Public Health Emergency - Leading a Nation Prepared
Q&A Moderator: Dr. Cindy Bruckner-Lea, Senior Scientist and Manager, Pacific Northwest National Laboratory
>> CINDY BRUCKNER-LEA: Thank you all three for the range of comments and expertise we have here. We are lucky to have them here today. And also all of you. So now I would like to open the floor up to the audience to provide, to share your perspectives regarding goal one and the questions that we are reminded of here in the risk awareness goals. So, yes. And I think we have, could you step up to the microphone? I think, yes there are two on each side.
>>DAN JACOBS: Yes, my name is Dan Jacobs. I'm chairman and CEO of the Federal Market Group and chairman of the Subcontract Management Institute. I want to thank each of you for your contributions and particularly to Dr. Heinz for what was it, bio shield and so forth. That really got us started on a lot of things. Heightened awareness. My concern is that we are not addressing what I consider the greatest single challenge we have today, and that is lack of leadership at every level. We've got a gathering of eagles here. But at the end of the day, people you work for or the people who work for you and who are to execute this plan and the school, they are not qualified as leaders. Stop and think about that. They are very competent in their particular field and so forth, but decision-making, risk management is a critical issue. But you've got to begin, I mean you've got to go there from the outset. Stop and think about the workforce. It's in transition. Our bureau of labor statistics suggests that by 2020 more than 50% of the workforce will be millennials. We are dismissing them. We are not paying attention to them. Most of us here have had mentors through our career. Good ones and bad ones. But we are not training them properly. It's a cookbook training approach. So we've got to pay attention to that. And if we don't, we are at greater risk and we will never get there. But thank you all for your contributions. I'm suggesting every one of you here think about that. We are, most of us were born in the industrial age. We are now in the digital age and if we don't pay attention to those young people, every one of them are just like us who come to work every day wanting to do the right thing and we put them in positions, we train government contracting officers, program project managers and industry as well, but then we put them into a role of responsibility and they haven't any training in critical decision-making and things like this so they can't develop a risk management plan, if we don't train them and invest in that. Thank you.
>> CINDY BRUCKNER-LEA: Thank you for your comments. Are there others in the audience? Yeah, I see a few others. Someone is heading up. And we will limit, I forgot to mention about two minutes per person. So, we have time to get as much input as we can. And if anyone would like to speak you can line up after those that are at the microphone so we can kind of go through quickly, make sure we get as many as we can. Okay.
>> MARK KORTEPETER: Good afternoon, good morning thanks for all your comments thus far, Mark Kortepeter from the University of Nebraska and my background is both as an infectious disease provider as well as a public health leader and formerly in the military. But one of the things I'm curious, and this goal one, they talk about recognition of surveillance of bio hackers and bio event, and I recently spoke at Grand Rapids Washington Hospital Center and I looked at the audience of the medical residents and really none of them had been anywhere near even college when the anthrax attacks occurred. So I think about your first comment about trying to stop something very early, recognize it very early, so I feel like the healthcare providers across the country are really the tip of the spear, and despite all our fancy surveillance systems and detection devices really it's going to be an individual who makes a connection that something unusual is occurring. So I'm wondering is there something that could be done in terms of national interest in a training platform for care providers across the country, kind of as a tip of the spear to be early recognition sentinels for a new event? Thanks a lot.
>> CINDY BRUCKNER-LEA: Yeah, I think that's an important point. Dr. Heinz, do you have any comments on that, given your medical, from the medical perspective?
>> NOREEN HYNES: Well, okay I think it's very interesting that we have a tendency to be very reactive rather than proactive. And so following the events of 911 and the anthrax attacks, there was a tremendous push to train healthcare providers and being able to recognize high consequence pathogens, including even including questions on their national certifying examinations. This is almost totally disappeared. So I actually agree with Dr. Kortepeter. I do think having a national curriculum that we wanted all healthcare providers, be they physicians, nurse practitioners, physician’s assistants and nurses to know about becomes very critically important. We are rolling out something in collaboration with the state of Maryland at Hopkins to try to train front-line hospital providers and transport folks throughout front-line hospitals and assessment hospitals to recognize high consequence pathogens. We are trying to do this as a first step, but I think Dr. Kortepeter is quite correct. I think we need a national effort.
