[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:05.50,0:00:07.40,Default,,0000,0000,0000,,When I was a kid,
Dialogue: 0,0:00:07.40,0:00:10.96,Default,,0000,0000,0000,,the disaster we worried about most \Nwas a nuclear war.
Dialogue: 0,0:00:11.82,0:00:15.08,Default,,0000,0000,0000,,That's why we had a barrel like this\Ndown in our basement,
Dialogue: 0,0:00:15.08,0:00:17.66,Default,,0000,0000,0000,,filled with cans of food and water.
Dialogue: 0,0:00:18.26,0:00:19.90,Default,,0000,0000,0000,,When the nuclear attack came,
Dialogue: 0,0:00:19.90,0:00:24.64,Default,,0000,0000,0000,,we were supposed to go downstairs,\Nhunker down, and eat out of that barrel.
Dialogue: 0,0:00:25.88,0:00:29.60,Default,,0000,0000,0000,,Today the greatest risk \Nof global catastrophe
Dialogue: 0,0:00:29.60,0:00:32.46,Default,,0000,0000,0000,,doesn't look like this.
Dialogue: 0,0:00:32.46,0:00:35.24,Default,,0000,0000,0000,,Instead, it looks like this.
Dialogue: 0,0:00:36.44,0:00:41.93,Default,,0000,0000,0000,,If anything kills over 10 million people\Nin the next few decades,
Dialogue: 0,0:00:41.93,0:00:45.31,Default,,0000,0000,0000,,it's most likely to be \Na highly infectious virus
Dialogue: 0,0:00:45.31,0:00:47.79,Default,,0000,0000,0000,,rather than a war.
Dialogue: 0,0:00:47.79,0:00:51.68,Default,,0000,0000,0000,,Not missiles, but microbes.
Dialogue: 0,0:00:51.68,0:00:53.88,Default,,0000,0000,0000,,Now, part of the reason for this is that
Dialogue: 0,0:00:53.88,0:00:58.08,Default,,0000,0000,0000,,we've invested a huge amount\Nin nuclear deterrents.
Dialogue: 0,0:00:58.08,0:01:03.18,Default,,0000,0000,0000,,But we've actually invested very little \Nin a system to stop an epidemic.
Dialogue: 0,0:01:04.13,0:01:07.09,Default,,0000,0000,0000,,We're not ready for the next epidemic.
Dialogue: 0,0:01:08.02,0:01:09.76,Default,,0000,0000,0000,,Let's look at Ebola.
Dialogue: 0,0:01:09.76,0:01:13.62,Default,,0000,0000,0000,,I'm sure all of you read about it \Nin the newspaper,
Dialogue: 0,0:01:13.62,0:01:15.22,Default,,0000,0000,0000,,lots of tough challenges.
Dialogue: 0,0:01:15.22,0:01:18.88,Default,,0000,0000,0000,,I followed it carefully \Nthrough the case analysis tools
Dialogue: 0,0:01:18.88,0:01:23.72,Default,,0000,0000,0000,,we use to track polio eradication.
Dialogue: 0,0:01:23.72,0:01:25.57,Default,,0000,0000,0000,,And as you look at what went on,
Dialogue: 0,0:01:25.57,0:01:30.08,Default,,0000,0000,0000,,the problem wasn't that there was a system\Nthat didn't work well enough,
Dialogue: 0,0:01:30.08,0:01:33.65,Default,,0000,0000,0000,,the problem was that we \Ndidn't have a system at all.
Dialogue: 0,0:01:34.59,0:01:39.03,Default,,0000,0000,0000,,In fact, there's some pretty obvious\Nkey missing pieces.
Dialogue: 0,0:01:39.03,0:01:43.94,Default,,0000,0000,0000,,We didn't have a group of epidemiologists \Nready to go, who would have gone,
Dialogue: 0,0:01:43.94,0:01:47.70,Default,,0000,0000,0000,,seen what the disease was,\Nseen how far it had spread.
