Addressing the Zika Virus Threat

[Applause] good evening and welcome to the john f kennedy junior forum i'm maggie williams i'm the director of the institute of politics here at harvard tonight we discuss the grave threat of the zika virus and strategies to address it our discussion will be led by a panel of distinguished medical and public health experts and moderated by sheila burke who has focused her lifetime of leadership on a clear mission protecting public health and improving health care for people here at home and around the world sheila is the adjunct lecturer in public policy and faculty research fellow at the weiner center for social policy at the harvard kennedy school she served as the executive dean of the kennedy school from 1996 to 2000. for over a decade sheila was chief of staff to senate majority leader bob dole and was deputy staff director of one of the most powerful committees in congress the senate committee on finance sheila is a member of the institute of medicine at the national academy of sciences and is a fellow at the national academy of public administration in the academy of american nursing she also serves on many commissions and boards by including the kaiser institute's commission on the future of medicaid and the uninsured she earned her master's in public administration here at the kennedy school and earned her nursing degree at the university of san francisco we are fortunate to have as our moderator tonight a mom a nurse an educator and the caring public policy leader and my friend sheila just like i wrote it thank you meg thank you all for being here and my thanks to our panel who are gathered here this evening to discuss an issue of great concern to all of us in a january 2016 article in the new england journal of medicine tony fauci described the zika virus as the most recent of four unexpected arrivals of viral diseases in the western hemisphere in the last 20 years he like many others asks if this in fact reflects a new pattern in disease emergence pandemics cause devastation in lives in livelihoods as much as do wars financial crisis and climate change the plague cholera and smallpox killed millions in the last hundred years the spanish flu of 1918 the the hiv aids crisis killed more than a hundred million people sars in 2002 zika in 2007 cholera in 2008 h1n1 in 2009 cholera again in 2010 along with measles mears in 2012 zika ebola and chikungunya in 2013 which brings us to today zika is a virus that was incidentally recognized and identified in 1947 in uganda in the course of mosquito and primate surveillance it was occurring at the time in tropical areas with large mosquito populations africa the the americas southern asia and the western pacific at the time the virus rarely caused a spill over to humans there have been sporadic cases since that time and in 19 in 2007 the first documented outbreak in the pacific zika has now circled the globe following the outbreak of ebola and the widely held view globally i believe that we were ill-prepared for such infectious disease issues an effort was made to develop a framework for the management of such crisis today in fact the who published a six-month plan to coordinate a multinational response to the spread of zika illustrating lessons that were learned from ebola the agency said it would need 56 million dollars to fund the efforts which includes a so-called global strategic response framework and a joint operation plan to bring into line agencies and experts to surveil the virus its impact and immediate response to it and including the development of research it aims to include and improve vector control communicating the risks guidance and protection measures provide medical care to those affected and fast track research in the development of vaccines diagnostics and therapeutics of the total funds 25 million will go to the effort of wh asia's surveillance group and the pan-american health organization another 31 would fund the work of key partners in the interim who said it had tapped a recently established emergency contingency fund to finance its initial operations managing the response to the zika virus contrasts with the fragmented and delayed action that in fact responded to ebola this evening we're going to have the opportunity to examine how well prepared we really are what we know about the most recent virus its transmission identification and the possibility of a vaccine we'll examine the challenges in keeping the public informed and we'll ask about the lessons of ebola and how our state and our federal government should respond and whether in fact we are prepared for this most recent problem and what the preventive measures ought to be so we have three people with us who are uniquely prepared to be able to talk about each of these issues with us michael van roonen is the director of the harvard humanitarian initiative at harvard university he has worked as an emergency physician and health specialist in over 30 countries affected by war and disease including darfur chad the democratic republic of the congo he's worked in the field as an expert and has provided information to the who and worked with them in the past we also have with us dr howard zucker who is the commissioner of health for the state of new york if any of you are old enough to remember the show doogie hauser who remembers doogie howser okay one person two people howard was in fact the basis upon which the doogie howser store was developed i didn't know that no that's silly howard graduated from medical school at 22. and trained in pediatrics anesthesiology and critical care and pediatric cardiology at hopkins university of pennsylvania and harvard before joining the state health department howard was the professor and pediatric anesthesiologist at einstein he has served as the director of the pediatric icu at new york presbyterian and on the faculty of both colombia and cornell his previous public service positions which make him particularly uniquely able to help us in this issue as well as his current position he was a white house fellow the deputy assistant secretary for health at hhs and the assistant general of the world health organization so again he served as an iop fellow here at the kennedy school and has essentially dealt with these issues in a whole variety of places and can bring that unique perspective to our discussion and then helen branswell who is also with us is a senior writer at stat which is a boston-based life sciences news website which is owned by the boston globe and covers infectious diseases and global health she has been a reporter for more than three decades most of it in her native canada and has experienced a whole variety of these issues including the sars problems that confronted toronto and canada some years ago she spent the summer embedded at the essentially the disease center for disease control and was a neiman fellow here at harvard so all three of my colleagues are going to talk with us about their concerns and what we know about these issues but i'm going to ask each of them to give brief remarks and then i'll ask them a few questions and then we will open it up for discussion mike let me begin with you thank you sheila and thank you for the opportunity to talk to the group and to be with this distinguished crowd and welcome everyone it's great to talk with you today um i'm going to give you a couple disclaimers disclaimer number one is that my position in this is pretty practical i'm an emergency physician and chair of the emergency department at brigham and women's hospital and so my my role is kind of as a frontline physician and in my work in humanitarian settings around the world it's also