[MUSIC PLAYING]
- And so now it's a particular pleasure
to introduce to you our keynote speaker, Laurie Garrett.
Laurie Garrett is a journalist focused on global public health
and infectious disease.
She's the only person to win the three
P's of journalism, the Pulitzer, the Polk, and the Peabody.
And she does so by explaining the science behind new threats
while navigating the politics that may help or hinder
global response.
She's a fellow at the Council on Foreign Relations
and the author of several books, some of which
you may recognize, The Coming Plague, Betrayal of Trust--
The Collapse of Global Public, and I Heard the Sirens Scream--
How Americans Responded to the 9/11 and Anthrax Attacks.
And if that wasn't enough for you,
she was a script consultant for the film Contagion,
directed by Steven Soderbergh and starring Matt Damon.
She is a member and former president
of the National Association of Science Writers
and chaired the scientific advisory panel
at the UNAIDS High Level Commission on HIV Prevention.
Please join me in welcoming Laurie Garrett.
[APPLAUSE]
- OK.
Hello, all.
I know you're tired, so I'll make this go so fast.
And it's always a pleasure to be here at Harvard.
I was a visiting fellow here years ago when
I wrote The Coming Plague.
And I've been, as is typical with sessions
here, learning a great deal today,
along with all the rest of you, because there have been so
many really brilliant speakers.
So I'll try to be at least somewhere in that ballpark
for you.
So let's just get started.
As I said, I was writing The Coming Plague.
And I started working on it in 1993
when I was a visiting fellow in the Harvard School
of Public Health.
And at that time, the very premise
that infectious diseases were emerging and reemerging
was controversial, because the general feeling was, well,
we've licked it all.
And HIV, which obviously was catastrophic levels already,
was treated as if it was an aberrant problem, because after
all, it was drug users and gay men,
so it couldn't be as dangerous-- it couldn't have arisen out
of a zoonotic situation in Africa.
It couldn't have contributed to perhaps warning us
of what was to come.
And so here we are today all these years later.
More than 60 million people have been infected with HIV.
38 million are living with it today, only half of them
medicated with appropriate drugs.
And it really ranks as the third worst plague
in the history of our species.
Many key amplifiers were already obvious in the 1990s
as sources of amplified infection.
Obviously, contaminated water systems,
whether they be public or private water
systems, horrible housing, and megacities,
with people bringing their rural lifestyles
into these new, burgeoning megacities
and living in peripheral slum conditions side
by side with their pigs, chickens, and so on.
Deforestation and the devastation of natural habitat
environments for all sorts of species,
including those that might carry pathogens.
The nature of the livestock industry, especially where
there's live market sales right in the middle of cities,
and poultry and swine.
Massive abuse of anti-microbials,
especially antibiotics, all over the world,
sold over the counter, black market, and every other way.
Sexual transmission, particularly
involving individuals with multiple sex partners,
high-density sexual activity.
Bats and the encroachment on bat habitats in
particular and stressing those populations.
Nosocomial transmission, meaning filthy,
non-hygienic hospital conditions,
and the spread of blood-borne diseases
within hospital settings.
Of course, the needle itself as an amplifier, as the mosquito
made by humans, if you will.
All of these combined, and were obviously,
in the 90s, already contributing.
Zoonotic transmission, globalization,
lack of preparedness, the inappropriate activities
under conditions of panic, and almost no governance
whatsoever, particularly at the global level,
over any of this that could result in rational preparedness
and response.
I argued in 2000 that the answer was
to bolster our global public health
infrastructure, both inside nations
and as a multilateral effort.
But it was not bolstered, and we've
seen a huge number of outbreaks since, a steady pattern.
All those pictured here in red are
of previously unknown microorganisms,
and all have emerged in the last 20 years.
This doesn't even begin to capture
the entirety of the perspective, but it gives you a sense.
So let's review a few of these.
1994.