Dialogue: 0,0:01:47.70,0:01:50.45,Default,,0000,0000,0000,,The case reports came in on paper.
Dialogue: 0,0:01:50.45,0:01:52.81,Default,,0000,0000,0000,,It was very delayed\Nbefore they were put online
Dialogue: 0,0:01:52.81,0:01:54.78,Default,,0000,0000,0000,,and they were extremely inaccurate.
Dialogue: 0,0:01:55.49,0:01:57.86,Default,,0000,0000,0000,,We didn't have a medical team ready to go.
Dialogue: 0,0:01:57.86,0:02:00.45,Default,,0000,0000,0000,,We didn't have a way of preparing people.
Dialogue: 0,0:02:00.45,0:02:05.78,Default,,0000,0000,0000,,Now, Médecins Sans Frontières \Ndid a great job orchestrating volunteers.
Dialogue: 0,0:02:05.78,0:02:08.88,Default,,0000,0000,0000,,But even so, we were far slower\Nthan we should have been
Dialogue: 0,0:02:08.88,0:02:12.02,Default,,0000,0000,0000,,getting the thousands of workers\Ninto these countries.
Dialogue: 0,0:02:12.02,0:02:19.01,Default,,0000,0000,0000,,And a large epidemic would require us\Nto have hundreds of thousands of workers.
Dialogue: 0,0:02:20.75,0:02:25.16,Default,,0000,0000,0000,,There was no one there \Nto look at treatment approaches.
Dialogue: 0,0:02:25.16,0:02:26.95,Default,,0000,0000,0000,,No one to look at the diagnostics.
Dialogue: 0,0:02:26.95,0:02:30.24,Default,,0000,0000,0000,,No one to figure out \Nwhat tools should be used.
Dialogue: 0,0:02:30.24,0:02:33.72,Default,,0000,0000,0000,,As an example, we could have \Ntaken the blood of survivors,
Dialogue: 0,0:02:33.72,0:02:39.16,Default,,0000,0000,0000,,processed it, and put that plasma\Nback in people to protect them.
Dialogue: 0,0:02:39.16,0:02:41.76,Default,,0000,0000,0000,,But that was never tried.
Dialogue: 0,0:02:41.76,0:02:43.52,Default,,0000,0000,0000,,So there was a lot that was missing.
Dialogue: 0,0:02:43.52,0:02:47.42,Default,,0000,0000,0000,,And these things \Nare really a global failure.
Dialogue: 0,0:02:48.30,0:02:53.87,Default,,0000,0000,0000,,The WHO is funded to monitor epidemics,\Nbut not to do these things I talked about.
Dialogue: 0,0:02:55.05,0:02:57.84,Default,,0000,0000,0000,,Now, in the movies it's quite different.
Dialogue: 0,0:02:57.84,0:03:02.67,Default,,0000,0000,0000,,There's a group of handsome\Nepidemiologists ready to go,
Dialogue: 0,0:03:02.67,0:03:08.45,Default,,0000,0000,0000,,they move in, they save the day,\Nbut that's just pure Hollywood.
Dialogue: 0,0:03:10.18,0:03:13.89,Default,,0000,0000,0000,,The failure to prepare \Ncould allow the next epidemic
Dialogue: 0,0:03:13.89,0:03:17.70,Default,,0000,0000,0000,,to be dramatically \Nmore devastating than Ebola
Dialogue: 0,0:03:18.74,0:03:23.53,Default,,0000,0000,0000,,Let's look at the progression \Nof Ebola over this year.
Dialogue: 0,0:03:24.31,0:03:27.15,Default,,0000,0000,0000,,About 10,000 people died, \N
Dialogue: 0,0:03:27.15,0:03:31.85,Default,,0000,0000,0000,,and nearly all were in the three\NWest African countries.
Dialogue: 0,0:03:31.85,0:03:34.43,Default,,0000,0000,0000,,There's three reasons why\Nit didn't spread more.