been on the ground and so my approach is going to be less as a virologist and more as a pragmatist in the way we sort of address and think about these issues my second disclaimer is that i worked in the er today so i didn't read all the news today so there's probably given the velocity of the news that's coming out you're probably ahead of me so if you you know catch anything that i missed just let me know um well first let's talk about zika as an entity zeke is an arbor virus or a virus that is spread by a vector that vector is the 80s mosquito it's an interesting mosquito in that it's typically a day biting mosquito that is in urban settings so it follows the path of like dengue and chikungunya compared to say malaria for example the anopheles mosquito is a night biting mosquito or a dusk biting mosquito and they behave a little bit differently the 80s mosquito is a little bit more aggressive and so you have to protect yourself during the day so that will come to bear later on zika is interesting also in that it's um mostly asymptomatic so uh you know eight out of ten people or i guess four out of five people that get it don't know you have it never know you have it so it makes identifying the illness um and if you have it very difficult to do because you'll never know that you have it so when we talk about testing in symptomatic patients it doesn't really make sense right because most people who get it are asymptomatic how is it spread it's spread typically by these day biting mosquitoes that will will spread the disease but it also can be spread by sexual transmission so people who are infected with the virus can spread it by sexual contact so that's one way presumably probably by blood transfusions as well although i don't know if it's demonstrated or not um it all right so it has been good um um and the the spread of the virus has been explosive so we've seen the you know the spread of the epidemic having been self-contained for 50 years or nearly self-contained for 50 years now move to our hemisphere and certainly advance rapidly and it will continue to advance into the southern united states and we we will see growing number of cases in the united states certainly some of the fear is that the virus can then leap over to other species of mosquito that populate the rest of the united states as well so there's every reason to believe and to predict that zika will be you know part of us and nationally and part of our our health care system as well is it treatable the answer is no it's a viral infection that is not treatable is it detectable yes but it's tricky right so there's a couple tests for the the zika virus one is a pcr essay and one of them is an igm assay the both tests are fraught with difficulty because they are the ig i'm sorry the pcr testing is difficult to detect you need a very small amount of viremia in order to i'm sorry a small period of viremi in order to test for it which means that you could have the infection and pass over that period of viremia and test negative right igm for example is difficult because it cross-reacts with a lot of things like dengue and chikungunya or if you've had yellow fever vaccination so none of the testing is easy so if you test positive for it you may have the disease if you test negative for it you still may have the disease and testing is not readily available it's a reference lab matter of fact i was we were talking today i was working at the brigham in the er today prior to coming here and so i decided to get a zika test and to figure out if i could get tested and so i was informed that i had to make an appointment with ob first the ob department they're the only ones that can actually order it i had to make out a requisition i had to get counseled first to discuss it i have to send a serum and a urine sample to get it tested and they'll send it to a reference lab and it was going to take about three and a half weeks to get back so by by the time i got an appointment and got the test it was going to be a month and a half before i found out i decided not to get tested so um so it's tricky it's it's tricky and finally um what are our best tools to sort of think about stopping and controlling this the first one would be vaccination right so vaccine is one like the yellow fever vaccination or similar flava virus type vaccinations are not developed and won't be developed in the short order so we can talk about vaccines a little bit later but it's going to be a while before we see a vaccine that's available and helen and i were talking the economics of vaccine development too are such that it may never be developed so we'll discuss that probably later the best ways to think about controlling this is going to be primary prevention first of all vector control spraying and getting rid of mosquitoes very tricky as well because these are mosquitoes that need little areas to breed in they breed in cups of water and underturned tires and urban areas where it's a lot more difficult to try to control these and secondly it's individual practices that will help protect your household and yourself um particularly that of pregnant women and that's the last thing i'll say is that what are the health consequences aside from the asymptomatic consequences of um in people that are infected the big worry as you all know is the the worry that and increasing evidence although not definitive evidence that it can lead to neurologic outcomes in uh fetuses including microcephaly and the complications as it relates to microcephaly i think that's been shown to be correlated but not definitively proven so there's some work to be done there as well as well as some other possible neurologic outcomes in in utero as well as a possible link to guillain-barre which is a neurologic disorder as well i'm not going to go into how we do further screening and testing i think that'll probably come up with with questions some of the surveillance around if you have zika and if you can demonstrate the risk and you get follow-up testing and how you get ultrasound to determine if you have microcephaly those are things that will probably come out in question so i won't go so far into that right now but to suffice it to say that the nature of this one is going to be difficult because of the asymptomatic nature in most patients the difficulty in screening the late positive testing that we get in ultrasound screening and the difficult nature of controlling this particular mosquito and this particular virus thank you howard sure uh so thank you thank you for having me here you know as sheila mentioned this plague does cholera there's sars h1n1 you've heard of all these h5n1 zika and i think that pandemics are not new so we've had them for a while they've been around all through history but they seem to be happening more frequently but part of it is also that we are much more in connect interconnected as a world right it used to be that some things came across the ocean and it took uh you know months to come across and things didn't spread as quickly but now you can get on an airplane and you're you're anywhere you want to be in the world within within a day even as far you know even if you were to fly to australia you'll still get there within a day um and besides more morbidity mortality there's there are other things that can happen when you have these pandemics right so it can affect uh economic issues as well and as a matter of fact soros is a good example uh when stars happened everyone was concerned about uh toronto and the airport and and travel you know their economy or their tourist component their economy went down and it went down for a while until it came back up so global problems uh really