>> CINDY BRUCKNER-LEA: Okay other comments?
>> ROBERT MALONE: My name is Robert Malone. I'm a consultant but I've worked with over 30 years in discovering new technologies, as an academic I work for nonprofits, I worked for the government, I worked for the IC, worked a lot with DOD. And I suggest for your consideration, personally I like a case study approach. And we kind of lucked out with Zika. But it turns out Zika wasn't really a black swan. But it was pretty close. And our response in those early days, I think could really inform if you're thinking about processes and gaps, what we encountered was a very fragmented ability to process information with an IC that didn't have sufficient analyst capacity that understands bio threats and is able to process that signal that was coming in. That signal as it came in was, you know, CDC had the foreshadowing of it, they published the papers, but they completely missed it and their response was really biased by preconceived notions about things like sexual transmission. But the data were all there. What we end up doing, not that we were so great, but in the gap pulled together a group of folks that cross, DOD, IC and other communities and were able to come it turns out in retrospect pretty accurately analyze that signal and make an assessment. We published it in public access journals, multiple papers, and in retrospect we pretty much got it right. But it was because we had an interdisciplinary group. We did use computational processing. We did take a lot of information in. We very actively reached out to the Latin American communities, the Brazilian communities, got the primary data, approached it without bias, were able to quickly call the sexual transmission risk and made accurate predictions about viable strategies for countermeasures. Fortunately those, we were very skeptical, as a vaccinologist, we were very skeptical about the timelines for vaccine development. So I'm just, not that we were so great, but as they say in the land of the blind, the one eyed man is king. And in this case, we had one eye open. And we were able to make some good calls. But in [MACE] as they all are, it's always the fog of war. When these things happen, and for too many. A diverse group that isn't, that tries really hard to have preconceived notions about the data and digs in hard can analyze these small fragments of unsecure data, of questionable integrity and come up with a reasonable analysis and strategic plan. But I suggest then in closure that that particular series of events could make for superduper case study as you look at what those gaps are because they all presented themselves and it was possible to process that information and come up with accurate predictions. You can look at our papers. But those things were very different decisions were made and analyses were made by existing HHS infrastructure and they missed a lot of stuff.
>> CINDY BRUCKNER-LEA: Thank you so much for those comments. Yeah there's definitely a huge data challenge and how to look at that in an unbiased way and integrate the data is a huge challenge. Yeah?
>> FRED LIKEM: Yeah, I'm Fred Likem with Washington Institute and a visiting scientist with Lawrence Livermore national lab and I've been working on this stuff for more decades than I will admit to, but I have some general comments and some specific suggestions for each of our three speakers. I think the most important aspect of this bio defense problem is context. And the context as defined is we have to be worried about naturally occurring epidemics, pandemics. We have to be worried about accidents. We also have to be worried about the nature of warfare and the nature may involve peer rivals and their means to take covert, clandestine special operations tactics to deliver weapons of mass destruction, which could be limited use of nuclear, certainly strategic use of bio and most likely as any attack that China or Russia has shown on any neighboring concerns, it will be cyber and the ability to disrupt communications. The other aspect of the future nature of warfare will be that unlike the Cold War, where it was launching missiles at each other's missile silos or command and control centers, certainly there could be some of that, but the more likely limited use of force by peer rivals in particular will include destroying or disrupting the infrastructure for public health, for safety and for food supply and all the things that society going together. So the message that I'm trying to suggest, this is a complex multidimensional problem. But we need to introduce the concept with the strategy of a systematic systems architecture. We have, in addition to those goals, those goals translate into a warning and detection system, which everyone here knows is both based on epidemiology and we are all in the Canary course, and someone was alluding to that, but if we don't get out in front of what we like to call the epidemic curve, and be able to actually be effective and break any kind of change in transmission or further infection, then the ability to control the entire activity is going to be quite disappointing and the other thing to keep in mind is you either can sample, as we have been doing with bio watch on a limited basis as a means to get some more timely warning then syndromic surveillance let’s say might give you, but if you are not prepared to do more extensive sampling, you won't know where the hazards are if in fact it was released. The number one target if you want a strategic target, there is one major one. It's called the New York City subway system and also you all on the West Coast have subway systems as well. Those are both weapons and detection systems and I and my colleagues did some really extensive work after 9/11 with the New York City health Department emergency planners and we were absolutely amazed if you had a hypothetical release, let's say of a communicable disease like smallpox, as to how many generations of transmission would occur, and I will stop there on that one. So specific comments with respect to Dr. Heinz, I thought not surprisingly with her experience a lot of good observations. But remember that we don't control the gain of function and dual use technology. If you look carefully, and I know you have at what the Chinese did when we had a ban on research in that area, they did a lot of the very experiments that we would have wanted to do. And I think, without naming names, the Dutch researcher that misspoke about being able to transfer virulence and human affinity of H5N1 influenza created more damage actually in the final analysis. So just keep in mind that we may want restrictions on young things and educate younger students as they come up and I think Noreen is absolutely right on that. But this is a multiway street.