Dialogue: 0,0:03:34.43,0:03:38.87,Default,,0000,0000,0000,,The first is that there was a lot \Nof heroic work by the health workers.
Dialogue: 0,0:03:38.87,0:03:42.14,Default,,0000,0000,0000,,They found the people and they \Nprevented more infections.
Dialogue: 0,0:03:42.14,0:03:44.62,Default,,0000,0000,0000,,The second is the nature of the virus.
Dialogue: 0,0:03:44.62,0:03:47.70,Default,,0000,0000,0000,,Ebola does not spread through the air.
Dialogue: 0,0:03:47.70,0:03:49.81,Default,,0000,0000,0000,,And by the time you're contagious,
Dialogue: 0,0:03:49.81,0:03:52.55,Default,,0000,0000,0000,,most people are so sick \Nthat they're bedridden.
Dialogue: 0,0:03:54.22,0:03:58.41,Default,,0000,0000,0000,,Third, it didn't get\Ninto many urban areas.
Dialogue: 0,0:03:58.41,0:04:00.12,Default,,0000,0000,0000,,And that was just luck.
Dialogue: 0,0:04:00.12,0:04:02.36,Default,,0000,0000,0000,,If it had gotten into a lot \Nmore urban areas,
Dialogue: 0,0:04:02.36,0:04:05.88,Default,,0000,0000,0000,,the case numbers \Nwould have been much larger.
Dialogue: 0,0:04:05.88,0:04:09.47,Default,,0000,0000,0000,,So next time, we might not be so lucky.
Dialogue: 0,0:04:09.47,0:04:14.53,Default,,0000,0000,0000,,You can have a virus where people \Nfeel well enough while they're infectious
Dialogue: 0,0:04:14.53,0:04:17.84,Default,,0000,0000,0000,,that they get on a plane\Nor they go to a market.
Dialogue: 0,0:04:17.84,0:04:20.85,Default,,0000,0000,0000,,The source of the virus could be \Na natural epidemic like Ebola,
Dialogue: 0,0:04:20.85,0:04:22.83,Default,,0000,0000,0000,,or it could be bioterrorism.
Dialogue: 0,0:04:22.83,0:04:27.47,Default,,0000,0000,0000,,So there are things that would literally\Nmake things a thousand times worse.
Dialogue: 0,0:04:27.47,0:04:33.48,Default,,0000,0000,0000,,In fact, let's look at a model\Nof a virus spread through the air,
Dialogue: 0,0:04:33.48,0:04:37.07,Default,,0000,0000,0000,,like the Spanish Flu back in 1918.
Dialogue: 0,0:04:37.63,0:04:39.56,Default,,0000,0000,0000,,So here's what would happen:
Dialogue: 0,0:04:39.56,0:04:43.56,Default,,0000,0000,0000,,It would spread throughout the world\Nvery, very quickly.
Dialogue: 0,0:04:43.56,0:04:48.68,Default,,0000,0000,0000,,And you can see over 30 million people\Ndied from that epidemic.
Dialogue: 0,0:04:48.68,0:04:50.50,Default,,0000,0000,0000,,So this is a serious problem.
Dialogue: 0,0:04:50.50,0:04:52.26,Default,,0000,0000,0000,,We should be concerned.
Dialogue: 0,0:04:52.26,0:04:56.69,Default,,0000,0000,0000,,But in fact, we can build\Na really good response system.
Dialogue: 0,0:04:56.69,0:05:01.84,Default,,0000,0000,0000,,We have the benefits of all the science\Nand technology that we talk about here.
Dialogue: 0,0:05:01.84,0:05:02.88,Default,,0000,0000,0000,,We've got cell phones
Dialogue: 0,0:05:02.88,0:05:06.14,Default,,0000,0000,0000,,to get information from the public \Nand get information out to them.