sometimes have many different has impacts in different ways and needs global global solutions and a lot of this is really a coordinated international effort we've seen this before we've done this before a lot of times things begin locally they spray into a global issue global organizations uh tackle this like world health organization and others and there are many more we could talk about this in the q a there are many different organizations today that are involved in global health responses and there were 20 or even 10 years ago and then and the response sometimes ends up where the the message could be global but it ends up that locally a lot of things have to change and we could talk a little bit about what the roles of state versus federal are as well research continues to go move forward on viruses but things don't move as fast as people want sometimes you know the press wants an answer right away the public wants to answer right away but but research takes a period of time these things are not so easy think about these viruses wouldn't have lasted in nature for so long if they weren't uh you know one little finicky and also uh able to adapt to changing environments but every time we have one of these pandemics we learn lessons and and we learn and just any kind of infectious diseases that spread across borders we learn lessons about how to tackle this what do we need to do who needs to be involved how do you coordinate and i think that's a real issue there's all issues of global cooperation there's issues of commitment commitment could be both from funds resources uh commitment could be people commitment could be just communicating message to others uh and and or following recommendations that are put forth uh there's infrastructure sometimes uh some countries like the united states have the resources but there are many times these these uh these issues affect countries where they don't even have the infrastructure or you end up in a situation where the infrastructure once was there and it was disrupted by other pandemics or other problems and then you don't have the resources available and then you need to track things evaluate things unfortunately we do you know we see the pluses and minuses of the um the internet uh but there are ways because of the the interconnectedness of our society there's an opportunity to get information quick to individuals you can get you know text something out to every one of your friends i'm sure if you wanted to you could text information out to a lot of people so there's an advantage to that particularly even the developing world where everyone seems to have a cell phone so there's an advantage to uh to having a communication that's that's relatively quick but we also have to balance a lot of the the health concerns along with the issues of other concerns because what happens sometimes a lot of resources go into one thing but you want to balance that against other long-term chronic health issues or or other challenges to countries particularly those countries where their resources aren't available so you have to look at what the investments are you don't want to dismantle a system just to respond to one thing uh global pandemics the the who uh are usually glo because of a global pandemic they'll say 60 billion dollars a year the who uh said it cost of res uh recommended about 4.5 billion dollars per year for developing a global system for a pandemic and uh and when we do decide we have to figure out what tests are available you heard a little bit about the tests that are out there how do you detect people what do you need to do um when we dealt with um ebola you know there we realized how you know we know this but how many people travel through uh different airports uh just jfk you can pick the top five airports in the united states whether it's atlanta dulles jfk uh lax and others and o'hare and you would find millions and millions of people coming through every uh every year from from countries all around the world the role of the state government in preparedness you you want to be sure that you have a trusted messenger that you have relationships with the physicians who are out there and the nurse practitioners and nurses and all the health care professionals because they're going to carry your message they're going to be able to to provide the information patients usually respond to like who is their doctor if you have a question they pick up the phone they'll call their doctor their pharmacist they'll call the people who they feel are their trusted advisor on health so when you have a situation like this you really need to be sure that you uh reach out to those and as a state official is is sort of to make sure that we work with those individuals for not just this issue but for all issues and you want to build on that relationship that's been established before uh you want to tailor messages to the communities you want to tailor to cultural uh issues because sometimes those trust issues and i realize this when we were dealing with ebola there's a trust issue you want to be sure that they feel that what you're you're sharing with them uh is uh they they believe and sometimes you have to have someone else carry the message for you uh that they they um trust also as issues of coordination and and support so we're moving forward on this and and then also it crosses over other agencies so sometimes we think about health but health is not a lot of these things are not just health take take this whole issue of zika mosquitoes it's water it's environment it crosses in a lot of different areas of of um of our society we really sort of have to tackle those uh when we move forward when we do any kind of response and this one is with let's say environment but there are other kinds of infectious diseases as well i will mention one thing because if i forget because i may not mention questions you also have to look at these things we were talking about this before about infectious diseases that are at this is an important point contagious and not contagious and i always think about these things because a lot of times people mix up infectious and contagious and they're not i mean they're infectious diseases that are contagious like flu right and then there are non-contagious infectious diseases uh that that you get but nobody else is gonna get and then on the contagious ones you should break those down sort of what are respiratory infectious diseases that are contagious what are ones that are from body secretions and what are sort of sexually transmitted diseases as well and then you look at the mortality morbidity from those and i think that when you start to look at that as a framework you could figure out like where we are on that um on that uh sort of algorithm as we as we work uh work through on that so i will leave there's a lot of things i could bring up about uh states and as well but we could do that q a okay great thanks hi um so i'm a reporter i've been a reporter for a very long time as you've heard in 2003 i was relatively new to the health beat i was working in toronto for the canadian press which is the equivalent of the associated press here and i had my first experience covering an outbreak before the world knew that there was a thing called sars before sars had a name it was already in toronto and so by the time the who issued an alert telling everybody around the world to be on the lookout for this new disease that was at that point nameless and called an atypical pneumonia it was already racing through toronto hospitals it was a horrible time for many people in toronto for health care workers who got sick and brought the infection home to their families