Pneumonic plague in India.
Emerges in Surat in Gujarat and paralyzes
the entire Indian nation, though it is,
of course, treatable and preventable.
And we understand it.
What were the key points?
The origin of it was never identified.
Zoonotic, obviously.
Everybody knows that about plague.
It was pneumonic transmission.
There was no rapid diagnostics, so there
was a great overestimate of caseload.
1% mortality.
And of course, the government response was to say,
it came from Pakistan as a biological weapon.
And the Minister of Health was terrified.
The next year we have in Kikwit, which
you heard about earlier from Anne
Rimoin, the emergence of Ebola.
Kikwit, a "city," quote unquote, of 480,000 people
with no running water, electricity, et cetera.
What were the key characteristics?
Again, zoonotic, coming from bats.
Massive deforestation impact, no rapid diagnostic
of any kind, no vaccine, no treatment,
incredible spread within hospital settings,
and a 92% fatality rate.
Total government failure.
And so in this case, we're looking at something
that comes from bats.
We don't know the intermediary species
that Gaspar Minga was exposed to in the rain
forest outside the city, but from then on, transmission
was human to human.
Now we're in the 21st century.
We've already-- we're not even a full 17 years in,
and we've already had quite a number of novel outbreaks
and re-emergences of old familiar friends, if you will,
of our species, including cholera and yellow fever.
Among the ones that I find most disturbing, often overlooked,
are NDM and MCR, the two giant classes
of plasmids I'll get into more.
So the big one at the opening of our century
was SARS, which began literally as the political committee was
choosing Hu Jintao as the next leader in November of 2002.
Key features, again, zoonotic, related to deforestation, bats
and civets.
No diagnostic, no vaccine, no treatment,
incredible spread within hospital settings,
general population risk, 9% mortality in the end,
and complete governance failure by the Chinese government
to such a degree that the only way they ultimately brought it
down was by treating the entire population as suspect infected
and quarantining every single person with a fever
in the entire nation.
This was, of course, a classic zoonotic, bats
to civets to restaurant workers, where they were live
killing the animals, and then from there
into the general population.
Next we have the emergence of a highly virulent form
of avian influenza, H5N1, which in 2005 really looked like it
might be the next big one.
It was another zoonotic, involving wild and livestock
poultry.
No rapid diagnostic, no vaccine, no treatment,
general population risk, transcontinental spread.
Fortunately, it has not yet evolved a mechanism for human
to human steady transmission.
And so this 60% human mortality microbe
remains a relatively rare event in human beings.
But by two different studies, the number of point mutations
necessary to make it a mammalian transmitter
are fewer than three.
H1N1 was a rapid transmitter, fortunately
of relatively low virulence.
Swine flu of 2009.
Global spread, truly dramatic, highly contagious,
again zoonotic.
Swine is the source.
No rapid diagnostic, no vaccine, no effective treatment,
general population risk, vaccine was not available
until the epidemic was pretty much over already
in North America.
Yet we had, even for this low-virulence microbe,
12,500 deaths in the US and more than a quarter
of a million deaths worldwide.
It was, again, a transmission, swine to person,
people to people.
And that is the classic pattern of a swine flu.
Well, unfortunately of far higher virulence and spreading
equally rapidly was the New Delhi form of plasmid,
found originally in an individual who
traveled in India and now available in 19 mutant forms
around the world, at least.
Again, this appears to have come out
of the poultry industry and the overuse of antibiotics
as growth promoters for livestock,
chickens in particular.
There's no rapid diagnostic.
There's no vaccine.
There's no treatment, per se, because by definition,
it disrupts possible treatment.
To give you an idea how severely, this individual was
treated for a broken leg in India, came home to Nevada,
tiny, almost invisible scratch infected.
She went through 26 rounds of antibiotics and succumbed.
Cholera was mentioned earlier as an United
Nations-created epidemic, if you will,
because of peacekeepers from Nepal.
