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Week of 5.8.09

Transcript: Swine Flu Pandemic

BRANCACCIO: If there's one good thing that's come out of all the talk about swine flu, it is this: the revelation that mankind now has an array of high-tech tools for tracking pandemics just like this one.

We'll be hearing from Larry Brilliant, the former head of Google.org, the non-profit arm of that web giant. He's just started a new job running the Skoll Urgent Threats Fund,—a California based outfit that combats pandemics, among other things. The related Skoll Foundation, it should be noted, is one of NOW's funders. I wanted to go beyond the headlines and get straight insights on the perils of global disease, starting with the h1n1 flu that's at hand.

BRILLIANT: This is a potentially very bad disease. So far, it appears to be mild. Let's—let's talk a little bit about why people were so concerned about it early on. Mexican government announced that there were 169 deaths.

So the reaction that CDC made, the reaction that the Obama administration made, was pitch perfect. They did exactly the right thing, and fortunately, after five years of planning for bird flu, they had all the protocols in place, all the counties that had their meetings, all the states had done their tabletop exercises. And they put those in motion, exactly the right way.

BRANCACCIO: It's sort of a paradox though, because the danger is that the public ends up in another week, thinking this was all overblown.

BRILLIANT: Yeah.

BRANCACCIO: But there's some really important lessons, while we're thinking about this flu, that we have to consider.

BRILLIANT: That's actually my biggest fear is that—five years ago, we had—bird flu. Everybody got worried. Nothing much happened, except to the 200 people who died, but—it didn't happen in the way people had dire projections, and right now, it—you can almost feel the air coming out of the fear balloon. And my—my fear is that the next time it happens, people will think, "Oh yeah, I know what a pandemic is. It's not a big deal, and—"

BRANCACCIO: They close a couple schools. Some people get sick in Mexico. A few in this country, but the world, but the world doesn't end.

BRILLIANT: This pandemic has yet to show its hand. It can go in either direction. Right now, we're seeing a mild disease, no different than seasonal flu. We—we can't overreact to it, but we shouldn't underestimate it.

BRANCACCIO: Larry Brilliant is an epidemiologist who has fought disease and pandemics for decades. He has rock-star cred in the public health crowd for his role in eradicating smallpox in the 1970s... and he ran a foundation that helped to cure millions of people of blindness. Last year, Time Magazine named him one of the one hundred most influential people in the world.

These days, he's trying to move disease prevention into the 21st century using the latest information technology. He spent the last three years with internet giant Google, running their philanthropic arm, Google.org. There, Brilliant worked on strategies to fight infectious diseases and focused the sharp minds at Google to think of ways to predict and prevent epidemics before they spread. One idea: Google Flu Trends.

BRILLIANT: Google's Flu Trends is a masterpiece of design. Three young engineers at Google got the idea that by studying the way people use the Internet, they could predict where flu would occur, looking just for the kinds of things that they were interested in searching for.

BRANCACCIO: When people get the flu, they're more likely to search online for words like "fever" and "thermometer". Of course, not all of those web searchers are sick... so Google's engineers figured out which terms were most likely to yield an accurate flu count for a particular area.

After testing their model, they compared their results to the flu data at the centers for disease control over five years. The results: not perfect... but a pretty good match. In a way that could get health officials crucial earlier warnings.

And while it takes time for the CDC to gather flu data from hospitals and doctors, Google Flu Trends gathers data at the speed of cyberspace.

BRILLIANT: This one little program, done by three engineers, outperforms CDC or WHO's very expensive surveillance system by two or three weeks. And CDC is thrilled about that. They're not unhappy. It's not a competitive issue. They're really happy. So you can find less expensive ways to know when the flu season is beginning, what states should get the first shipment of vaccine or antivirals, using these technologies.

BRANCACCIO: When the swine flu outbreak emerged, Google flu trends announced an experimental version of their product that measured flu-related searches in Mexico... giving flu trackers another valuable source of information. And there are other internet sites that are tracking the swine flu... like health map, which consolidates data from news reports and official health alerts to show the latest information about an outbreak.

But the big hope for Dr. Brilliant and others who are tracking disease is to prevent pandemics from happening in the first place. one way to help do that is to look at how human beings interact with animals.