and terrible times because stars didn't spread very well but it spread in close con when you had close contact with somebody who was sick and so it tended to you know cluster in families and some of the people who died multiple members of the same family were sick and sometimes died so it was a terrible terrible time for some people in the community and the community took a huge hit i was relatively new to toronto and i thought downtown toronto was kind of quiet on weekends it was only a couple of years later that i realized that that was actually because of sars there was plenty of activity in downtown toronto on weekends um for me it was fascinating i was watching science evolve in real time and learning i was at one of the epicenters of the outbreak and learning sort of minute by minute with the scientists and the the people in the hospitals who are treating these patients how this thing was evolving and i got really hooked i have to say i love outbreaks it's a terrible thing to say but it's true so um over the years i've covered a bunch of them i've i covered bird flu very very closely i covered merce that you heard about the disease in the middle east that seems to jump from camels to people i worked for years covering the development of ebola vaccines and and wrote a lot about ebola in the past couple of years and then zika arrived and i remember last november looking at the who website one afternoon i keep an eye on something that's called their they have a thing that's called a dawn a disease outbreak notice and i saw then these diseases are always infectious diseases and i saw microcephaly in brazil and i thought microcephaly is not an infectious disease what's going on so i read this thing and thought oh i've been hearing a little bit about this zika thing but i hadn't really been paying such close attention because there were other things going on and i thought oh i think i need to start watching this and i watched for a while and then early january started writing and haven't written about anything else since and actually don't really unless flu season which has been very slow to take off this year unless it sort of picks up i don't anticipate writing about anything else very soon you know every time i one of these things happens it's um interesting because there are commonalities to them outbreaks you know garner a lot of interest you have you don't get enough sleep uh and and people are are really concerned but they're also differences so you know people who want to say we need to learn the lessons from ebola we definitely need to learn the lessons of ebola but uh some of the lessons from abolo don't really apply in this circumstance and we can go into that if you want to to learn more about that in the question and answer period um this one's fascinating it's challenging as a reporter because as you've heard it's a disease that for most people is inconsequential i mean the reason why very little is known about it at this point is because for most people it's inconsequential but it appears that for a small percentage of people and nobody knows yet what percentage that is infection can lead to devastating consequences if these correlations prove to be true so some pregnant women if infected during pregnancy appear to give birth to babies with very small heads that are in you know underdeveloped brains who probably have face a lifetime of trouble of problems um and there's increasing evidence that there is a link to guillain-barre syndrome which is a progressive paralysis that is generally um it generally resolves itself but people who get guillain-barre syndrome sometimes you can tell me what percentage i think i read 25 or something like that end up on a respirator or ventilator for a period of time because they can't breathe for themselves and the road back can take months and longer so it's not inconsequential but it doesn't appear that this these numbers are huge and the world is trying to find out now percentage of people face this and whether or not these associations are real so writing about this is um it's fascinating but it's also challenging because you have to do you have to be very careful about hitting the right balance reporting what's known not over reporting it in terms of taking the the facts beyond what is known and um not sensationalizing it i mean you know the reality is this is probably here for a while it's it's not clear how how it's going to continue to spread in some places that have had it they've actually had these huge spike of cases and then it disappears and that may be facing the americas as well but you know we won't know that for a while so it's a challenge but it's interesting story and i recommend that you read about it thank you helen we have helen to thank as well for the materials that are on each of your chairs she's given us a an array of materials that the stat has prepared touching on this issue we're going to add we're going to open it up for questions in just a moment if folks want to line up at the mics but let me begin mike the one of the issues and helen just touched on it as did howard and that is the uncertainty the uncertainty of transmission we believe it's transmitted by mosquitoes but the question of semen and other sexual transmission uncertainty in terms of the actual linkage with microcephaly and with guillain-barre how in fact do we deal with those questions of uncertainty i mean the public wants information they want it quickly but we're dealing in a world where there's some question as to what do we actually know i mean you touched on the sense that we knew these things but how much do we know and how reliable is the testing so there's i think the the anchor with all of this is to start with what we know right we know that this is a viral disease it's vector as a mosquito we know the behavior of the mosquito we know the disease uh infects people almost entirely or largely by this uh by the mosquito vector and it causes you know four out of five people are asymptomatic and then the disease itself is usually self-limited it's kind of a variant of dengue which is you know chills and fever and rash and uh conjunctivitis uh and uh myalgias and then it resolves after a while we know things about the incubation period being four to ten days or thereabouts so we know the behavior of the virus right we know kind of how to test for it but the testing is not particularly reliable and we know that the testing is not very available i know personally from today but i also know that the testing that is recommended in most websites by the who or by the cdc for example i think can't be accomplished i would say or at least can't be accomplished easily which is one of the several controversies that is surrounding this this disease and that is that the testing of getting serial ultrasonography for example if you're a pregnant woman or getting a number of getting tests for example and acting on those tests um it's fine to use those as sort of to to give advice about what to do but but frankly it's not easily attainable because those tests are not easily obtained anyway they're not necessarily reliable as we've discussed and usually things like say getting serial ultrasounds for example in to screen for microcephaly does it's often difficult to do that until late in pregnancy up to the third trimester so the we know the behavior of the virus and we know the nature of the vector we know most we have a decent idea of the transmission patterns um but we there's a lot about sort of testing and surveillance and how to act on testing that we really don't know and it's really difficult to measure that in a consistent way howard one of the issues that this raises