Dialogue: 0,0:05:06.14,0:05:10.32,Default,,0000,0000,0000,,We have satellite maps where we can see\Nwhere people are and where they're moving.
Dialogue: 0,0:05:10.32,0:05:12.63,Default,,0000,0000,0000,,We have advances in biology
Dialogue: 0,0:05:12.63,0:05:16.45,Default,,0000,0000,0000,,that should dramatically change \Nthe turnaround time to look at a pathogen
Dialogue: 0,0:05:16.45,0:05:21.32,Default,,0000,0000,0000,,and be able to make drugs and vaccines\Nthat fit for that pathogen.
Dialogue: 0,0:05:21.32,0:05:22.89,Default,,0000,0000,0000,,So we can have tools,
Dialogue: 0,0:05:22.89,0:05:27.50,Default,,0000,0000,0000,,but those tools need to be put\Ninto an overall global health system.
Dialogue: 0,0:05:27.50,0:05:29.79,Default,,0000,0000,0000,,And we need preparedness.
Dialogue: 0,0:05:29.79,0:05:32.26,Default,,0000,0000,0000,,The best lessons, I think, \Non how to get prepared
Dialogue: 0,0:05:32.26,0:05:34.76,Default,,0000,0000,0000,,are again, what we do for war.
Dialogue: 0,0:05:34.76,0:05:39.00,Default,,0000,0000,0000,,For soldiers, we have full-time,\Nwaiting to go.
Dialogue: 0,0:05:39.00,0:05:42.32,Default,,0000,0000,0000,,We have reserves that can scale \Nus up to large numbers.
Dialogue: 0,0:05:42.32,0:05:46.00,Default,,0000,0000,0000,,NATO has a mobile unit \Nthat can deploy very rapidly.
Dialogue: 0,0:05:46.00,0:05:49.46,Default,,0000,0000,0000,,NATO does a lot of war games \Nto check, are people well trained?
Dialogue: 0,0:05:49.46,0:05:51.88,Default,,0000,0000,0000,,Do they understand \Nabout fuel and logistics
Dialogue: 0,0:05:51.88,0:05:54.24,Default,,0000,0000,0000,,and the same radio frequencies?
Dialogue: 0,0:05:54.24,0:05:56.78,Default,,0000,0000,0000,,So they are absolutely ready to go.
Dialogue: 0,0:05:56.78,0:06:01.13,Default,,0000,0000,0000,,So those are the kinds of things\Nwe need to deal with an epidemic.
Dialogue: 0,0:06:01.13,0:06:03.30,Default,,0000,0000,0000,,What are the key pieces?
Dialogue: 0,0:06:03.30,0:06:08.59,Default,,0000,0000,0000,,First, we need strong health systems\Nin poor countries.
Dialogue: 0,0:06:08.59,0:06:11.78,Default,,0000,0000,0000,,That's where mothers \Ncan give birth safely,
Dialogue: 0,0:06:11.78,0:06:13.30,Default,,0000,0000,0000,,kids can get all their vaccines.
Dialogue: 0,0:06:13.30,0:06:17.63,Default,,0000,0000,0000,,But, also where we'll see \Nthe outbreak very early on.
Dialogue: 0,0:06:18.15,0:06:19.94,Default,,0000,0000,0000,,We need a medical reserve corps:
Dialogue: 0,0:06:19.94,0:06:22.50,Default,,0000,0000,0000,,lots of people who've got \Nthe training and background
Dialogue: 0,0:06:22.50,0:06:25.85,Default,,0000,0000,0000,,who are ready to go, with the expertise.
Dialogue: 0,0:06:25.85,0:06:30.27,Default,,0000,0000,0000,,And then we need to pair those\Nmedical people with the military.
Dialogue: 0,0:06:30.27,0:06:34.42,Default,,0000,0000,0000,,taking advantage of the military's ability\Nto move fast, do logistics
Dialogue: 0,0:06:34.42,0:06:36.22,Default,,0000,0000,0000,,and secure areas.