Once it entered from those individuals fecally
into the environment, it's been a catastrophic outbreak
and continues today.
Human carriers in response to the earthquake,
environmental exposure now in every rivulet, stream, and lake
in all of Haiti, no rapid diagnostic.
It requires laboratory work.
Vaccine never really properly applied.
MERS.
Close genetic cousin to SARS.
Despite our history with SARS, MERS arrives, we still
don't have a rapid diagnostic for a coronavirus.
We still are surprised and don't fully
understand the zoonotic pattern.
It does appear to be a bat virus.
Somehow it's in camels, and somehow it's
getting from camels to people.
There is no rapid point of care diagnostic for it.
And it remains one of those diseases
with a 42% mortality rate that just
keeps going on and on and on, largely
within Saudi Arabia, where there are
some difficulties in pursuing appropriate research
to understand this virus more completely.
Ebola then of course emerged starting in late 2013
into 2016 in West Africa.
And here again, it's zoonotic transmission
from bats in a highly deforested area of Guinea.
We had no rapid point of care diagnostic,
no vaccine, no real treatment.
It had concentrated, intense spread, nosocomially
within clinical settings, and a massive death
toll, the largest, of course, we've ever seen from Ebola.
I mentioned plasmids.
Well, the one, MCR plasma, which emerged
two years ago out of China from the swine industry,
is already available in three forms, at least, worldwide.
And we see it in at least 32 countries around the world,
including ours.
This confers broad resistance against colistin
and a whole class of antibiotics in a huge range
of different bacteria.
We have no quick, swift way of diagnosing
whether an individual is suffering from this.
Again, it requires laboratory work.
And it appears to have arisen in a country that
never allowed use of colistin as an antibiotic clinically
in people.
It's 100% associated with the use of the compound
to fatten up livestock and passage via both swine
and poultry to human beings and, as it turns out, to pet food
and from the infected pet to the pet owner.
And so we have a cycle in place that is so far uninterrupted.
Well, of course, 2015 was also the beginning
of the Zika outbreak, which was missed for two years.
Had actually been in Brazil since 2013,
now found across almost all of the American hemisphere.
Vector-borne, associated with climate change, and novel forms
of transmission, not merely mosquito-borne,
also sexual transmission and other possible forms
of transmission, more HIV-like.
Huge impact on, of course, developing fetuses,
with massive cranial and brain injuries.
Yellow fever, the ancient scourge
for which we've had a terribly effective vaccine
for a very log time, and yet it emerged with huge impact
in Angola last year and obviously had
been from the monkey population via mosquitoes.
No really good treatment exists for yellow fever.
The vaccine is the key to stopping it.
But of course, what was determined was
we were low on vaccine, and Angola
had allowed its whole vaccination program to lapse
for quite a number of years.
In the end, once it reached Congo and got to Kinshasa,
there was terrible fear that we were
going to lose control of this problem.
And so Brazil donated yellow fever vaccine stockpiles
because the world was running out.
It was diluted five to one.
It still worked.
But then yellow fever emerged in the Amazon,
and Brazil didn't have vaccine.
They were finally able to manufacture vaccine,
but the world is out.
CDC says we won't have vaccine till 2019 for Americans.
Cholera in Yemen.
Thank you very much, Saudi Arabia.
You not only brought us MERS, you
bombed the heck out of all the Yemen infrastructure,
and now it's almost impossible to bring their cholera
under control.
It's estimated there will be certainly
a million cases in total in Yemen alone
by the end of December.
And regionally, across the Horn of Africa,
we have a full-blown cholera pandemic.
All right, why is all this happening?
And what do I see going forward?
Welcome to the Anthropocene, which is more than just CO2,
more than just climate change and global warming.
It is increased atmospheric CO2, acidification of our oceans
and water systems all over the world, a melting
and deterioration of all ice structures and glacial systems
worldwide, a decrease in oxygen for the planet.
