We're very excited about this final keynote session.

It's entitled Preparing for the next Epidemic.

Um, we have speakers Dr Jim Needn, Dr Michael Foster home and Dr Sonya Rasmus in I'm an infectious disease of a genealogist.

So I'm probably biased, but these are the real heavy hitters in the field.

So we're really excited about this panel.

These air literally the folks that CDC has on speed dial when they're trying to deal with anti microbial resistance or outbreaks of Zika and Ebola.

Um, this session will be moderated by Dr Susan Klein.

She is head of the division of our She is in the division of infectious diseases at the School of Medicine and is no less a giant in her field of health care associated infections, particularly in identifying novel devices and practices to prevent these infections.

Please join me in welcoming these experts to the stage.

Hi, and thank you for the introduction.

So I just wanted to tell you a little bit more about myself and then introduce the speakers and tell you what sort of format will be using today.

So I am an infectious disease physician at the University of Minnesota Medical School.

And I do practice in the medical center in clinic that I'm also the hospital epidemiologist, and I am actually an alumni of this school of public health.

I did get the master's in public health and epidemiology, so I use that stuff and, um so today I just wanted to let you know that what we're gonna do is have the three speakers come up individually and give some background.

They're gonna be talking about epidemics that we've been dealing with in the recent past and then talking about looking into the future and preparing for future epidemics.

And then after they beach had a chance to give some background, we're gonna have some moderated discussion between the speakers, and then we're gonna welcome questions from the audience.

So I want you to start thinking about your questions, and there should be some cards on your tables you can write questions on, and they'll be someone coming through the audience to pick up cards.

And if you want to ask you questions directly, there will be someone coming through the audience with a microphone and So now I just want to briefly tell you about our three speakers.

Jim Needn is, Ah, professor of biostatistics in the School of Public Health here at the University of Minnesota, and he's really an expert in design conduct, an analysis of clinical trials.

And he's, um, I've done a lot of really important work related to clinical trials internationally with HIV treatment.

And then, most recently, he's been very involved with response to the Ebola outbreaks in Africa, in particular working on vaccine trials.

And he can tell you more about that.

And then we also have Dr Auster home.

Michael Osterholm is the region's professor in the division Environmental Health Sciences, and he has done really, ah lot of work over his career.

Initially at the Minnesota Department of Health as state epidemiologist and then since joining the School of Public Health here, he's been very active not only locally, but nationally and internationally, and has served on advisory boards for biosecurity.

So he'll be starting off our session, and then our last speaker will be Sonja Rasmussen and Dr Rasmussen is a professor in the Department of Pediatrics and Epidemiology College of Medicine in the school of public health and health professions at the University of Florida.

And Dr Rasmussen recently joined the University of Florida faculty after spending 20 years at the Centers for Disease Control and Prevention in Atlanta.

And while there she provided significant scientific expertise and leadership dealing with birth defects.

Developmental disabilities associate director for science senior scientist.

She worked on the 2009 H one n one Pandemic and then most recently worked on the Zika outbreak.

So, no, I'm going to ask Dr Auster home to come up to start off the session.

Thank you, Sue in good afternoon to all of you.

It's a true honor to be here today and celebrating the 75th anniversary.

It does give me pause that we're hitting 75.

I actually is one of the co chairs, the 50th anniversary celebration 25 years ago, and I don't know where the 25 years went so and this march, my 45th year being at school public health.

So it's a wonderful experience to be here today, so my job is to kind of provide a quick overview of what we're talking about today where we're going.

Let me just say that my life is a calculus equation, I can tell you that probably more has happened in infectious diseases in the last 10 years and happen in the 1st 35 years of my career, and it's getting faster and faster and fashion to now Try to reflect that because that's the world that we respond to.

That's the world that we live in and have to deal with.

This slide is one of about 80,000 slides of having electronic slide file, and I've said over and over again, even though it's an older slide.