BRILLIANT: The world is changing. And humans and animals are living so close together, and humans are eating more animals. And—and let explain why that's important because 65 percent of all infectious diseases originate as animal viruses. We call them zooanoses for that reason, whether West Nile or Ebola or SARS or bird flu or swine flu. They begin as animal diseases. And it used to be, as in HIV/AIDS, that a virus would continue and propagate itself in a monkey population or a rat population or a bird population, and nobody would ever see a human. 'Cause we had swaths of green in between the animals and us. We had the Amazon forest. We had green belts. Those have all been cut down now. So we live in each other's area. And when—a monkey was eaten by a chimpanzee, and the chimpanzee met a human, that's how we got HIV/AIDS.

BRANCACCIO: Few people know more about animal-bourne viruses than Dr. Nathan Wolfe, an epidemiologist who runs the Global Viral Forecasting Initiative. While Google's engineers work in the virtual world looking for the next pandemic, Wolfe hunts down viruses at their source. Studying populations that interact closely with animals.

WOLFE: We spend tons of energy working to forecast things like hurricanes and tsunamis. Now imagine a hurricane that could strike globally. Instead of lasting for a few days it could last for years. Instead of killing thousands of people it could kill millions of people. Wouldn't we need—not only want, but need to be able to have the capacity to forecast those sorts of things.

BRANCACCIO: If someone had found the monkey who carried the AIDS virus before it spread to humans, Wolfe argues, millions of lives would have been saved. So he's out to find the next deadly virus... visiting some of the most high-risk areas of the globe.

WOLFE: We go to—individuals in communities where there's a high level of contact with wild animals. People who are—hunting and butchering wild animals. Most often really just for—basic caloric needs. In order to feed their families.

BRANCACCIO: It starts with testing the blood of animals and the humans who are in contact with the animals for signs a disease is moving into people. Wolfe points out the AIDS virus had already made the leap from animals to humans as early as 1929, but took decades to reach epidemic proportions.

WOLFE: That's why our approach at the Global Viral Forecasting Initiative is to focus on this interface between humans and animal population. Sounds obvious, but nobody's really been doing this. And so what we've done is we've created this network—which now exists in central Africa and Southeast Asia, where we actually go and monitor the interaction between say pigs and farmers. Between - primates and hunters. Between individuals that work in wild animal markets and the animals that may be in those markets.

BRANCACCIO: Wolfe, who receives money from the Skoll Foundation, is based in San Francisco with his core staff, but the bulk of the work happens out in the field.

WOLFE: We have a great team on the ground—comprised of mostly Cameroonian scientists and public health workers and conservation workers. There's really nothing like getting out to some of these sites, establishing new sites. That's some of the real fun that we get to do. And yeah, it can be certainly challenging. We've definitely collected specimens from time-to-time where we had to cross rivers with specimens in order to get 'em back to the lab. Or run into sort of trucks jackknifed across the road where we had to dig our land cruiser around in order to get the specimens out.

BRANCACCIO: He's already discovered dozens of previously unidentified viruses that have made the leap from animal to human. Some of them are retroviruses similar to H.I.V. that have the potential of causing a worldwide epidemic.

WOLFE: We try to catch people when they're sick. Certainly when we find a new virus has entered into one of these individuals we follow it very closely. Is it spreading? You know, how can we address this particular threat? Does it cause disease? And this is—this is pretty much our model. And by doing this we hope to be able to catch the moment at which these viruses are entering into the human population.

BRANCACCIO: So much public health work these days is focused on fighting outbreaks. but Wolfe says in a better world these diseases would be stopped short before they really spread.

WOLFE: In terms of pandemics and epidemics—I would say global disease control is mostly geared for response. So—and I mean you can see this with the swine flu, the H1N1 epidemic, perfectly, which is there's sort of—a delay from the point in time which the virus or disease originally enters into the human population until the time when it sort of hits the radar. Okay? And when it hits the radar from our perspective is relatively late. Often by the time they find out about these things the cat is already out of the bag.

BRANCACCIO: Wolfe's job is not getting any easier as the world becomes smaller and more interconnected. and there's another culprit that makes disease prevention more difficult, according to Dr. Brilliant: the threat of climate change.

BRILLIANT: I call climate change the great exacerbator. It exacerbates all of these problems. We're cutting down the rain forests, and the waters are rising along the sea level. And they're bringing salt water underneath into the aquifers. So, lands will no longer produce—farm lands will no longer produce enough calories per hectare for a farmer to feed their family. So what happens is that Mexicans and Europeans and Africans all seek different kinds of food. Africa last year—Africans consumed 700 million wild animals, two billion kilograms of bush meat. And I—I would argue that, you know, we worry about the exchange of bodily fluids, when we're talking about certain diseases. But there's no more intimate exchange of bodily fluids than to eat an animal. And when we do that, all the viruses that are there. Human diseases that are yet to be discovered. But they're in animals. And as we live closer and closer with animals and we don't have an early warning system, and we don't have a way for checking these, we're likely to get these zooanotic diseases becoming pandemics.

