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  • >>> GOOD AFTERNOON AND WELCOME. ON BEHALF OF CDC, I'D LIKE TO

  • WELCOME YOU TO PUBLIC HEALTH GRAND ROUNDS.

  • CONTINUING EDUCATION CREDITS FOR PUBLIC HEALTH GRAND ROUNDS ARE

  • AVAILABLE FOR PHYSICIANS, NURSES, PHARMACISTS, HEALTH

  • EDUCATORS, AND OTHER HEALTH PROFESSIONALS.

  • PLEASE SEE MORE AT THE GRAND ROUNDS WEBSITE.

  • GRAND ROUNDS IS AVAILABLE ON ALL OF YOUR FAVORITE WEB AND SOCIAL

  • MEDIA SITES. FOR TODAY'S SPECIAL SESSION, WE

  • WILL ONLY BE TAKING QUESTIONS BY E-MAIL AND SOCIAL MEDIA, AND

  • WE'RE ALSO LIVE TWEETING TODAY. HERE'S A PREVIEW OF UPCOMING

  • GRAND ROUNDS SESSIONS. PLEASE JOIN US LIVE OR ON THE

  • WEB AT YOUR CONVENIENCE. I'D LIKE TO THANK TODAY'S

  • FEATURED SPEAKERS AND THE MANY PEOPLE LISTED HERE WHO HELPED TO

  • MAKE THIS SESSION POSSIBLE. WE HAVE A FEATURED VIDEO SEGMENT

  • ON YOUTUBE AND OUR WEBSITE CALLED BEYOND THE DATA, WHICH IS

  • POSTED SHORTLY AFTER THE SESSION.

  • THIS MONTH'S SEGMENT FEATURES MY INTERVIEW WITH

  • DR. JORDAN TAPPERO. WE'VE ALSO PARTNERED WITH THE

  • CDC PUBLIC HEALTH LIBRARY TO FEATURE ARTICLING RELEVANT TO

  • THIS SESSION. IT'S NOW MY PLEASURE TO

  • INTRODUCE THE CDC DIRECTOR, DR. TOM FRIEDEN.

  • [ APPLAUSE ] >> THANK YOU ALL, VERY MUCH FOR

  • BEING HERE, AND THANKS TO THE SPEAKERS AND THOSE WHO

  • CONTRIBUTED TO THE TALKS THAT WE'LL HEAR.

  • EBOLA WAS AN UNPRECEDENTED EPIDEMIC WITH AN UNPRECEDENTED

  • RESPONSE. WE'VE NOT YET GOTTEN TO ZERO,

  • ALTHOUGH WE'RE TANTALIZINGLY CLOSE, BUT WE'RE OPTIMISTIC THAT

  • WE WILL. THE PROGRESS HAS BEEN ENORMOUS.

  • IT'S BEEN THE RESULT OF ENORMOUS ACTIVITY AND EFFORT ON REALLY

  • ALL PARTS OF CDC AND A LARGE NUMBER OF OUR NATIONAL AND

  • INTERNATIONAL PARTNERS AND THE COUNTRIES AND COMMUNITIES IN

  • WEST AFRICA. WE STILL HAVE 150 PEOPLE IN WEST

  • AFRICA IN THE THREE AFFECTED COUNTRIES, AND WE STILL NEED

  • PEOPLE TO GO. SO IF YOU'RE WILLING, BARB IS IN

  • THE FRONT OF THE ROOM. WE'LL ALSO TAKE E-MAILS WITH

  • VOLUNTEERS. I THINK THERE ARE REALLY THREE

  • KEY LESSONS FROM EBOLA. THE FIRST IS THAT EVERY SINGLE

  • COUNTRY NEEDS STRONG CAPACITY TO FIND, STOP, AND PREVENT HEALTH

  • THREATS WHEN THEY EMERGE. THAT'S WHAT GLOBAL HEALTH

  • SECURITY AGENDA IS ALL ABOUT, AND THIS IS A GOLDEN OPPORTUNITY

  • FOR THE WORLD, INCLUDING THE CDC, TO ACCELERATE PROGRESS AND

  • LABORATORY SYSTEMS, SURVEILLANCE SYSTEM, EMERGENCY RESPONSE,

  • VACCINATION, AND OTHER PROGRAMS IN THE COUNTRIES AROUND THE

  • WORLD THAT NEED IT MOST AND HAVE IT LEAST.

