master's in journalism where she is now a teacher at hopkins as science journalism. we will have a fascinating discussion civic this is my

fourth book and i wanted to look cathouses is microbes that are basil microscopic things cause these highly disruptive events that we call pent-up six. we have had 300 of those of our newly emerged were they have never been seen before. . .

these avian influenza viruses are only live in wild waterfowl. doesn't make animals sick at all but when those viruses are able to reach back tree farms full of captive chickens and birds, bacon wrapped locate really quickly, they can spread faster and they become more virulent and this is why we have seen an increasing frequency of the much more beer went forms of avian influenza emerging mostly in asia where most of the waterfowl live. the slides are advancing way too fast. we are about five slides ahead, i'm not sure why. thank you. the last one, just last year we had in avian influenza hatched in the giant poultry farms in asia, reach north america for the first time caused the

biggest outbreak of animal disease in u.s. history. so along with the crowding of our animals we are also getting getting -- thank you. it's that one that we want, number five. there we go. so we have a massive, we still have a sanitary crisis of human waste in our planet right now. we have 2.6 billion people around the world with no access to modern sanitation so they are still living in the equivalence of 19th century slums but what we also have now is a new kind of sanitary crisis and that is what their livestock excreta.

our livestock are producing 7 million tons of waste every year and this is far more than our continent could possibly absorb so what is happening is farmers are collecting them in things like manure look is essentially giant unlined pits of untreated animal waste so when it rains or when it storms all of this material can leak out into the empowerment and this is one reason why we have an increasing problem with virulent forms of e. coli. there is an e. coli strain, it doesn't make the cows sick but because cattle manure contaminates so much of our food and water we have about 70,000 people, americans coming down with this virulent form of e. coli every year.

so in all these ways we are driving these pathogens in term garment carrying them around in the most efficient way possible. we don't have just a few airports and a few towns but we have hundreds of airports in small towns and cities and hundreds of thousands of connections between them which means where -- when a pathogen breaks at one part of the world that can rapidly spread to the rest of the world and this is a simulation of a food pandemic on a geographic map and you can see how quick we disperse his. but if you plot that same pandemic on a map like this which is all the cities connected by direct flights you can see when it comes up it will resolve into a series of waste. you can actually predict where and when a city will get infected if you look at the number of direct flights between infected and uninfected cities.

one of the things they did in my book is not only reporting to look at where emerging pathogens were coming from and i went to haiti and south china and new delhi and elsewhere but i also looked at the history of some of our most powerful pandemics in and the one i focused on was cholera because it's one of our most successful pandemic pathogens. it's caused seven global pandemic since it immersed -- and merge the 1970s. we think of cholera is a disease of poverty and it is that today but when it first emerged, -- there we go. this is a map of an epidemic in

1832 in new york city. thousands of people died and this happened again and again over the course of the 19th century. it wasn't just new york city was also london paris and new orleans in the number of cities were plagued by cholera epidemics in the 19th century. what i wanted to look at is how that happened and how we responded and how that could shed light on the challenges we face today as we face our own era of new pandemics. back in 1832 doctors collected data. it shows a pretty clear picture. cholera coming down the hudson river coming down the airy canal heading straight for new york city however nobody in the city of new york wanted to quarantine the reverse through the waterways because this is the engine of economic growth. this is the time of the robber barons, huge amounts of commerce

coming of the waterways so they refuse to quarantine the river. my powerpoint wants to give the talk all by itself without me saying anything. very annoying. they didn't want to cornstein in a the waterways and they didn't and doctors went along with it. they said well you know they looked at this map and they said it looks like cholera is contagious and coming down the waterways but in fact it's not. backed cholera is caused by these decomposing vegetable matter organic. this is based on a 2000-year-old hippocratic theory so they said it's not the water it's just these bad smells and do you know who is to blame for these bad smells? it's the poor comets immigrants, it's the drunks and so cholera came down the waterways and in

fact did new york city again and again over the course of the 19th century. so there are companies that were making money selling cholera contaminated water to new yorkers in the 19th century. the epicenter of a lot of the epidemics of cholera in a which is pictured here, this is a slum that if anyone has seen the film gangs of new york, so it's very crowded very dirty, very crowded place about 77,000 people, six times more crowded than tokyo today but this had been built on what was once a pond. that pond had been filled up with garbage and the slum had been built on top of that. there wasn't a sewer system in 19th century new york.