as well is the behavioral response to the information that we have we found in the case of ebola there were certain societal practices that created greater difficulties for example the burial practices that essentially had direct contact although we knew at the time for a fact that physical contact in fact was an enormous risk as a state health commissioner how do you deal with it in the case of zika we know there are certain societal practices around whether it's on pregnancy or around a variety of other things how do you deal with the societal pressures that will put a limitation on the prevention measures that you can employ how one responds to that and how one gets that message out right so i think there's a couple things on this the um there are cultural issues that you have to address as i mentioned in ebola we saw that uh and to get the message out you really do need to have someone carrier sometimes who as i mentioned that are trusted sometimes some of these cultural issues aren't uh aren't easy um to address i mean clearly um those are the things that came up as sheila mentioned with burial practices and when you talk to people who work in who and others who work in some of the countries particularly with ebola it's there's customs and people are not going to be so quick to change customs unless there's science to support ultimately what ends up happening is people start to recognize that that the custom is causing uh sort of the spread of the disease and and then when that gets changed or there's modifications to that or or they do what they can to continue uh cultural uh practices and customs that they have uh but to make sure the disease doesn't spread and i think that we have to tackle that as we move forward with any of these diseases whether it's zika or not although at this point i don't see that there may be some concerns there as well but we we will learn more about this as we as we get more information and helen just quickly and then we'll turn to our uh questions um the public wants to know they want to know now they want to know on an ongoing basis things change very quickly the information in this case has changed very quickly how do you decide what to write and when as you suggest you want facts in this case we have some as as mike has pointed out in other cases there is great uncertainty or in the case of testing not readily available so how do you make a decision as to what the public needs to know and when they need to know it sometimes it depends on what i'm hearing from the sources i speak to you know for instance yesterday the institute of medicine or what used to be called the institute of medicine the national academy of science had a meeting in d.c setting out what the top prior the health and the secretary of health and human services had asked the iom to set out what the top priorities were for research like what are the key questions that need to be answered as quickly as possible so they convened a group of experts and i went to cover that meeting and i will be writing some stories as a consequence of having attended that other times it relates to what i'm seeing being reported places so for instance about two weeks ago maybe three now i wrote a piece about the fact that you should not expect a zika vaccine anytime soon because it just takes time to make a vaccine there is simply no way around it you can't produce a new vaccine quickly it needs to be the science needs to be done it needs to be tested it needs to be tested in animals there currently isn't a known animal model so they don't know what animals have disease like humans do so to test whether that this vaccine might actually be protective in people they can't currently do that they don't know what um a protected immune system looks like which parts of the immune system have to be activated that's called the correlates of protection they don't know that yet so to you can't develop a vaccine that you know is going to work overnight and some it's just going to take time so i wrote this piece and i quoted people including tony fauci at the niaid saying that you know he he said three to seven i think which or five to seven which i actually thought was wildly optimistic but uh and other people said longer and then the day my story came out reuters ran a story saying that uh um um that a company out of that has an affiliation with the university of pennsylvania had a vaccine that they thought they could start testing in the summer and it could be ready for emergency use in the fall i was like whoa somebody on twitter said eight years or october which one is it it's like okay so the next week i saw a piece out of india saying that you know an indian company was the first company to produce an india a zika vaccine they were talking about a candidate vaccine a vaccine that might actually be producible after it was tested but it's years away from being written and so i thought okay i don't think people understand the difference between a candidate vaccine or the claims that companies are making and the kind of vaccine you can actually have injected into your arm that might protect you so i wrote a piece at that point about you know what you're hearing now is hype it's it's aimed at the market it's not really any company that says it has a vaccine or any even any research group they have a experimental vaccine that may someday be a product that you can get but it isn't going to be available anytime soon so i try to sort of gauge like that see where the coverage is going as well let me turn i'm going to ask each of our questioners to identify yourself and um make sure what you ask ends with a question mark um i i'm not sure if this is it's on it's on um my name is kat i'm an mpp one student um i wanted to start by thanking you all for being here so the prevailing message of the outbreak has been given the absence of a vaccine that women shouldn't get pregnant i wanted to ask in countries and cultures where contraception and sex education are not widespread and not accessible women don't really have a choice about whether they get pregnant or not and in situations where abortion is illegal the risk of illegal termination is very high and i wanted to get your thoughts on how governments can protect women in that situation mike i'm interested to hear the answers well first there's a few things that we know about prevention that i think helen's business can help us with and that is that we know that the preventative measures that the personal preventative measures around preventing mosquito bites in the first place are actually pretty effective and and so one thing that we can do is message completely and accurately and pervasively the notion that if you are you know pregnant or going to become pregnant or you have uh you're the spouse of somebody or a partner of somebody that is pregnant um one of the protective measures that you can take and maybe that's not the only one there are certain other protective measures but one we know is to take is to use uh permethrin for example and deet they're all very safe in pregnancy they're very safe in everybody unless you take a kid and dip them in it make them swim in it then it's safe in kids as well so using mosquito elimination tactics and using personal protection in terms of screens and air conditioners if you have them but particularly personal use of insecticides um repellents that is is actually really effective so that's just it's one thing it is not a comprehensive strategy i'll give you that and certainly there is a lot of controversy about this whole issue of availability of testing and screening and birth control and abortion and all those other issues that this brings