  • THE SECOND KEY LESSON I BELIEVE IS THAT WHEN COUNTRY CAPACITIES

  • ARE OVERWHELMED, THE WORLD NEEDS TO BE ABLE TO SURGE IN MORE

  • RAPIDLY TO SUPPORT PROGRESS. THAT MEANS AT CDC, WE'VE CREATED

  • THE GLOBAL RAPID RESPONSE TEAM, ABLE TO PUT 50 PEOPLE VIRTUALLY

  • ANYWHERE IN THE WORLD WITHIN JUST A COUPLE DAYS.

  • WE'RE WORKING TO SUPPORT AND STRENGTHEN THE WORLD HEALTH

  • ORGANIZATION, THE AFRICAN UNION CDC, AND OTHER ORGANIZATIONS SO

  • THAT THE WORLD CAN MOVE RAPIDLY WHEN SOMETHING IS TOO MUCH FOR

  • AN INDIVIDUAL COUNTRY. AND THE THIRD IS THE ENORMOUS

  • IMPORTANCE OF INFECTION CONTROL. HEALTH CARE WORKERS ARE ON THE

  • FRONT LINE. THEY'RE POTENTIALLY AT RISK.

  • THEY'RE ALSO CRITICALLY IMPORTANT IN REPORTING DISEASES

  • AND OUTBREAKS, AND HEALTH CARE FACILITIES CAN BE BOTH

  • AMPLIFIERS OF DISEASE AND CONTROLLERS OF OUTBREAKS.

  • AND WE NEED TO MAKE SURE THAT THEY'RE SAFE FOR HEALTH CARE

  • WORKERS, SAFE FOR PATIENTS, GOOD INFORMATION SOURCES FOR PUBLIC

  • HEALTH, AND PART OF THE SOLUTION IN TERMS OF STOPPING OUTBREAKS.

  • AS WE MOVE FORWARD, WE HAVE A UNIQUE OPPORTUNITY TO MAKE SURE

  • THAT WE DON'T GO BACK TO THE WORLD THAT EXISTED BEFORE EBOLA,

  • A WORLD IN WHICH THERE WAS NO ACCOUNTABILITY FOR WHETHER

  • COUNTRIES WERE READY, ON THE ONE HAND, AND INADEQUATE ASSISTANCE

  • FROM THE WORLD TO SUPPORT COUNTRIES TO BECOME READY ON THE

  • OTHER. EBOLA PROVIDES US WITH REALLY A

  • UNIQUE OPPORTUNITY TO IMPROVE PREPAREDNESS IN COUNTRIES AROUND

  • THE WORLD, AND IT'S UP TO US TO SEIZE THAT OPPORTUNITY AND MAKE

  • SURE WE MAKE AS MUCH PROGRESS AS RAPIDLY AS POSSIBLE.

  • SO I'M VERY MUCH LOOKING FORWARD TO THE PRESENTATIONS AND THANK

  • THE SPEAKERS FOR BEING HERE. [ APPLAUSE ]

  • >> THANK YOU VERY MUCH, DR. FRIEDEN.

  • OUR NEXT SPEAKER IS JENNIFER NUZZO.

  • >> THANK YOU SO MUCH. I'M VERY GLAD TO BE HERE TO TALK

  • ABOUT WHAT'S CLEARLY ONE OF THE MOST PRESSING HEALTH SECURITY

  • CHALLENGES IN A VERY LONG TIME. THE EBOLA CRISIS STARTED IN WEST

  • AFRICA AND SICKENED MORE THAN 28,000 PEOPLE.

  • IT'S CAUSED UPWARDS OF 11,000 DEATHS.

  • IT'S BEEN DEVASTATING TO THE ECONOMIES THAT HAVE BEEN

  • AFFECTED. PRESIDENT OBAMA AND DIRECTOR

  • FRIEDEN BOTH RIGHTLY DESCRIBE IT AS A THREAT TO OUR NATIONAL

  • SECURITY. I COMPLETELY AGREE.