If I had one slide to protect in a slide file fire, this is the one I'd rescue.

It basically was come from the 2000 time period, but it gives you a sense of the dynamics of the world today.

In 18 50 we had roughly 350,000 people in the face of the earth, 350 million people in the face of the earth, and today we're at 7.8 billion people.

That's a remarkable concept to think of how the world has changed in terms of days to circumnavigate the globe with the fast sailing vessels.

We sped that up a bit in the 18 fifties, but by 1950 with the jet engine, we change that completely.

Now that line looks pretty flat from 1950 on.

I will suggest, you know, right now that that's the most incredibly dynamic part of the entire graph, and I'll share with you today.

Why that's important with infectious diseases.

I might also add in this graph this is public health at its finest.

Just remember that in 1900 average life expectancy in this country was 45 years grand.

Shoot men not quite as long as women.

Today, the average life expectancy is 78 years, a little again and not doing quite as well as women.

For every three and 1/2 days we've lived in the last century, we've gained one day of life expectancy.

Think about that.

It took us from 80,000 generations in the caves to get to 45 years.

Think where we've come.

That's all.

Public health, basically public health.

How was the world changing?

Well, this is an example.

We're gonna hear about this and we talk about Ebola.

But today the fastest growing region of the world is not Asia.

It's not in many places.

Actually central Africa, Kinshasa today, 13.8 million people in for the other cities in the DRC over a 1,000,000.

I was in contrast, in 1985 working on HIV.

I can tell you at that time in the population was 2.8 million people.

Look at the difference shoes since 1985 six 0.5 billion people A 1,000,000 people live in Kinshasa in some of the worst squalor you could imagine in terms of the kind of living conditions.

And I'm sure that in a minute a big challenge.

The other cities.

You can see whether the Legos night in a row, b down the line.

All of these, in fact Monrovia, Freetown in Conakry, the three capital cities of West Africa where the Ebola epidemic took off in 2014.

15.

Really?

If you look at the 4.2 million combined population was just a gas can waiting for Ebola match to hit it Kinshasa's or gas tank waiting for a table, a match to hit it.

This is contrasted as we know it today.

If you've ever been there, you will never forget it.

It's incredible conditions for which lack of sewage, lack of city planning, etcetera is a cold room for the development and the spread of infectious diseases.

And if we wanna worry about Ken Bugs move, I've always said a a germ anywhere in the world today could be everywhere tomorrow.

Think about this.

In 18 2004.1 billion international domestic air passengers flew somewhere between Point A and Point B.

Now, some of those flew more than once.

That was 39.4 million flights, an average of about 100 and 8000 flights per day, where anyone time, about 4800 planes were in the air, going from somewhere to somewhere.

Think how that mixes up all the potential or infectious agents that we could imagine very different than that fast sailing vessel.

I showed you where it was at a moment ago.

In terms of the U.

S.

366 132 million individuals represent about 18.6% of all passengers worldwide, and China was next 550 million.

The bottom line is we are a big mixing vessel today, unlike it any time in history that adds complexity to infectious diseases.

This slide, which who I took this morning every hour on the hour All 63,000 fast sailing vessels in the world are basic warehouses for all the goods that we use every day report their location and weather conditions.

We track this.

You can tell where hurricanes are coming typhoons, et cetera.

These fans sailing vessels like this one right here are now the new modern warehouse of manufacturing from around the world.

Just to give you some sense of the size of these, this particular ship right here can hold one million washing machines on his trip from Seoul to Long Beach, California gives you a sense of the dynamics.

Well, this is also a challenge for us today from an infectious disease perspective in particular because you're going to see in a minute we need a lot of things from around the world to deal with our jobs every day.

This is an area that I think is by far the one of the biggest crisis is were yet to face.

But we will face it.

I worry sooner than later.

Were now involved with the study supported by the Walton Family Foundation.

This has been something near and dear to my heart, and I wrote about in my book several years ago, they published Is the absence of critical acute care drugs when we need them?