up but that's one thing that actually would would if i was you know putting seven out of 10 cents out of there you know seven out of 10 70 of my money into it i would probably look at issues like that can i just be a devil's advocate um i don't disagree i mean i think this the studies that american uh public health officials rely on suggest that even if the the the virus arrives in places in the united states that have uh 80s egyptian mosquitoes that they're pro we're probably not going to see the huge kinds of explosives spread because of screens because of air conditioning because of the way we live but to your question about women who are in places where they may not have access to birth control and they may not have access to abortion they may also not have access to uh mosquito repellent expensive mosquito repellents if they are expensive there and they probably live in places that don't have screens and i don't know that there's a good answer i'll so that brings back to the who of what they can do so in situations of screens and and and how you can help a community particularly a poor community to have the necessary uh um things that you would need to protect yourself as well so that would be a benefit of having when you have a public health emergency of international concern this would provide some of the resources hopefully for that thank you yes please all right good evening i'm annis alfrabe i'm a phd candidate in health policy here and a primary care physician as well thank you for an illuminating panel discussion already um i wanted to ask a question about the political response to the zika outbreak um and i asked a question in the context of having spent the last five months working as a consultant the national academy of medicine's global health panel on the future forum um which produced the 60 billion dollar year figure that howard mentioned earlier which there's a piece of work that i worked on with a colleague phil cenish here at the kennedy school that report's fairly clear that the actual incremental investment needed to strengthen public health systems to really do something substantive against future infectious disease threats works out about four and a half billion dollars per year that's less than a dollar per person per year but we've known that for about 10 years and there's been no political movement the risk with an outbreak like zika is that what we'll do is we'll respond urgently to the fire that's burning now and not install the smoke alarms for the next cycle so how do we change that good question it needs to be changed i mean i was talking today with the director general of the who margaret chan and we were talking about financing because of course the who has been hammered in about its response to ebola and there have been a number of reports like the one you mentioned that have all come to sort of the same conclusion about where who needs to go and where the international community needs to go in terms of being able to strengthen the response but last year at the world health assembly which is the annual general meeting of the who's member countries they asked for a 5 assessment increase for countries like mandatory five percent and an additional three percent voluntary and the countries refused them the five percent so you know you can want something but if you don't pay for it you get what you don't pay for i love that line it's not mine i'm afraid um howard you've spent time at who and at hhs your sense of this so i think there's two parts to this one is uh you need to keep these things on the radar uh and i understand about the dollar per day and all these issues and i also understand that sometimes uh from the standpoint of media it gets a national international attention and then when another story comes low and that goes away next thing so you have to keep it on the radar i also think that countries need to you know sort of um keep that pressure on and it's not you know as i mentioned before this who but there are many different international organizations there are a lot that work on things there's a lot of uh people who have whether it's the gates foundation or other foundations that are out there and i'm not just saying the gates foundation but there are many different groups that are that are out there uh that tackle different issues and and in some ways maybe you have to direct some of the energies towards them because as you've just heard the who is is really dependent upon country investment but perhaps there's a way to get your private investment uh whether it's a philanthropy or or or corporations involved in this to tackle the challenge with some of these uh diseases is that they affect countries which uh which are unfortunately you know some of the countries where where um the issues aren't uh brought to the light as much but i believe that that because of what we've been seeing in the last couple years where things there are no borders uh you know as we know and these diseases spread i think there's more and more attention being brought to this and i think that that is an advantage and as i also mentioned that the way the social media works today a lot of this information will get out there as well i would add to that i mean i think one of the issues you're confronting is the politics of distance which is what howard just touched on and that is the fact that it seems at a distance that these things occur largely in countries that are at a long distance from us uh sometimes in conflict zones in places where it's difficult to get services uh made them available there was a piece i think in the new york times yesterday front page about venezuela and how their health system has gone to hell in a hand basket and so you know the question is the balance between the domestic commitment on the part of those countries as well as the u.s commitment which is the largest of all of the countries in terms of resources but there is this you know disconnect until it crosses the borders so that when a bowl across the border now zika is likely the southern tier all the southern states mosquito zones suddenly are going to become quite activated i suspect in terms of these issues so i think it's managing those issues keeping it on the radar screen and getting engaged because making it a very personal thing it's the old story if you want to put a human face in front of the issue and make it one of your own rather than a distance and i think that's what has to happen here uh the gentleman on the riser hi my name is ben bolger and i'm a harvard alum uh my question is about uh to dr zucker and um you know there's a great importance in developing drugs that can fight disease the traditional process of developing drugs is very lengthy and a lot of regulatory processes some of which are important for health reasons others are just to protect against litigious concerns what is the best way to accelerate research so the delivery of life-saving vaccinations or other drugs can be delivered to stop or limit pandemics in a timely way question i think part of it is also collaboration you know a lot of these things are not so simple to develop and and and sometimes it's just not one researcher one pharmacist one lab that's working on it and more collaboration uh would be helpful i know that's the challenges of of regulation and and part of it is you know part of the regulations protect the public right because you can end up with something out there and then the next thing you know how did that get out there that's the balance you know how fast do you move something out there uh and also how slow do you move it out there to make sure they're there there are no problems there's a risk