  • THE CHALLENGES THAT HAVE ARISEN DURING THIS CRISIS REALLY ARE

  • ENORMOUS, BUT WE CAN AND SHOULD LEARN FROM THEM SO WE UNDERSTAND

  • HOW WE CAN RESPOND BETTER IN THE FUTURE.

  • AND HOPEFULLY PREVENT SUCH A CRISIS FROM HAPPENING AGAIN.

  • THAT'S WHAT I WANT TO TALK ABOUT TODAY, SOME OF THESE LESSONS.

  • BEFORE I GET INTO THE CHALLENGES, I WANT TO TALK A

  • LITTLE BIT ABOUT WHAT I THINK WORKED WELL BECAUSE THERE HAVE

  • BEEN A LOT OF BAD NEWS STORIES THAT HAVE DOMINATED, AND I WANT

  • TO RIGHTLY SORT OF CELEBRATE RESPONSES THAT WENT WELL.

  • FIRST, THERE'S ABSOLUTELY NO DOUBT THAT THE EBOLA CRISIS

  • WOULD HAVE BEEN MUCH, MUCH WORSE IF IT WEREN'T FOR THE HEALTH

  • CARE AND PUBLIC HEALTH PROFESSIONALS WHO ARE ON THE

  • FRONT LINES TACKLING THIS CRISIS.

  • THE BRAVERY, SACRIFICE, AND IMPACT OF THESE INDIVIDUALS IS

  • REALLY ENORMOUS. THEY WERE RIGHTLY RECOGNIZED AS

  • "TIME" MAGAZINE'S PERSON OF THE YEAR.

  • I CONSIDER THAT TO BE AN ENORMOUS SUCCESS.

  • I'M ALSO INCREDIBLY PROUD OF U.S. LEADERSHIP DURING THIS

  • CRISIS. THIS GRAPH HERE SHOWS SOME OF

  • THE U.S. COMMITMENTS. IT DOESN'T INCLUDE THE EBOLA

  • SUPPLEMENTAL THAT CONGRESS PASSED.

  • QUITE ENORMOUS, ESPECIALLY TO OTHER COUNTRIES.

  • AND IT'S NOT JUST THE U.S. ALSO NGOs AND VOLUNTEERS WENT

  • OVER, POTENTIALLY PUTTING THEIR LIVES AT RISK.

  • I KNOW THAT CDC STAFF PLAYED A PIVOTAL ROLE IN ALL OF THIS, AND

  • REALLY, YOU DESERVE OUR NATION'S THANKS FOR ALL OF YOUR HARD WORK

  • AND EFFORTS. I KNOW THAT THE WORK CONTINUES,

  • AND WE SHOULD CONTINUE TO OFFER THANKS ON THAT FRONT.

  • IT'S NOT JUST ME WHO THINKS THIS IS IMPORTANT.

  • THE AMERICAN PUBLIC REALLY DOES TOO, AND IT'S REALLY HARD TO

  • TELL IN THE MEDIA REPORTS, BUT IF YOU LOOK AT THIS POLLING DATA

  • FROM THE KAISER FAMILY FOUNDATION, THE MAJORITY OF

  • AMERICANS THINK THAT WORKING OVERSEAS, YOU KNOW, TO MAKE

  • INVESTMENTS IN DEVELOPING COUNTRIES HELPS PROTECT

  • AMERICANS HERE, LIKE IT HELPS TO PREVENT BY SPREADING -- HELPS

  • THE PREVENTION OF SPREADING DISEASES.

  • AND NEARLY SIX IN TEN THINK THIS IS IMPORTANT TO DO NOT JUST FOR

  • OUR OWN PUBLIC HEALTH BUT ALSO TO ENHANCE PROTECTION ABROAD.

  • THERE'S ALSO GOOD SUPPORT FOR WHAT WE'VE DONE AT HOME TO

  • TACKLE EBOLA CASES THAT HAVE RISEN IN THE U.S.