>> CINDY BRUCKNER-LEA: We need to move on, sorry to limit...
>> FRED LIKEM: The final thing I would just add is really what we are talking about is a kind of set of strategic capabilities going back to the architecture notion where we are going to have both environmental monitoring of some sort and we are going to also have epidemiological investigation. And there needs to be a recognition as to what the court environmental capabilities are going to be, and secondarily, what, after those core capabilities are used, what they are going to have to be augmented with. And a final thing is…
>> CINDY BRUCKNER-LEA: I'm sorry, I'm so sorry we have to move on.
>> FRED LIKEM: I was going to say real quickly with the state with respect to the local government problem you have to have organized your stakeholders and the stakeholders have to get behind you, and as you know already, and back you, otherwise nothing is going to happen, but the box gets checked.
>> CINDY BRUCKNER-LEA: Thank you. Yeah, okay. Next?
>> FEMALE SPEAKER: In keeping with the theme of bio defense as a public issue we have a question from the watchers at the live stream, how can we best incorporate biosafety and bio security into elementary and high school classrooms in the US?
>> CINDY BRUCKNER-LEA: Could we answer very quickly because then I can have just the last, we only have time for one more question.
>> NOREEN HYNES: Just very quickly I think that it's very important to be a part of active STEM education. These are poorly funded now and decreased funding in elementary schools, middle schools and secondary schools, and I think we have to try to bring this back so that we can begin to incorporate this.
>> CINDY BRUCKNER-LEA: So I think, given our schedule we only have time for one more comment or question and others we have online, so there's opportunity to provide input beyond this. I wish we had more time. So go ahead
>> CAROLINE KENNEDY: Hi, my name is Caroline Kennedy. I work at the Mitre Corporation. So addressing one of the challenges at the national level, and thank you to all the panels and specifically the colleague at the Long Beach Department of Health and Human Services, but just want to touch on, that we know these disease threats don't respect borders. They are often international in nature, and with airplane travel being what it is today and movement of migrants and things like that they can quickly cross from other countries into the domestic territory. So I think the challenge that we face is that the discussion about health and bio threats has to be had at the local level because you are right in that it is our local stakeholders who are often first noticing disease incidence, but those quote unquote local stakeholders could be in Ethiopia. They could be in any country around the world operating at a local level. So I think that is a significant challenge to convince federal stakeholders of the importance of the investment internationally and surveillance activities as well. Thank you.
>> CINDY BRUCKNER-LEA: Thank you so much. So I really, I think I'm energized by all the comments and the discussion so far and I think it just reiterates to me how important this area is and the implementation of the strategy is and really I'm looking forward to input. We really need input from all of you who weren't able to provide your comments and thoughts regarding these questions and goal one, please do so on ASPR bio at HHS.gov because we really need, as we said this is such a huge challenge, we need to all join together to really address the risk awareness challenges. So thank you. I think our time is up, correct. Otherwise I'd keep going. Okay.
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