The oceans alone are producing 6% less oxygen
than was baseline mid-20th century.
Decreased proper processing of nitrogen, sulfur, zinc,
a huge range of chemicals.
The changes are already so pronounced that we
can see that at least 300 different species of animals
have been shown to have changed their territorial distribution
in response to anthropogenic inputs,
chiefly climate-associated.
And as the animals move, such as cod,
which used to be the staple for people in southern Europe--
and when I was in Greenland, they can't even
catch it there anymore.
It's gone so far north.
And it's now been replaced by bony mackerel.
As the fish populations move, the birds move,
and the flyways are shifting, including the great Asia
flyway, which of course has been the source of almost
every single form of avian influenza we know about.
So as the flyways shift, as the animals shift,
as the birds shift, the patterns of microbial outbreaks
are likely to begin shifting quite dramatically.
And we're just at the very beginning of this right now.
Well, what this could mean going forward
is we have to look at such things as melting permafrost,
to begin to ask, are we thawing out our historical pathogens?
Last year, you had an outbreak of anthrax,
which killed reindeer and one human being
in Siberia, associated with melting permafrost.
And we have this whole class of these new, bizarre, giant
viruses, pandora viruses, that have
been retrieved from melting permafrost in Siberia.
Something's going on, because all of the grazing species
are dying out across the tundra and permafrost
of the Arctic, the saiga, the caribou, the reindeer.
In some cases, we're not exactly sure
why, what specific infections or microbial changes
are occurring, but the populations
are dying at a dramatic pace.
One giant survey of climate and anthropogenically-affected
pathogen distribution finds that 63% of human-animal pathogens
are climate sensitive, the majority of them
of zoonotic potential or reality already.
This means that we're going to see
more and more of the unpredictable occurring as we
change in the Anthropocene.
You've heard about the microbiome.
Let me talk to you about the Earth microbiome.
We can see changes occurring in the microbial distributions
all over the planet, even our troposphere.
You can see where microbes have come from
and what their nature of their source type might be,
fecal, water, salt water, what have you.
You can even measure microbial distribution associated
with specific weather events and hurricanes in the troposphere,
dropping from one side of the planet
all the way to the other side of the planet.
Habitats can be determined.
And we can actually see microbial patterns
of distribution around the world associated with, say, air
pollution events.
Kawasaki disease is an example.
Researchers at Columbia University
have shown it blew, literally, hitchhiking on dust in a dust
storm, from China to Japan, sickening children in Japan.
As the dust characteristics of the troposphere
get worse because of climate-associated changes,
all sorts of things can hitchhike around the world now,
including antibiotic-resistant microbes or plasmids.
And of course, the trend that we see
with anti-microbial resistance is a very worrying one.
I would even argue it's potentially
a reversal of our grand 20th century medical achievements.
By one analysis put forward by the British government
and presented to the United Nations General Assembly,
antibiotic resistance could well kill more people than cancer
within just a couple of decades.
This is terrifying.
And when we talk about how do you
go about controlling such a problem,
you need to think, what are the sources of the abuse?
It is not human use, though of course,
just like we heard with opioids, the tendency
is to chastise physicians for inappropriate practices.
But the real use of antibiotic products
is as fatteners for livestock, non-ailing livestock,
a permanent feature in their food.
And those livestock are secreting
antibiotic-resistant microbes in their feces,
and in their fertilizers and all the products, which end up
going right into the ecosphere.
And as we heard earlier today, just
try naming any ecological setting in which you can not
find antibiotic-resistant microbes and plasmids.
There's a big movement now to try and understand
what's called the resistome.
We're not just the microbiome, but the resistome.
And one of the most crucial ones is the rhizome
around the plant roots, which draw
from the soils nutrients, water molecules,
and so on into plants.
We're seeing growth stunting.
We're seeing the nature and quality
of our food crops disrupted by these larger
microbiome disruptions of our environment.