there weren't even rules you had to empty your cesspool so all the human waste was allowed to spill over into the streets into the alleys and into people's drinking water into people's wells and down to the groundwater. of course in this area the groundwater underneath the slum would be extremely contaminated because the ground attorney that was low-lying and it wasn't bedrock like the rest of manhattan. now the company that the state of new york chartered to deliver drinking water to the people of new york, rather than task up chain change sources of water which they knew at the time would be cleaner, fresher and would taste better, they tap that well right in the middle of that slum and they delivered out water to one third of the residents of new york city. they did this over the course of the century through repeated epidemics of cholera.

the company that did this as an adjusting aside they did this because they wanted to save money sort of like what happened in flint michigan. the reason they wanted to save money was because they wanted to start a bank and the companies call the manhattan company in and the bank is called the bank of the manhattan company predicts anyone here know what the bank of the manhattan company is called today? jpmorgan chase, yes, thank you. so i will lend the story by telling you how colorado -- in new york city because i think it's instructive. eventually new yorkers move the well from there too out there on

the crimson river but they didn't do it he cut his they wanted to uplift the public health. they didn't do because the people of new york were screaming for better water which they knew would make the more healthy. they did it because the local brewers wanted better tasting water for their beer. they felt like the water was putting their beer at a disadvantage especially 12 brewers in philadelphia so finally cholera vanish from new york city. a century of cholera pandemic links ended in the 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 the story to me says it's not necessarily about our technology. it's really about whether we have the political will to do it thank you so much for listening. [applause]

>> now we are going to welcome kessler the author of "capture" and i'm going to switch with you so i can see. i came to global health issues and might grow by accident or as a political reporter. i was an environmental reporter before that but i was at the national archives looking for something completely different and i stumbled upon some records that talk about how our

researchers during world war ii infected patients with malaria so they could test new drugs on them and this was shocking to me and i couldn't find a whole lot in the treatment of this and as i kept pulling threads in the archives i realized i was in uncharted territory and i had to tell the story. didn't know much about world war ii or malaria and didn't know much about bioethics but i got up to speed because this was a fascinating story that i wanted to tell. i actually wanted these slides to be the lead-in but i will whip through them as fast as i can. her records were stamped top secret. the world is at war and nobody had the good malaria drug and before normandy most of the fighting happened in highly

malaria's area so if you had a weapon against this disease you had a leg up on all the battles so our government, the roosevelt administration opened the spigot for this project. 50 universities, most of the american drug companies came together to find a bomb. it was the same umbrella organization of all the wartime science projects including the manhattan project. the reports were written by the lead investigators and sent to a central clearinghouse at johns hopkins university and there they met every month, scientists and they could compare notes. i figured out how to not be totally judgmental of the science -- the scientist he did this work. i was taught by this man bill collins. i got to sit next to this man and listen to his stories and dissect mosquitoes. he had been around long enough

to study the disease and test drugs on their induced infections. the problem back then was you couldn't throw malaria and a petri dish. you had to have life infections and asthma lariat dried up in northern europe and the northern states of the united states, it was hard to come by so to infect people you could to study it and he called those the good old days. i said you were talking to reporter, right? i'm going to write this and he was in fear. those were the good old days. now you have to infect monkeys and they were difficult and expensive than they tried to bite him and monkey malaria student extrapolate all that well and they had to write all the new vaccines on these monkeys so he did call them the good old days. a roomful of archives that no one had seen before from world war ii and the years immediately

following world war ii and he used the data and that was collected from these infected patients to inform today's vaccine researchers. the data they had have on life infections remained valuable to this day. he and one of his colleagues. so we actually got me thinking like a malariologists and i came to the story with a little bit more objectivity and not as much judgment and i tried to let the story speak for itself. this is a blood slide taken from an american soldier during world war ii. this is the blood stage of malaria. with the parasite does is in sunday's talk she called them a shape-shifting parasite. immediately gets into your liver and i thank you baits and hides from your immune system until it's ready to launch an attack on your red cells.