BRANCACCIO: Something many people worry about, when it comes to gathering as much data as we can, that might lead us to identify epidemics early, give us a shot at limiting their scope is the problem of too much information. There's this company up in—Washington state—Veratect, that has a system. They look at websites. They have analysts.

They apparently identified something going on in Mexico early, with regards to—swine flu. And communicated this to the Centers for Disease Control, the CDC. And apparently, the CDC didn't sit up and salute quite quickly enough, and there's a bit of—controversy over this. But then it turns out, Veratect put out 19,000 bulletins in the last two years. As many as five a day were sent to the CDC. Too much data can be almost as bad as no data.

BRILLIANT: Yeah. We have an epidemiology, two terms that we use. sensitivity and specificity. And one of them shows the ability to correctly identify a bad thing, and the other shows the ability to correctly identify something that's not bad. And just as you say, false positives flood the system, and that's why I'm optimistic about these new digital technologies because they'll be able to cast their net broad, find all the candidates to be bad things, pandemic candidates, and then bring 'em in closer by doing these laboratory tests. But the key is building a strong, robust public health service, public health system, at every level that's always here.

BRANCACCIO: Big challenges, even for a guy who likes to call himself a social change "addict." What drives a person to take on problems of this scale? Now, see, that's a picturesque tale.

Tell me the story of when you learned or how you learned that it would be your destiny to fight epidemics.

BRILLIANT: For those of your watchers who don't know this, the '60s were a very different time.

BRANCACCIO: Twenty-three-year-old Brilliant got a job in San Francisco in the summer of 1967, the summer of love. And things would get groovier still.

BRILLIANT: After I finished medical school, um, I got a strange phone call one day from Warner Brothers, asking me if I would like to act and play a young doctor—

BRANCACCIO: In a movie?

BRILLIANT: —in a movie. Yeah, it's called The Great Medicine Ball movie.

BRANCACCIO: I don't remember that movie.

BRILLIANT: It was a terrible movie.

BRANCACCIO: Oh dear.

BRILLIANT: But I did. I played a young doctor—in a caravan—going and doing rock and roll shows, so I became the doctor to a lot of rock and roll musicians, and became a lifelong friend of the Grateful Dead and—and others. And this movie—took us first to—our last concert was Pink Floyd in—in Canterbury.

BRANCACCIO: He got paid for this movie role, took the proceeds and did something you couldn't just do today...went overland to Kathmandu via Iraq, Afghanistan and Pakistan.

BRILLIANT: We were treated so well every place we went. And we learned so much about other cultures and communities. And I wound up living in a monastery in the Himalayas, and one day the teacher who ran that monastery—asked me if I was a doctor, knew that I was a doctor, and said that I should leave the ashram and go down and work for the United Nations. Now that meant taking off a white robe and putting on a three piece suit and walking into the United Nations office with hair down—let's just say my hair was pretty long.

BRANCACCIO: It wasn't just the hair. His guru in the Himalayas had specifically said go work to fight smallpox with the U.N. problem was, the U.N. pointed out they didn't have a smallpox eradication program. Back up in the mountains, Dr. Brilliant's teacher said go back, try again. And again.

BRILLIANT: Until one day I walked in and—there was this tall American in the—waiting room. And he said, "What are you doing here?" And I said, "Well, I'm living in a monastery in the Himalayas and my teacher said I'm supposed to come here and work for the smallpox eradication program, and this is God's will. What do you do?" He said, "Well, I'm the head of the smallpox program."

BRANCACCIO: Dr. Brilliant become of the very first hires in a team of epidemiologists fighting that horrendous, disfiguring and too-often fatal disease which had killed—listen to this figure—smallpox killed half-a-billion people in the twentieth century alone. Brilliant helped coordinate what would become a huge program to go through the Indian subcontinent village by village, family by family to make the case that the jab of vaccine was the right thing to do.

BRILLIANT: It's just that no one can protect themselves from a virus disease from which there is no cure and there is no vaccine. Now we had a vaccine. But the smallpox program took 150,000 people, cost $150 million dollars. But it's the best investment we've ever made. I stayed till the end of the program and turned off the lights. And—

BRANCACCIO: You turned off the lights 'cause you wiped out smallpox.