So the dysbiosis we heard described earlier
in the human body is a dysbiosis we're
seeing in every ecological setting
we look on the planet today.
The problem is no one governs any of this.
There is no entity whose job it is
to make sure that the biology of the planet
remains intact or appropriate, with appropriate diversity.
We have no national government institution that
does this, no international.
And so when a crisis happens, the responses
are largely inappropriate.
Panic drives too much rapid movement,
people running away from an epidemic,
taking it with them when they go.
And this fear mongering that fills the airwaves
and fills the nature of the response
with inappropriate activity.
It doesn't help that when there should be governance
and we actually have sort of laws, if you will,
on the international books, they fail to implement,
as happened with Ebola in West Africa.
The first case appearing day after Christmas 2013,
no public health emergency declared for eight months
by WHO.
Well, governance is expensive.
It requires appropriate donor input
in order to maintain the kind of governance that I'm advocating.
And we do not see that kind of appropriate donor input.
If you look at all funding for global health writ large,
that little piece that's about epidemics and so on
can't even be found on a pie chart.
What it does exist is a global health infrastructure
that is highly dependent on two donors, the United States
government and Bill Gates.
The two Washingtons are calling the shots.
Now one of those Washingtons is very likely
going to say, [BLOWS RASPBERRY] global health very soon.
And the other one has no board and no accountability.
He could wake up tomorrow and say, you know,
I'm really sick of this global health stuff.
I think I'll switch to climate change.
Preparedness financing, such as it is, 60% of it
comes from the United States government.
And most of the remainder is Bill Gates
and the British government.
So look at the vulnerability that this dependency
on a very finite number of sources
has put the entire world in at this moment.
With Brexit, we have no idea where the UK is going,
and with Gates, well, the majority
of Gates' commitment, particularly to WHO,
is about eradicating polio.
And he's made it very clear that when polio is eradicated,
he's walking away, which could be next year or the year after.
Well, WHO has been using polio money in a highly fungible
manner so that its dependency for everything at WHO
is tremendous.
30 percent of all health physicians for WHO in Africa
are funded by polio money.
Entire government health systems are funded by polio money.
How will WHO stay afloat if a year or two years
from now that polio money goes away?
Nobody has an answer.
Believe me.
I've asked everybody at WHO.
It's a quiet, behind-the-scenes panic.
All right, so what would I predict
when I go out on a limb?
I predict we're going to see a lot more dangerous plasmids
emerging and spreading with equal rapidity to the NDM
and MCR.
I predict we're going to see far more virulent crop
pathogens that will make Ug99 rust look like a plaything.
I think we're going to have more incurable STDs.
We already see antibiotic resistance
just overwhelming gonorrhea.
And we're going to see more diseases exploit
sexual transmission.
We're going to see microbes play a role in hastening
the pace of climate change.
For example, these microbes that are red that
are now growing on the surface of Greenland,
shifting the albedo and causing the ice to melt more rapidly.
We have methanogens thawing out of the permafrost that actively
produce methane, which is 80 times worse than CO2
for the climate change impact.
We will see more microbes emerging
from the most diverse mammalian phyla on the planet, bats,
and more associated with migratory birds,
particularly, of course, as I said, influenza strains.
Changes in climate will affect all of the animal species
that feed in the upper canopies of rain forests.
We will have more of the ancient microbes reemerging,
as we've already seen with yellow fever and cholera.
And I will predict that we will have a second great HIV
pandemic.
It will be far larger than the one we are currently
in the midst of.
It will occur because now, 10% of new infections worldwide
involve drug-resistant strains of the virus,
because donor support is declining rapidly,
because less than half of the ARV need is currently met,
and--
I'm going to go back one second here--
we do not have a cure.
In fact, we don't even research and look for a cure anymore.
And though you occasionally hear some good news about a vaccine
innovation, we don't have a vaccine.