when it does that your red cells end up looking like this. you have truly is the parasites in your body sicker than you've ever been. it's a terrible weeklong infection. at some point during this time when you are feeling the most sick for some of these parasites mature and they become distinct and migrate as it cannot collect tracks mosquitoes. the mosquitoes drink demand and the mosquitoes week or two later depending on temperature they burst into microbes to get get into the saliva and they migrate again. i tell the story about the world war ii project for several reasons. for one i've really liked them and i didn't want to spend my whole book on one of the scientists who i felt that there biological linking dialed up a little bit too much without really having enough empathy for their patience.

i identified with him. after the war he was 18 of the university of chicago medical school and vice president there and he advised the eisenhower frustration on medical education. he said we are teaching our medical students to specialize to focus on body parts and that is unsafe for us we should be focusing on the whole body. we as medical professionals and he was called a communist ford in the 1950s. before the war he was a malaria expert. he started out as a large network of american researchers trying to get a handle on the u.s. and pandemic will area. in leesburg georgia the infection reached 80%. he worked in places that look like this where the cypress trees were being ripped out to keep up with the development going on and they were left with

these gaping holes of larger producing swamps that filled the skies with mosquitoes that carry malaria. throughout the course of the 1920s and 30s he worked with , this was samuel darling. he was the brain behind the effort to build the panama can tell. samuel darling was responsible for -- which the americans attempt to build the panama canal and next him as paul russell. he is one of malaria's most favorite sons. through the new deal and tie poverty program building dams in a way that eliminated mosquito larva instead of producing mosquito mosquito larva bringing electricity to communities in the south and fans and air-conditioning and attracted industry which brought jobs and

people could get out of shaxson get into homes with tight deeds. by 1940 most of america's malaria had been completely dried up. while we were working on malaria julia's you're a good one and nobel prize. he figured out how to give malaria to neuro-cefl addicts and cure them of insanity. in 1927 he won a nobel prize because syphilis was rampant. the late stage of syphilis is an infection of the brain that causes erratic pay for your, in same behavior and most and up and asylums and hospitals and they would die. malaria fever, he controlled them with quinine which increase the body's immune system to a point where he could fight off

that difficult stage of syphilis because you can't grow parasites in a petri dish he got the strains of malaria going by taking blood from infected patients and giving them to new patients so this became the new way of treatment. state hospitals all over the world picked up this. it costs money because she needed lab work but if you are lucky you could kick malaria if you have neuro-syphilis and you could be potentially cured or if this was a major breakthrough. he is one of two psychiatrists to win a nobel prize in medicine in history. the germans were very clever, the chemists who were trying to come up with synthetic drugs for malaria. we don't need to do our studies in africa and in places where malaria is a pandemic.

we will run drug studies on patients who are going through malaria. they came up with two potential drugs and the drug made from the yellow dye. the dye attaches to the parasite and they add a side chain asleep parasite and carries the drug to the target and wipes out the infection. the only problem is they are pretty toxic drugs so they never broke into the market. quinine was he only drug made from the bark of a tree that grew on plantations that the dutch have the monopoly on. the world just kept using quinine. this is a german, one of the leading malariologists in germany who ran some of these studies for bayer and he said why stop there? why not run the studies on prisoners. we have wars coming and we need

to find a drug soaked he wrote a proposal to do studies on prisoners. he said let's give malaria to prisoners and we can test our drugs on them and heinrich himmler thought that was a great idea and gave them the dachau prison camp where he infected 1000 prisoners. some were russians. his prisons got an extra ration of food and they slept on clean sheets and they were given their fever so he could test this drug and then given quinine and cured and sent back to the barracks where they died, a lot of them because of ifas in colorado. this is him trying to explain to american lawyers who liberated the camp that hugh was just doing malaria therapy that this was the standard. he wasn't doing anything wrong and they didn't understand malaria therapy and he hanged. meanwhile back before the war

now and he knows another leading malariologists they are testing their drugs on state hospital patients in making progress in building drugs and he nationalizes a plan for the americans to do the same thing. he temporarily is sidetracked to africa because an air route that we had created to supply the british in egypt and the russians with guns and planes were completely shut down because of malaria and west africa so the supplies were flown out of i am the to the elbow of brazil to the of african boom they are stopped to kiss the airfields there, the workers are all completely injected with malaria.