BRILLIANT: That's right. It was an amazing experience to be part of—the first and so far only—disease ever eradicated and it is my hope that there will be other diseases added to that list, the game is to take the major causes of suffering in the world that affect human beings, that list, and scratch them off, one at a time. What I worry about is if we don't pay attention with Ebola and West Nile and Lassa Fever and Monkey Pox and HIV, we might be adding more to that list. And I think for all of us, we need to make that list smaller, not larger.

BRANCACCIO: You're saying we need to be watching over this much more effectively. But are you talking about essentially large scale investments in public health?

BRILLIANT: I am. We have to build—a real public health system at every level. The county system has got to be well-funded. The state and the feds and right now, because of the recession, as you mentioned, those are the people getting the pink slips. And the irony is just as the newspaper said, "Pandemic reaches category six," people at the state level were getting pink slips in public health and let go.

BRANCACCIO: Even if the death rate for the swine flu continues to be relatively low, the economic costs are already rippling through countries around the world. Using data from the bird flu a while back, economists looked at all sorts of lost business, from disruptions in international trade and travel to losses of income in empty restaurants. Conclusion: the costs of a pandemic are dramatically high.

BRILLIANT: Dr. Sherry Cooper, who's the chief economist of the Bank of Montreal, crunched the numbers for the bird flu five years ago. And she looked at mild, moderate and severe. Let's just talk about mild. She said that it would cost the whole world two percent of our entire global GDP, over a trillion dollars.

BRANCACCIO: The fear is an especially deadly pandemic could cripple the global economy. The spread of disease is about economic well being and human well being. And it's also about national security. Brilliant is part of team created by Presidential order to reduce the chances that terrorists could use germs and viruses as weapons.

BRILLIANT: The National Bio-Surveillance Advisory Subcommittee advises the director of CDC, on the things that can be done to improve our ability to have early warning of any kind of disease, whether it's from a deliberate release of a pathogen, bio-terror, a laboratory accident, or a newly emerging communicable disease.

BRANCACCIO: What sort of person would also sit on that subcommittee?

BRILLIANT: Oh, it's—several dozen of the smartest, most dedicated scientist and regular people that I've ever had the privilege—

BRANCACCIO: You've got the hotline to Atlanta, the CDC?

BRILLIANT: Well, I wouldn't call it a hotline, but you know, we're trying very hard, and there's lots of committees like ours that are looking at trying to find a way to help build our own security. But the world's security as well, in dealing with any one of these new threats, that are biological in origin. And you know, clearly, the world has changed. If you—looking at nuclear weapons as an incident of terrorisms, nuclear weapons leave a signature. U235 leaves a specific signature. That's not true for bio-weapons. Bio-weapons are the poor person's WMDs. So there's a lot to worry about.

BRANCACCIO: That's a horrifying notion. It's not that hard, in the grand scheme of things, to put one of these things together?

BRILLIANT: In the grand scheme of things, it's not that hard. And if you understand that, again, it—it changes the whole way you think of the world. You know—you almost have to think of building a world where no one hates life more than they love living, where no one wants to find a way to kill tens or hundreds of millions of people. And because that's difficult to do, you have to build a defense. You have to build a surveillance system. In fact, you have to do both at once. You have to improve the living conditions of people who otherwise might be tempted to play with these very dangerous matches and at the same time, you have to build a surveillance shield, so if ever anyone does, you pick it up immediately and you can respond quicker.

BRANCACCIO: One reaction to talk about bio-terror, talking about the potential for new, scary viruses to cross over into humans. One possible reaction is to dig, not a bomb shelter in your backyard, but some sort of flu shelter. Go in there with a can of frozen peas and survivalist DVDs and wait it out. And you're a person who continues to engage, despite the size of the problem.

BRILLIANT: The problem's no bigger than it was 30 years ago. In some ways, the problem is smaller, because we have more tools. We have more, better-trained people. We have better science. And I think we have good public will. Ultimately, it is all about public will. Do we gather together, as a community, and say we are all in this together, or do we all go separately? You know, it—it was—almost an axiom of American faith that we would say, "We should all hang together, or surely, we will each hang separately." There's never been anything truer than in dealing with biological problems.

BRANCACCIO: Well, Larry Brilliant, thank you very much.

BRILLIANT: David, thank you for having me.

BRANCACCIO: As you can see, in the midst of a pandemic, it's crucial to separate fact from fiction. On our website, get the truth about swine flu, what it is, and how it's transmitted. You'll also find an educational movie to help kids understand as well. You can find all this by starting at the PBS website.

And that's it for NOW. From New York, I'm David Brancaccio. We'll see you next week.

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Bio: Dr. Larry Brilliant


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