We have a huge youth bulge emerging in Africa.
And currently, the new infection rate is twice the death rate.
So just do the math, and you can see what's coming.
We will have, as we heard earlier,
greater potential for man-made microbial threats,
including simply as accidents, simply
as stupid things done by a high school student in a high school
lab.
And the Anthropocene writ large is
going to have an enormous impact, because we're
seeing more estrogen compounds, possibly associated with why
we have a huge decline in sperm production
by men in the Western world.
We'll have more antibiotic and antiseptic waste,
increased toxic algae, an entire range of anthropogenic inputs
that will have an effect on the totality of the planet,
resulting in an ever-increasing threat of the emergence
of pathogenic disease.
Thank you.
[APPLAUSE]
- Want to take questions?
Thank you very much.
We've got about 15 minutes for questions.
- I know I've wiped everybody out.
They're all--
- There we go.
Great.
- Sure.
Go ahead.
- Hi.
I don't want to suggest that there's
is one cause of all these things,
but how do you think neoliberalism
as a set of policies that shape political economies ties
together climate change, unregulated pharmaceuticals,
but also the retreat of states in many
of these countries leading to a lack of governance
at both the state and the global level?
- Well, I don't know about neoliberalism,
but certainly nationalism and the retreat from globalization
back to putting the nation-state first,
and in the case of Donald Trump, only,
and certainly with the Brexit retreat,
we're getting the same signals from Britain--
this doesn't help when what we're trying to deal with
is supra-national problems.
They know no borders.
The problems cannot be tackled by any one country alone.
The People's Republic of California
is doing everything it can to lower its CO2 footprint.
Bravo.
Go for it.
But no matter what California does,
Californians will still experience
all of the threats I described.
- That was a cheery talk.
[LAUGHTER]
Strategy.
Culture eats strategy for lunch.
And this community is focused a lot
on strategy and rational solutions to tough problems.
And you're out in the community a lot as an author.
Do you have a way to engage this community and others
at a cultural level?
- Thank you for that.
Let me say, first of all, I do see several mitigation points
that could help us a lot.
It starts with how we got here, which
is that when Jim Hansen published
his first warning in 1983 saying,
we're filling the atmosphere of CO2
and it's going to have this horrible impact that
came to be called global warming, the whole team
of scientists that eventually piled on and joined in with Jim
and echoed his concerns came out of NASA, the planetary science
community, geophysics, populations
of people for whom it was code to say increasing CO2.
They totally got it.
But you know, I'm going to just ask all of you
here in this audience-- keep it to yourself,
but how many of you, just really seriously,
if you sat down with your grandmother,
could explain how carbon dioxide causes climate change?
Well, I didn't ask for a show of hands, but thank you.
The truth is very few people can.
And frankly, the majority of the world population
doesn't even know what carbon dioxide is.
It allows denialism when you don't understand
and when it seems like an elite group does
think they understand, but they're not
making it clear to you.
Moreover, we're talking about a whole lot
more than one molecule in terms of the larger
anthropogenic impact and what it's
doing to disrupt the planetary microbiome.
I very much believe we need to--
it's fine if we tie certain treaty agreements
and so on to carbon and make countries
meet CO2 limitations and so on.
That's a completely fine way to go about trying
to reduce risk to the planet.
But it's insufficient as a way to talk
to the people of the planet about what is happening,
because the people of the planet don't know what CO2 is.
If they know anything, they had a grammar school course
that taught that plants breathe it in, and we exhale it out,
and that's kind of the end of the story.
And certainly they don't understand
how the chemistry of what goes on in the upper atmosphere that
leads to this weakening of our very
fragile protective atmospheric layer that
keeps us from being mercury.
And I think it's really important
that we start having a conversation that
goes to this kind of putting biology first.
We've had the chemistry first and the physics
first for a really long time.
We need to bring the biology front and center,
because everybody knows pets.