so the usair command asked if they would go over there and clean it up. he got there and found airfields there 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 a malaria. he had quinine but he realized under these conditions it didn't work. he had a jog under these conditions that didn't work so they were going to screen -- you guys are going to roll down your sleeves and where netting over your helmets and to the best of your ability you're going to wear bug spray. he had sessions every day. he made education most important part of what he did. he told them if you're going to go the dash you have to go during the day exists the

malaria carrying mosquito bites at night. in the course of six months the infection rates in liberia were 100% and it was brought down to 1%. it was completely successful. the quinine used as a backup to save them from this african form of malaria called service are pro-malaria can kill you in a day. he brought that back to the u.s. military and said the war department said it's not just drugs you need a multipronged approach and they said we don't have time for you. we will talk to you later. after the japanese attacked pearl harbor they attacked the philippines. macarthur's chirps were forced out of manila and down the

peninsula and within a month and their quinine ran out they started falling with malaria. 80% of them have malaria the time of surrender and commander said we had rifles and bullets and plenty of ammunition but everybody was sick with malaria and we had no quinine. that woke up the war department. a lot of other scientists came together to argue. while 10,000 marines were landing on guadalcanal they were recruiting scientists, top scientists and airfields. many of these men had never learned about lariat that they were needed for this project. this is the number one priority of the war department and they started working on drugs as the marines on guadalcanal bricked

up the landscape. the waters cooled, the mosquito spread in the camps turn into mud holes. at one point a battle commander said we have got to do something about all of the mosquitoes that are breeding and creating turbo malaria. .. >> >> they are screening drugs

they are doing toxicity tests on dogs which it did not translate very well for humans. the war department said stop just make this drug so they did. the american drug companies started to make it and we were overdosing the troops they were soiling their payments in the middle of battle because of uncontrollable diarrhea and vomiting and crashing is psychological episodes it is say neurotropic drug so the men refused to take it. the war department turned on the propagandist machine so

and dr. seuss drew cartoons, made posters and, of the troops the posters were so ubiquitous that they understood and they started to get it if they listen to the commanders had would roll down there pants protecting themselves that day would not get this disease malaria. they had or the dose that they could use it as up prophylactic clearly they thought sexual intercourse would get the message out. [laughter] they treat 10,000 men in new orleans to form malaria units so instead of using

rifles they could catch the larva in the waters to study the mosquito larva. was there were attached to the combat you did they hire thousands of local men to clear though bader ways running water kills larva stagnant water produces mosquitos. they sprayed tire tracks and dumps and kerosene to kill the larvae up. they studied the problem in their tents where they would take blood from local people to figure out how seated they were and how large of a malaria problem they would have had to go to malarias school the one that you can control quite easily and it is a deadly force is the

kind you get in africa that is quite deadly you have to know the difference between day relapse and macarthur even had to go to school everybody up the chain was educated on malaria and how it worked. into sprayed those flooded areas in italy after the germans destroyed to flood the landscape and to slow the army down with malaria. it was about this time to have the major breakthrough. to make almost 7,000 compounds. nothing that was produced was worth anything.

and it up with their report on their desk it was a report that shows results from studies of the adobe villages of tunisia to use this drug from bear. it was the most advanced to come up from the synthetic quite nine say and the study showed hidden only work as a prophylactic but it was a cure in to nearly 100%. sova malaria project is it used the state hospital patients to have clinical material including james shannon who was the head of the nih. they decided they should go into prisons to of plenty of

men to do their research in the present so in goldwater oriole hospital in the men coming home from the war ended the boston psychopathic hospital so the blood from them but then they were said to this man. so try to figure how to use this drug and a need to go into the state hospitals.