  • THIS SURVEY SHOWS THAT THERE'S A HIGH LEVEL OF CONFIDENCE IN BOTH

  • CDC, PUBLIC HEALTH AGENCIES, AND LOCAL HOSPITALS TO BE ABLE TO

  • RESPOND -- RESPONDENTS WERE ASKED IF EBOLA WAS DIAGNOSED IN

  • YOUR AREA, HOW CONFIDENT WERE THEY THAT THE AREA WOULD BE ABLE

  • TO RESPOND. THERE WAS A DIP IN CONFIDENCE

  • FOR SURE AFTER THE TEXAS EBOLA DEATH, BUT IF YOU LOOK AT THE

  • NUMBERS, THEY'RE STILL PRETTY HIGH AND CERTAINLY WELL ABOVE

  • WHAT YOU TYPICALLY SEE FOR MEMBERS OF CONGRESS.

  • I KNOW, DON'T SET THE BAR TOO HIGH.

  • I THINK ANOTHER KEY SUCCESS IS THE RAPID EXPANSION OF

  • DIAGNOSTIC CAPABILITIES WITHIN THE REGION.

  • IT'S IMPORTANT TO REMEMBER THAT, YOU KNOW, ALTHOUGH WE THINK THAT

  • THE FIRST EBOLA CASES PROBABLY HAPPENED SOMETIME IN MAYBE

  • DECEMBER 2013, THE FIRST CASE THAT WAS CONFIRMED WAS CONFIRMED

  • IN MARCH 2014 WHEN A SPECIMEN WAS SENT TO FRANCE FOR

  • LABORATORY TESTING. THAT WASN'T GOING TO BE

  • SUSTAINABLE TO SEND SPECIMENS OUT, SO THERE WAS MUCH EFFORT IN

  • ENHANCING THE DIAGNOSTIC CAPABILITIES LOCALLY.

  • I KNOW CDC STAFF WERE PARTICULARLY INVOLVED IN SETTING

  • UP THESE LABORATORY NETWORKS THAT EMERGES REALLY WITHIN A

  • MATTER OF MONTHS. THAT'S A GREAT SUCCESS AS WELL.

  • THIS WASN'T THE FIRST TIME THE U.S. GOVERNMENT THOUGHT ABOUT

  • EBOLA. THANKS TO SOME ADVANCED

  • INVESTMENTS ON BEHALF OF THE U.S. GOVERNMENT, RAPID RESPONSE

  • FROM THE PRIVATE SECTOR, AND FLEXIBLE REGULATORY MECHANISMS

  • LIKE EMERGENCY USE. WE ALSO SAW THE DEVELOPMENT OF

  • ADDITIONAL DIAGNOSTIC TOOLS FOR EBOLA.

  • SINCE AUGUST 2014, TEN DIAGNOSTIC TOOLS HAVE NOW BEEN

  • DEVELOPED THAT CAN BE POTENTIALLY USED UNDER EMERGENCY

  • CONDITIONS. SO THAT IS BY FAR NOT A

  • COMPREHENSIVE LIST OF ALL THE SUCCESSES.

  • I JUST WANTED TO REALLY HIGHLIGHT WHAT I THINK IS

  • PARTICULARLY HELPFUL. BUT I REALLY DO WANT TO TURN

  • ATTENTION NOW TO WHAT ARE SOME OF THE CHALLENGES THAT WE NOT

  • ONLY EXPERIENCE DURING EBOLA BUT WHAT WE'RE LIKELY TO EXPERIENCE,

  • YOU KNOW, MOVING FORWARD FOR FUTURE HEALTH SECURITY THREATS.

  • THERE HAVE BEEN A LOT OF AFTER-ACTION REPORTS, EXPOSES OF

  • ALL THE THINGS THAT WENT WRONG. I'M NOT GOING TO TRY TO GIVE A

  • COMPREHENSIVE LIST OF EVERYTHING THAT I THINK DIDN'T WORK, BUT

  • WHAT I DO WANT TO FOCUS ON IS WHAT I THINK ARE THE KEY ISSUES

  • THAT WE NEED TO ADDRESS GOING FORWARD BECAUSE WITHOUT

  • ADDRESSING THESE ISSUES, WE'RE GOING TO HAVE SIMILARLY

  • DIFFICULT PROBLEMS IN FUTURE HEALTH SECURITY THREATS.