It turns out that we brought together a group and defined What is the high likelihood that people will die within eight hours out this drug or cannot provide humane care without this drug or an alternative?

We identified 100 and 53 drugs across 28 drug categories.

It turns out that well over 94% originate from China, either The AP eyes active pharmaceutical ingredient is made in shine and sent to India, or it's actually made in China.

Today.

China has us literally hostage.

If we could not go to war today with China, we would lose immediately because today there are many thousands and thousands of people depended on these drugs every day 690,000 Americans and in stage renal disease or advanced renal disease, all their medications much there, dialysis coming from China.

And yet these air drugs, by the way, we're putting terror side.

So when one looks at this.

You realize anything that would interrupt traitor travel like a pandemic could have collateral damage far beyond anything we could imagine.

Our own modeling was suggest more people will die in the 1st 6 months of a severe influenza pandemic from the lack of these drugs will die from influence itself.

If you look at the shortage situation that's occurring because of the manufacturing challenges just with making these drugs available regularly not during a crisis you can see here is you look that today the these air, the 100 of 153 drugs.

Look at these numbers here and you can get a sense.

As of right now, 63 of those 153 drugs on Shorty status in this country, we are constantly acting out to find some way to get an alternative or a different drug.

This is just every day.

Also, we're gonna be facing water shortages that are going to be remarkable.

We've been mining groundwater around the world for decades and decades.

I can tell you, I was a location.

Hyderabad, India, 40 years ago, almost 40 years ago in which they were drilling in finding water 12 to 15 feet below the surface today, the wells were abandoned at 700 feet because they become too salty, they've run out of water.

Well, you can see from this map all the serious water shortages around the world.

Yet this is the internal solvent for public health.

How do we run our sewer system?

How do we grow food?

How do we have safe and clean water when you don't have water?

And climate change is only going to continue to influence that because the runoff is going to often be massive events due to high high volume, short term rainfall that we're seeing already.

So this is gonna be a challenge for public health, and then this one probably is the one that really is the most concerning.

In many ways, this is a map showing the fragile state status of 178 countries in the world.

And anything here from warning on which you see there the yellow is actually a country that is literally on the potential edge of destabilization or not able to govern its population.

When you look at that may up, just know that 75 of the 178.

Excuse me, 95 178 countries up here right now or in warning or more severe, That's 80% of the world's population live in a government were country where basically it's relatively unstable.

Try to do public health in those kinds of conditions.

Two years ago I published a book, and I'm not here to try to sell it, only to say it's the framework for which I look at this deadliest enemy Marv organs killer germs.

And frankly, it was a love letter from my perspective, to my kids and grandkids.

What do I have left to give them?

What can we do with this world that we live in now for the future?

And in that I came up with nine priority areas, The 1st 2 really are the only two that I consider a pandemic potential.

An epidemic of worldwide proportions.

Influenza will come back over and over again, and Amoco be resistance.

Why?

It's not one book kind of situation.

It is a truly a pandemic in terms of all the collective resistance were seen.

And then we get into the disease of critical regional importance that can have major impact in a region like Ebola, like Zika mosquitoes.

Clearly important bioterrorism.

All of these areas are ones we have to address.

But let me today concentrate really on those top ones to give you a sense of the challenges we have.

And I know that Sonya and Jim will be following up in similar fashion with these diseases.

This is an op ed piece.

I wrote a New York Times several years ago saying, You know, the real threat to national security is deadly disease.

Let me just say, if we had a severe pandemic today and we basically couldn't bring those drugs from trying to hear because manufacturing was shut down, transportation was shut down.

This would make a war seem kind of not so bad.

That's a pretty hard thought to think about.

So, in fact, we have to begin looking at national security.

And these infectious diseases asked the developing world countries, low income countries of the world that have had a bowl outbreaks that have had severe cholera outbreaks what this means to them?