so he grew malaria in tested his drug habit and then even used prisoners as technicians among the most famous and though he remember the leopold murder case the crime of the century? he saved him from hanging in then to pick up a neighbor because they thought they were so smart that they could. and was brilliant in the lab to help turn this drug at after the war was used like

aspirin in the tropics. with that approach to eliminating malaria it was hard and it cost money and a restaurant of ddt a allegis use these projects ended did you leizhou use them in a global effort to eradicate malaria. >> in the resistance developed in by 1978 and spread from africa. and replace the drug in the same route would hold true them also for the same fate

in the last remaining drugs the only drug that we use a was a created to police that parent molecule during the wartime project also ghost town the same route resistance to developing nations and it is spreading. the reason why i find this story so important because it is instructive. we have these schools will halt programs that focus on drugs, we need vaccines but we need to do harder work. [applause]

>> with that pink and green map with that develop into resistance so in your book you talk about the development of resistance to multiple pathogens with the paradigm shift necessary to move and between the dominant paradigm of searching for a magic bullet as wading into the complex

intersection of commerce and politics anwr and the environment that leave it to the emergence of these pathogens to their spread and to their success. how should we be thinking about that? >> it is a great question. there is an elephant in the room that we never get to this if we aim of the biomedical interventions that does match with the economic interest and those that benefit from that and drug companies and others. talking about public health interventions they are often in conflict and what i have

been writing about now and that is partially because they have been underfinanced with the public-private partnerships that generally is a good idea but when companies tell the ctc of a earmark the money to say looking into this or that this is now we sell more products or divert research away the whole interview with the economic interest now the who gets two-thirds or more of the budget from private donors and we really need to address that course we do the more industry friendly public health

interventions as it is such as huge influence on public health. they didn't know keep water would make us that much healthier. their theories were all wrong but the thoughts for clean water and better housing in the face of a lot of scientific uncertainty may need to reform public health it doesn't matter if it disrupts commerce and we will demand that. steel that is the missing factor. but then to come up with a magic pill.

>> if it is a matter of perception we have a perception of how to handle anything that has to do with diseased. is bugging me and i go to the doctor to save weber cited san tendinitis' he should get a cortisone shot this is my first time anyone to give me a shot? what about my acupuncture he said i just need to loosen your muscle and stick a needle in your arm after a couple of weeks you will have to get that but that medical and media solution to a problem that needles will take longer believe longer or more permanent with no side effects.

and to have global health with these matters of pandemic said the only thing we can do is come up with a drug or vaccine but think of poverty and surveillance and health systems and if they will be protected from the things across our borders we need to care about how well the surveillance systems are with the percentage of the money that we spend much of that comes back to western labs. and decided we should spend a son different ways to

create a better surveillance system. they will last longer and work better. so i our perception is off it is always medicalized the germ theory of the best there. we came to understand terms as the devices that cause elvis in the stuff out of chemistry labs but it is more than that we need to take a broader view. >> and would like to open up for questions. >> i will repeat the question.

>> they give for the presentation. i have noticed every time there is an outbreak or zika virus there seems to be a fringe group of a conspiracy theorist. it is caused by gm no so we have a public is it taking the threat seriously and to say any vaccine that might be prevented is out of the question so what are they trying to combat that even though it is a fringe group so it is spreading almost like the virus why isn't

there is so little trust that even if we have good evidence to be carried by mosquitoes, we have good evidence. why is it there are groups of people who believe otherwise to come up with the alternative theories? but our traditional response is to save day are ignorant the same with people who do vaccines. so that is a real mistake. what if we trace that back? where does that mistrust come from? so it does come from something real that people are mistrustful of the corporate influence of

madison but what is happening all over the world and contempt -- chemical contaminant -- contaminants in my opinion that is a real concern that needs to be addressed in an honest way. with conspiracies coming from the of mind that comes from somewhere real and leads to be addressed a real way and we have not done that yet. >> i agree it is the other side of the clean where a majority would have a medical response to a health problem but it is the most appropriate when there is a push back because the pharmaceutical industry's has so much influence as

they pushed back so why should i trust you if it is not in line with my personal interest? i view that as the extremes that are coming from with the public is too trusting that is to our own health. >> between the public and private interest of if you find that the gag laws are based on the way animals are treated but the same laws are hindering getting accurate information on these factory farms or how

big in from the in a rights perspective i never put that together. >> i am not familiar of those laws of disclosure so i really don't know but there is a great deal of proprietary secrecy. so my research method is looking into the gray literature. in the unlikely places to find this data. >> we see doctors over