Everybody gets sick.
Everybody takes antibiotics.
Everybody eats food.
Everybody breathes air.
Everybody drinks water.
Ergo, we share a risk that's very tangible and very real.
And we need to take the discussion there.
Thank you.
- Thank you.
Thank you very much.
[APPLAUSE]
I want to thank Laurie Garrett for sounding the alarm and all
of our speakers today, who I think
did a great job of outlining the scale and the scope
of the problems but also many of the solutions and the new tools
that we've got to face these challenges.
You've heard today cutting-edge science that
demonstrates the vast amplitude of public health and expands,
perhaps even explodes, your concept of what an epidemic is
and how we can research them.
We have come a long way in a century
from the lists of John Graunt and the shoe
leather of John Snow.
We heard about microbiomes, signal processing,
computational analyses of networks, CRISPR and gene
drive as novel solutions.
And we also heard about mixed methods,
the importance of listening to the voices that are not heard,
voices of Ebola survivors, of men suffering
from mental illness, of the close affiliates of gunshot
victims.
And you've also heard a call for resources,
for some new resources like a global immunologic laboratory,
for data storage to contain all the gigabytes and terabytes
of data that are coming in from all corners,
and as well for good old-fashioned public health
infrastructure.
We've heard a call for transparency,
including for scientific literacy, which
I think is fundamental to really marshaling
public support for the kinds of resources
we need to combat these challenges.
You've also heard a very clear call, particularly
from Kevin Esvelt today, for open science
and for sharing data as a way to break
the personal and institutional barriers
and bring the research out of the ivory tower
and into the community.
Part of this is breaking the grip
of the pharmaceutical industry on government and medical
doctor response, including the overprescription of drugs
and the overuse of anti-microbials.
Part of this is local capacity building, including
self-reliance and empowerment.
I was particularly inspired by Christian [? Habpie's ?] talk
this morning about how Nigeria got ahead of the curve
and really marshaled a lot of local resources
to really prevent Ebola from taking a grip on their country.
It really comes down to the front line.
Pandemics, as Caroline Buckee said, start locally.
And they require both speed and accuracy.
This all leads up, to me, to an urgency
to align our academic, our industry, and government
incentives to do the right thing,
as we heard over and over again.
We need to demand more from our institutions
and particularly from our governments.
We also talked a lot about networks today.
Like microbes, they're all about context.
We heard about networks, of course, of contagious disease
and also of pernicious social conditions,
but we also heard about networks that form
communities and improve health.
I think the consensus of the day is
that if we can pull our act together,
we increasingly have the power to combat
these networks of disease with networks
of information, of knowledge, communication, collaboration,
and shared resources, just taking Nigeria as one example.
At the beginning of the day, we talked about the public health
triumphs of the 20th century.
And while any program on epidemics
isn't doing its job if it doesn't alarm you
about new and emerging threats, today we
also heard about novel emerging tools from, frankly,
a lot of brilliant and quite young
scientists dedicated to sharing their work.
I think we have reason for a lot of caution,
but I also think we have reason for a fair bit of optimism,
looking at the lineup of young scientists that we had.
And I'm still optimistic that the 21st century
will bring an even greater list of public health victories.
But it really depends on us demanding more, demanding more
from our institutions, from our philanthropists,
and from our governments.
And I'll leave you with that thought.
Thank you very much for today, for coming, for listening,
for staying the whole day, as many of you have.
I also want to thank our online audience, which
was large and incredibly diverse, all over the globe.
Please come back for our series of lectures
on epidemics throughout the year.
You'll find postcards at the back of the hall and downstairs
at the registration desk that will tell you
about what those are.
The next one coming up is in February
by Louise Oaklander from Mass General on fibromyalgia,
some groundbreaking research there.
And for now, please join us for a reception
and to see those fantastic posters of the students
in Fay House, which is next door.
Thank you again, and I look forward to seeing you there.
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