Dialogue: 0,0:06:36.22,0:06:39.13,Default,,0000,0000,0000,,We need to do simulations,
Dialogue: 0,0:06:39.13,0:06:43.93,Default,,0000,0000,0000,,germ games, not war games,\Nso that we see where the holes are.
Dialogue: 0,0:06:43.93,0:06:46.72,Default,,0000,0000,0000,,The last time a germ game \Nwas done in the United States
Dialogue: 0,0:06:46.72,0:06:50.44,Default,,0000,0000,0000,,was back in 2001, \Nand it didn't go so well.
Dialogue: 0,0:06:50.45,0:06:55.49,Default,,0000,0000,0000,,So far the score is germs: 1, people: 0.
Dialogue: 0,0:06:55.49,0:07:01.61,Default,,0000,0000,0000,,Finally, we need lots of advanced R&D\Nin areas of vaccines and diagnostics.
Dialogue: 0,0:07:01.61,0:07:05.25,Default,,0000,0000,0000,,There are some big breakthroughs, \Nlike the Adeno-associated virus,
Dialogue: 0,0:07:05.25,0:07:09.23,Default,,0000,0000,0000,,that could work very, very quickly.
Dialogue: 0,0:07:09.23,0:07:12.60,Default,,0000,0000,0000,,Now I don't have an exact budget\Nfor what this would cost,
Dialogue: 0,0:07:12.60,0:07:17.10,Default,,0000,0000,0000,,but I'm quite sure it's very modest\Ncompared to the potential harm.
Dialogue: 0,0:07:17.10,0:07:21.74,Default,,0000,0000,0000,,The World Bank estimates that \Nif we have a worldwide flu epidemic,
Dialogue: 0,0:07:21.74,0:07:25.46,Default,,0000,0000,0000,,global wealth will go down\Nby over three trillion dollars
Dialogue: 0,0:07:25.46,0:07:29.33,Default,,0000,0000,0000,,and we'd have millions\Nand millions of deaths.
Dialogue: 0,0:07:29.33,0:07:32.32,Default,,0000,0000,0000,,These investments \Noffer significant benefits
Dialogue: 0,0:07:32.32,0:07:34.52,Default,,0000,0000,0000,,beyond just being ready for the epidemic.
Dialogue: 0,0:07:34.52,0:07:36.98,Default,,0000,0000,0000,,The primary healthcare, the R&D,
Dialogue: 0,0:07:36.98,0:07:39.81,Default,,0000,0000,0000,,those things would reduce \Nglobal health equity
Dialogue: 0,0:07:39.81,0:07:43.50,Default,,0000,0000,0000,,and make the world more just \Nas well as more safe.
Dialogue: 0,0:07:43.50,0:07:46.86,Default,,0000,0000,0000,,So I think this should absolutely\Nbe a priority.
Dialogue: 0,0:07:47.51,0:07:48.98,Default,,0000,0000,0000,,There's no need to panic.
Dialogue: 0,0:07:48.98,0:07:53.47,Default,,0000,0000,0000,,We don't have to hoard cans of spaghetti\Nor go down into the basement.
Dialogue: 0,0:07:53.47,0:07:57.31,Default,,0000,0000,0000,,But we need to get going,\Nbecause time is not on our side.
Dialogue: 0,0:07:57.31,0:08:03.52,Default,,0000,0000,0000,,In fact, if there's one positive thing\Nthat can come out of the Ebola epidemic,
Dialogue: 0,0:08:03.52,0:08:09.33,Default,,0000,0000,0000,,it's that it can serve as an early \Nwarning, a wake-up call, to get ready.
Dialogue: 0,0:08:09.33,0:08:14.98,Default,,0000,0000,0000,,If we start now, we can be ready \Nfor the next epidemic.
Dialogue: 0,0:08:14.98,0:08:16.57,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:08:16.57,0:08:19.87,Default,,0000,0000,0000,,(Applause)