benefit ratio on this and and on some of these other diseases like we're talking about it's a little bit more of a challenge because where are the resources for it but but there have been efforts on on the part of uh again foundations of philanthropy to push forward on some of these areas and and to to move this forward a lot of different um pharmaceutical companies also have foundations attached to them uh that are involved this uh and i think that more of a collaboration between uh groups working these things would be helpful britain's welcome trust is really seized of this jeremy farrell runs it is really um essentially tired of watching uh crises occur and the response you know the cavalry arrives after the the outbreak is over which is really essentially what happened in h1n1 the pandemic in 2009 if you look at a graph uh the the out in the united states the illness went like that and the vaccine came became available there and it essentially the outbreak was over when the vaccine was starting to be injected in people's arms with ebola you know even with herculean efforts it didn't make it in time to make a real difference in the outbreak and so i know that they're really trying to figure out ways to devise platforms that you could sort of fast track these things but i'm not i'm not sure exactly how you you get there because in the end of the day it really does take time and i mean in the case of zika you know for instance you're talking about a creating a vaccine that will probably be um targeted at pre pre-adolescent girls because you want to get them before they're pregnant and pregnant women potentially and the safety bar on a vaccine that would be directed at those populations will be really high and it's also a a virus that appears to be associated with guillain-barre syndrome which will make regulators very nervous because there have been cases in the past where vaccines have have induced higher rates of guillain-barre syndrome so you know it's not easy and you can't do it quickly you also might as well look back in history right because the guillain-barre with the flu vaccine back in the 70s before everyone was probably born that's why i feel right that's why it flew and and the other um issue is sort of right collaboration on some of these issues that you bring up with and you know hpv is a good example of a vaccine right that you know now people take for granted but when that started to come out there were all these questions that were and they're still learning and there's still resistance to the rates aren't as science well you would know yes exactly also overcoming the challenges of the just simply the economics of vaccine production versus the you know and the financial outlay that it takes um because these the the companies that have the capacity to do this and produce it are for-profit companies that have to look at their margin right and so one big problem as someone said these vaccines may be developed too late to actually really be sellable essentially or at least profitable hi my name is christian i'm a postdoc at the harvard school of public health um learning from what we have from sars ebola we've always been reacting we'll we're always waiting until there's a pandemic of fear and then people start talking about the disease at what at what point do we need to move from reacting to become something that's more proactive we are investing in more health system resilience and health system strengthening so that each of these countries they can they can detect and manage the cases while it's still small and it doesn't have to be a global pandemic before everyone starts screaming this is judo i'm going to cue this up and then give it over to howard because he'll know more about it but the issue is um so question judo and that is the international health regulations i think it's just it's a it's a big hope the ihr sort of revitalization of 2005 and then seeing it as a as a true uh treaty right among you know nations that decide to get together and produce a platform for improving public health preparedness in pandemic diseases so i think that we have actually a really viable at least structure to build upon or to build public health preparedness and to to grow this uh ability to react not only just to react but also to plan and maybe hard if you want to comment on it i think there's there's the international front which ihrs and there's a lot in there i'm going to go back a little bit to the state front sort of what we did because you bring up a question about ebola which i can tell you about from ebola so and our experience with ebola after we moved forward and we did everything that to get things up to speed for the state you know we had 10 hospitals prepared to take people a lot of investment went into that and we are continuing the governor you know governor cuomo asked us make sure this stays active and that we are able to be prepared for something that comes down the pike so sure enough you know we those hospitals continue to prepare and to continue to uh go through the exercises for any kind of problem that would occur now clearly zika is not ebola and uh but the point is that you have to have an investment and the hospitals have to be up to speed the doctors have to uh recognize and all the health professionals should recognize what what's needed uh to sort of keep your um your skills uh up up on on any of these issues and so we're we're we do that working with all the hospitals and uh and the hospital associations in the state uh and also in addition to that the the health commission is for the region i mean this is probably for all the regions in the country but i know in the northeast region massachusetts included uh we every every monday morning we are on the phone for a half an hour early in the morning 7 30 in the morning to have a conversation about what is happening in the region and so uh i was on the phone with the person who coordinates it to say let's talk about zika on monday about what's going on with all the other states in effort to make sure that everyone is up to speed uh and that things don't drop can i just um can i make a point i think you were actually talking about as well countries not just the the the health systems here but health systems in places like sierra leone and guinea and places where the health systems had been destroyed essentially and that's a huge part of why that outbreak was so bad the report that gentleman helped to write probably would help but it you know it's hard to convince governments to make commitments to funding commitments to help other countries build up their health care systems but while healthcare systems in other countries are very weak when healthcare systems in other countries are very weak everybody else is more vulnerable as a consequence of it in one of the other issues and i do want to get to your questions um and so i'm i'm sensitive to the time but one of the other issues in this last go around that we found is that countries are very sensitive about releasing data that in fact will put them at risk either because of their tourism you know because of their own economic circumstances the reluctance to share data and i think that's one of the big problems that we face is the implications for countries that essentially are experiencing these things how quickly they are willing to share that information share samples so that people can test what's in fact occurring and part of what we saw in ebola was this reluctance to share that information we've seen it in other circumstances as well with asian flu and a lot of other issues and so there are a lot of country to country kinds of issues that have to be dealt with as well