  • SO ONE OF THE PROBLEMS IS ON SURVEILLANCE.

  • NOW, WHEN THE WORLD AWOKE TO THE CRISIS THAT WAS UNFOLDING IN

  • WEST AFRICA, THERE WERE A LOT OF PEOPLE, INCLUDING ESTEEMED

  • PUBLIC HEALTH FOLKS, WHO CALLED THIS CRISIS A SURPRISE.

  • YOU KNOW, THEY EXPLAINED IN THE PREVIOUS OUTBREAKS THERE WEREN'T

  • NEARLY AS MANY PEOPLE INVOLVED. THEY WERE IN RURAL AREAS AND

  • TYPICALLY CONTAINED. BUT I GUESS WE HAVE TO EXAMINE

  • WHETHER OR NOT IT REALLY SHOULD HAVE BEEN A SURPRISE.

  • THIS MAP HERE SHOWS THE RANGE OF FACTS THAT HAVE BEEN KNOWN TO

  • HARBOR THE EBOLA VIRUS. WHEN YOU ASK THE QUESTION, WAS

  • EBOLA IN WEST AFRICA A SURPRISE, THE ANSWER FROM THE HEALTH

  • COMMUNITY PERSPECTIVE IS NO. THIS IS SOMETHING THAT I WANT TO

  • TALK ABOUT A LITTLE BIT BECAUSE THOSE WHO ALSO WORK IN

  • PREPAREDNESS, THIS IS THE CHALLENGE.

  • DEFEATING THE MENTALITY OF IT HASN'T HAPPENED, THEREFORE IT

  • ISN'T GOING TO HAPPEN. WE HAVE TO FIGURE OUT HOW TO GET

  • AROUND THAT. I THINK IT'S SOMETHING THE

  • BIPARTISAN 9/11 COMMISSION CALLED A FAILURE OF IMAGINATION.

  • WE HAVE TO BETTER ANTICIPATE WHAT THREATS ARE GOING TO BE.

  • BUT EARLY DETECTION IS HARD. I DON'T THINK IT SHOULD BE OUR

  • SOLE FOCUS. WHAT I THINK IS ALSO PROBABLY

  • PERHAPS AN EVEN GREATER PRIORITY IS MAKING SURE WHEN WE DO

  • RECOGNIZE THERE'S A CRISIS THAT WE HAVE THE RIGHT INFORMATION AT

  • OUR HANDS TO BE ABLE TO RESPOND EFFECTIVELY.

  • CLEARLY WHAT HAPPENED IN TEXAS WAS A SHORTCOMING OF

  • SURVEILLANCE. IT TOOK DAYS AND MULTIPLE VISITS

  • TO A HOSPITAL FOR THAT PATIENT TO BE DIAGNOSED WITH EBOLA.

  • WE NOW KNOW THERE ARE VARIOUS REASONS FOR WHY THAT IS, BUT WE

  • NEED TO FIX THAT TO MAKE SURE THAT DOESN'T HAPPEN AGAIN.

  • THERE'S ALSO PROBLEMS ON THE GLOBAL GOVERNANCE FRONT.

  • AFTER SARS IN 2003, A LOT OF EFFORT WAS PUT INTO TRYING TO

  • FIX SOME OF THE PROBLEMS WE SAW WITH GLOBAL GOVERNANCE.