prescribing but also in the middle east when you combine antibiotics he does go to the drug store but a public health official is oman's said sometimes the problem is not what the doctor does it is the patient who travels a hundred miles to get their guests a prescription goes home after three days feels better so throws away the rest even though it is a than a regiment or doesn't feel better so no matter what happens deviances back to resistance. >> i'll take that one has the position. [laughter] the questions of monitoring

prescription importances because it is tons and tons of antibiotics there in even greater threats even as a growth enhancer for animals and in order to preserve those that we do have against our most dangerous pathogens. >> isn't just of those patients compliance directly as it informs our approach to tuberculosis for example,.

and regarding the specific disease in this is something this new use a genetically modified mosquitos and then if you could just talk about that with new disease control approach. >> river just talking about that as the entomologist have wonderful technology and it is exciting to modify a mosquito but then they stop their end of everyone else extrapolates the modified mosquitos to

displace national mosquitos in the entomologist all raised their hands. that is pretty hard we're pretty sure they can but we have the technology in their working with it. >> it is interesting in the varieties mosquitos and with zika virus viet is a delicate thing to account malaria is only female in effectiveness - - mosquitos 60 by one person and get infected then wait five to seven days before they in fact, another's. those of the 22 killed.

bill the way we approach cannot -- mosquito control is we don't need to kill all the mosquitos. and if you get down to 99% to reduce transmission and? who knows maybe they are very resilient because we're not studying this and the ecological way at all. there is a big push to use the latest technology but huge questions all thus been -- mosquito control they have been doing so there is an effort that is set number of villages use that

properly so as to live in the villages is the intense effort because if you know, anything if they're not used properly in many parts of africa all types of bad outcomes have developed using an excellent cleaner -- article but in the of villages the entomologists found with the most winter percent coverage the mosquitos change by being habits and they would bite to earlier. they find a way in are adaptable. they can change chaplet -- have it's pretty quickly so the main malaria carrier is the mosquito but says africa

urbanizes there are projections that malaria will not be as large of the problem by india has an urban mosquitos -- miskito they will adapt. is africa urbanizes there is no reason to believe that the mosquito larva adapt to become urban mosquito so the frustrating part of reading the news to have that simplistic representation of how insects operate in nature and i know that this is a lot harder said then done or we would have done it there are plenty of other diseases that came before zika virus that screamed for if mosquitos elimination and it isn't doable what we can

do is work koch of the conditions that people living and so they're not exposed to mosquitos we know that works with that is too politically difficult so we try to eliminate mosquitos as a species. >> in addition to mosquitos transmission if they are sexually transmitted. >> how many of these are wrenching viruses are sexually transmitted in addition to transmission through vectors? >> eggs decaf -- zika virus is interesting it is the only mosquito born virus that is also transmitted sexually that allows it to spread beyond where they are present so that will be interesting development how the disease flows but that

is the only one that can do that. >> referencing mosquito board of course, ebola and there is an interesting project in south africa right now looking at the viral population of the prostate so i will be very interested to see it is a clever plays for a virus to hide we may learn more. >> i have a question. >> this has been fascinating we keep running from one part of the world to another then ebola and now zika virus. this when you look at the world and just where do think we're going next with the next run?

is the barn doors left open what is coming up? >> there is a book for that. [laughter] and aviation just ended there. [laughter] i thank you are right is the million-dollar question can return this back to look at the driver's of where they're coming rather than waiting until they are wrapped in have exponentially outbreaks of untreatable disease then scurry to, but the vaccine to throw at it that has been our model and maybe that would work okay if we didn't have so many new pathogens but we do. so we have to go backward and will get access to health care in poor communities restore wildlife habitat intensification of agriculture and livestock waste that we know our

drivers we don't know which pathogen will cause the next pandemic but we know how happy is a beacon also predict where and then come up with maps or a hot spot where they're most likely to re-emerge we cannot track every single one but pac-10 surveillance to savor the microbe is changing and then analyze and tested before it starts to cause a problem and in the is a technological approach but by doing that we will learn so much more of the underlying conditions can be getting huge opportunity to address some. [applause]