and at some point i'd love to hear what you would say if you were the commissioner for the state of florida in terms of how you'd prepare but let's do uh quick fire questions and see if we can get through a couple more sure my name is noah and i'm an alum of the harvard teacher and school of public health my question is building on health systems how prepared you think brazil and the neighboring countries are in controlling and containing the short-term effects and also the long-term with all the children that will be born with defects go ahead and give it a shot well i think that this comes back to the issue of infrastructure and and making sure that you invest in in these issues i don't know the details about brazil at this point in time uh as to what um they are doing although i will say that when i was over at who uh they are very um sophisticated and very tied to the issues of health i do remember that when i was working in geneva on that so hopefully they will continue to invest remember there's always incentives there there's an olympics coming up and so there's a lot of other incentives that would drive them forward to do that and i will before you let me know i wouldn't mind talking about sort of a little bit what we are doing and how i would prepare if i were down in florida or how we're preparing now in the state of new york uh but we can do that after hi i'm erica i'm a freshman at the college and so i was wondering given that brazil is preparing to host the 2016 summer olympics how is zika going to factor into thinking in brazil and around the world for the upcoming olympics and also how should it be factoring and not just how people will think about it but how should they be thinking about it well it is their winter but i don't know that that is like i don't think they get the kind of winter that we do that would kill off mosquitoes you know i'm not sure that i know the answer to that um i i have read that some olympic olympic athletes are concerned about going the reality is i don't think many athletes at that level would be perform be performing pregnant they simply wouldn't be pregnant during an olympics so i don't think the risk to them would be very great i guess what the people i speak to think about in terms of you know the olympics and i is the potential for something like that to cede infection to places that don't currently have it so somebody going getting sick not knowing it going home developing illness when they get home getting bitten by mosquitoes if they're the right kind of mosquitoes and then maybe you could have some localized spread if if they're lucky or greater spread if they're unlucky and um you know mass gatherings like olympics like world cup like the hajj they are really uh occasionally opportunities for things like that to happen i would just add that i think um you know brazil as a nation probably has significant capacity for public health messaging which is really this is going to be a an issue around health messaging and trying to sort of calm external populations to see if they can parts so that they will participate in the olympics the financial consequences are massive actually and so there's significant consequences and motivation for the country to message this cleanly clearly and appropriately one last question and then we're going to thank our speakers who i think will stay for a few moments if people want to approach them but please hi zach coleman i'm a night science journalism fellow at mit and i just wanted to know i was in vietnam recently and they are dealing with the dengue fever outbreak i was covered head to toe in deet all day wasn't a lot of fun but i was wondering what are some measures for prevention for adis mosquitoes that are more effective there as opposed to preventing against malaria what are some for preventing against malaria that won't work for aids and um you know i there's been the topic of ddt reintroduction that's been thrown around i was wondering if that's an option or whether we should avoid that at all costs so can i just jump in on the ddt one of my colleagues who's a very very strong science writer she did a piece on that a couple of weeks ago because we were hearing that question and there's a lot of resistance to ddt amongst the mosquito population so um it wouldn't be the silver bullet that people are would hope it would be some control measures actually have been described as just brute force and that is i'm actually spraying measures whether it's dtt or other chemicals to to sort of stop breeding grounds and stop breeding of especially mosquitoes that are difficult to control because they are in urban settings for example in other words you probably read about genetically modified mosquitoes right so mosquitoes that induce sterility and other mosquitoes those are super interesting actually potentially promising but really difficult to scale and to scale up and so it's probably not a really a viable solution dengue is the same so the gates foundation is invested significantly in genetically mod or actually mosquitoes that carry a bacteria that do the same thing and then again these prevention method measures you you know you said it yourself i mean so deet and permethrin and others are actually really safe and usable and generally um accessible maybe not you know pan globally success accessible but they're going to be a key to help prevention so i think some of this is going to be creative solutions and some of this is going to be brute force which is uh you know vector control and um public health campaigns for uh prevention now i'll add one thing you know mosquitoes we monitor the state monitors and i'm sure other states do what's called mosquito pools long before zika or anything of that nature there are encephalitis encephalitis which are infections in the brain that are carried by mosquitoes or or concerned that that can be transmitted say by mosquitoes so we monitor every time the summer rolls around spring rolls around we actually test mosquito pools looking what's there and this is part of uh just the standard public health practice that the department takes on and i'm sure that other parts of the of the country take on as well um and so that's one thing worth knowing that this is and and we work with the environment environmental teams a lot of this is communication a lot of this is getting what we have done just so you know with with zika we've had multiple webinars and now i think we've reached 3 000 as of today 3 000 or 4 000 health professionals in the state just by telling them exactly what's going on with zika working with the other states as i mentioned having once every two or three days we have a meeting for all of our teams working this week we work with the labs on these issues to tackle it and and it's a lot about communication and the other thing i think a lot of this is about is trust it's trust between health professional and patient trust between government and and and the public trust between countries and another country trust between a lab and maybe a cdc lab and and international labs and and trust between all different organizations that involve and i think that's probably one of the biggest things with this issue of zika or any kind of infectious disease you really need to have a trust between colleagues and and all those who are working between the public and those who helped protect the public please join me in thanking our panel for being with us well done

Channel: Harvard Kennedy School's Institute of Politics

Views: 425

Rating: 4.5 out of 5

Keywords: Global & International, Pandemic, Public Health

Id: E32Rb3d0rDI

Length: 63min 43sec (3823 seconds)

Published: Thu May 20 2021