  • A LOT OF EFFORT WAS PUT ON TO UPDATING THE INTERNATIONAL

  • HEALTH REGULATIONS AND FOLLOWING THEM OUT AND PUTTING THEM INTO

  • FORCE. AND THERE'S ENORMOUS POTENTIAL

  • IN THE REVISED INTERNATIONAL HEALTH REGULATIONS, BUT

  • UNFORTUNATELY WHAT WE SAW IN EBOLA IS THEY DON'T COMPLETELY

  • SOLVE THE PROBLEM. IN FACT, I DON'T THINK ANYBODY

  • THINKS THAT IT'S A GOOD THING THAT EBOLA WASN'T DECLARED A

  • PUBLIC HEALTH EVENT OF INTERNATIONAL CONCERN UNTIL

  • AUGUST WHEN THERE WERE ALREADY FOUR COUNTRIES REPORTING CASES,

  • YOU KNOW, OVER 1700 CASES AND A THOUSAND DEATHS, WHICH WAS FOUR

  • TIMES AS MANY CASES AS WE HAD SEEN IN ANY PRIOR EBOLA

  • OUTBREAK. SO WE NEED TO FIGURE OUT BETTER

  • MECHANISMS FOR HOW WE MOTIVATE GLOBAL ACTION IN RESPONDING TO

  • CRISES. I THINK IF YOU LOOKED AT EARLIER

  • SLIDE OF U.S. CONTRIBUTIONS TO THE EBOLA CRISIS, I MEAN, THERE

  • WAS AN ENORMOUS, REALLY UNPRECEDENTED LEVELS OF

  • COMMITMENT TO RESPONDING. WE DID A LOT OF REALLY IMPORTANT

  • THINGS ON THE GROUND. ONE THING THAT WE DIDN'T DO WAS

  • ASSESS ORGANIZATIONS WHO WERE ON THE FRONT LINES WHICH KEPT

  • ASKING FOR TEAMS OF CLINICIANS WHO COULD TREAT SICK EBOLA

  • PATIENTS. THIS WAS SOMETHING THAT WAS

  • ABSOLUTELY NECESSARY, NOT JUST BECAUSE, OF COURSE, WE WANT TO

  • PROTECT PEOPLE, TAKE CARE OF PEOPLE WHO ARE SICK, BUT BECAUSE

  • WE FOUND THAT IT'S VERY HARD TO GET POPULATIONS TO ACCEPT OUR

  • PUBLIC HEALTH MESSAGES IF WE CAN'T GIVE THEM SOME ASSURANCES

  • THAT WE'RE GOING TO TAKE CARE OF THEIR LOVED ONES IF THEY GET

  • SICK. AND IT'S ALSO IMPORTANT THAT WE

  • HAVE EFFECTIVE MEDICAL RESPONSES TO INFECTIOUS DISEASE

  • EMERGENCIES. HEALTH CARE FACILITIES CAN

  • BECOME ULTIMATELY SOURCES OF INFECTIONS FOR THE REST OF THE

  • COMMUNITY IF WE DON'T FIGURE OUT HOW WE CARE FOR THE SICK AND

  • PROTECT THE WELL WITHIN THE FACILITIES AS WELL.

  • POLITICS WAS ANOTHER PROBLEM. IT'S ALWAYS A PROBLEM.

  • I'M GOING TO SHOW YOU AN EXCERPT FROM AN AFTER-ACTION REPORT.

  • THIS EXCERPT, JUST SOME OF THE THEMES THAT EMERGE ARE TENSIONS

  • BETWEEN FEDERAL AND STATE AUTHORITIES, DISAGREEMENTS OVER

  • WHAT LEVEL OF ACTION, WHETHER OR NOT WE SHOULD CLOSE BORDERS,

  • IMPLEMENT QUARANTINES. IT SOUNDS VERY FAMILIAR, RIGHT?

  • SOUNDS LIKE THE STORY OF EBOLA. IT'S ACTUALLY AN EXCERPT FROM A

  • TABLE TOP EXERCISE THAT OUR CENTER CONDUCTED IN 2001 CALLED

  • "DARK WINTER." IT WAS A FICTIONAL SMALLPOX

  • RESPONSE. BASED ON "DARK WINTER," REALLY

  • THREE OTHER EMERGING INFECTIOUS DISEASES SINCE 2001 SHOULD HAVE

  • BEEN COMPLETELY -- I MEAN, YOU COULD TELL THAT WITHIN

  • SHORT-ORDER, PUBLIC HEALTH OFFICIALS WERE GOING TO HAVE TO

  • DIVERT THEIR ATTENTION FROM RESPONDING TO THE CRISIS TO

  • TRYING TO MANAGE THE POLITICAL FALLOUT FROM LEADERS TRYING TO

  • DO THINGS LIKE SHUT DOWN BORDERS, CANCEL TRAVEL, ALL

  • THINGS THAT OUR BEST EVIDENCE SAY LIKELY WILL NOT WORK AND