 is going to talk about the zombie apocalypse versus international health regulations. Introducing a very important piece of international law and how to circumvent it. Florian, that's your stage. Thank you very much. Thanks for your kind introduction and also to you for coming so early in the morning at one o'clock. And special thanks to my friend, Dan, who borrowed me his computer. I mean, I know it's a computer conference, but I didn't bring my computer with me. I also have to start with a huge disappointment. I mean, remember when you found out the truth about the Easter Bunny and Father Christmas, zombies are not real. They are characters of imagination. However, I will assume for the rest of my talk that they are real and also that the apocalypse started less than 12 hours ago or not yet. And if you're more interested in what happens afterwards, I would like to refer you to the many documentaries out there. There are also interactive training environments on your computer, but we just pretend that it hasn't started yet. And infectious diseases always ignore borders, and they have been analysis from the Stone Age, where you could show that the causative agent of plague, Yersinia pestis, was moving from the areas we now call Asia to the areas we now call Europe. And they found it by analyzing the cavemen teeth. And in more recent times, we had in Europe devastating epidemics. Recent time means the 19th century. We had devastating cholera epidemics. And it's the kind of epidemics you have now in Civil War torn Yemen, where you have over 700,000 cases and over a thousand deaths. And cholera is really serious. Here now in our camp environment, if we had untreated cholera, about 50% of us would die. So they would die, probably. And this is why people came, the governments came together to discuss how to introduce rules to combat infectious diseases. And especially after the Second World War, when the United Nations were founded, the WHO, the World Health Organization was founded. And they started with the first iterations of the International Health Regulations in 1969. They had an update. And the goal was to monitor cholera, plague, yellow fever, smallpox, and some other diseases. However, these were defined diseases. Because at that time, we still thought that we know everything about bacteria, everything about diseases. So you didn't have unknown threats in there. And the diseases that are underlined are the ones that had to be notified. Which essentially means that if you are a nation state and you say, I have cholera, then your neighbors start implementing trade controls and travel control. So it's a disincentive from saying, oh, I have cholera. There were a lot of notifications which were saying, oh, we have an outbreak of watery diarrhea, which of course was cholera. But they didn't call it this way. Then there was an epic fail in 2003. SARS came. And it started in mainland China. And fortunately, there was an infectious disease network, the influenza network. They picked up a lot of people that became ill with respiratory diseases. And still, the H1 and 5 threat, it's basically the thing that scares everyone. And at first, they thought that now they have a very, very dangerous influenza epidemic, pandemic starting up. You had cases in the Philippines. You had cases in Vietnam. And it spread very, very quickly. The costs here are only the cost to food and travel. It's not the human tragedy which you see here. And the situation was really, really bad up until April 2003, when the Chinese government changed and Hu Jintao became president. Then the cooperation between mainland China and WHO and other countries improved. And when you go back here, SARS wasn't on this list. So China didn't do anything wrong. They didn't break any international laws. Fortunately, a miracle happened. And all the people who had really good ideas, all the years before, who were not heard, all the public health epidemiologists, they got together. Iran and United States were sitting on a negotiation table. You had Pakistan, India, all the classic enemies coming together and making up new rules. And the international health regulation came into force in 2007. And its primary purpose, of course, is to prevent and combat the cross-border health threats. This does include chemical, radiological and biological incidents. And it's important that it is a cross-border threat. So as long as the epidemic is in your own country, the international health regulations don't apply. But the moment it becomes a threat to infect other countries or people living in other countries, the international health regulations get triggered. It also has an important point in protecting human rights and human dignity. And, for example, in the 2014 Ebola intervention, it became very, very important to provide dignified burials because you had people who became sick of Ebola. They died and it became very important to keep the local population still engaged with the intervention team. So you needed dignified burials. And this is still an issue now in the current Ebola outbreak in the Democratic Republic of Congo, in the north of the Democratic Republic of Congo. Then since its governments agreeing to regulations, you have to respect the national sovereignty. And the last point, you need to avoid unnecessary impairment to international travel and, of course, trade. I'm coming to the zombies in a few moments. Mainly the international health regulation contain codified responsibilities. So things that a state thinks that a government needs to organize in order to, well, in order to fulfill those responsibilities. And we have the chemical, biological, radiological threats. When you think of Chernobyl, Chernobyl would qualify for a radiological health threat. It's a cross-border health threat or it was a cross-border health threat. And a lot of the things that are in the regulations deal with structural requirements. So you need to have surveillance capabilities. And surveillance here is something positive. So it's not evil state invading your privacy. It's good public health protecting you from infectious diseases. And I just read the email this morning that the surveillance team, Fachgebiet 32 from the RKI Robert Koch Institute is watching this stream as well. It also deals with the health of the state. And you can see the notification chain. For example, if you get diarrhea here and a lot of people would get diarrhea here, the local health department of this crisis would call the state health department. I work for a state health department in another part of Germany. And they get a notification and they notify the federal agency. So you can see that. And you can see that. And it's a cross-border checkpoints later. Another important tool is the public health emergency of international concern. It's kind of DEF CON 5 and the movies. You know, the wargame movie, movie wargame, DEF CON 5. And it's quite simple. The moment you have a public health risk that could also spread to other countries and the moment it requires a public health emergency of international concern. Examples would be the still ongoing polio eradication. Our huge influenza pandemic in 2009 was a fake, not a fake, but how do you pronounce this in English? Fake? Okay. And the Ebola 2014 was one. And the very recent ongoing Ebola outbreak 2019 was also a public or is a public health emergency of international concern. And now this is taken completely out of context. I know. But the first sentence they have is that the WHO legal department and the department of compliance risk management and ethics. So they briefed someone. Because I was thinking it's like a medical emergency, but they start with the department of compliance and legal, with the legal department. So now you are asking yourself, where do the zombies come in? Plan nine from outer space had a aliens who were chemically triggering the pituitary gland of recently deceased humans and they crawled from their grave and well did their thing. The classic night of the living dead had a space probe from Venus, which was sort of radioactive. And this triggered all the zombies. And the more plausible resident evil world was set or 28 days later, it was a biological agent. Now, 28 days later was very, very special because it was a movie about an epidemic spiraling out of control during a time when an epidemic was spiraling out of control during SARS. And when you think of this in terms of cosmic ripple effects, like the butterfly effects, I'm really sure, I'm honestly I'm really sure that presenting this SARS threat in a sort of movie where politicians can go to makes it explainable to them so that they actually do something. And it was a coincidence that 28 days later coincided with SARS, but I'm very sure that it helped to help the politician to grab the seriousness of the situation they were in. So, what's the Halbzeit score? The halftime score for the international health regulations is 0. And I have to say this, they are epidemiological plot holes in the movies. Because in epidemiology, you have exposure and outcomes. So, like you smoke cigarettes, you increase your risk of dying from lung cancer or you more likely die from coronary heart disease. However, dying from coronary heart disease has no feedback on smoking. With infectious disease epidemiology, the outcome is the exposure. So, you have nonlinear effects. Translating this into zombie movies, there's no way a zombie can sort of increase the radioactivity or that the zombie can increase the chemical exposure to something, because this is a linear effect here. Only with biological agents, you can have this epidemic spreading out. So, did we miss anything? Of course. This gentleman shows us that the WHO missed completely necromancy. And I wanted to make this as a sort of hacker contest or nerd contest, sorry, no hacker, a nerd contest for you to name them. I'm skipping that, but who can tell me, and shout it out, who can tell me who the most dangerous necromancer is here? It's not the white king. It's not the white king. Who is the most dangerous one? Shout out. My son did know the answer and he's eight years old when I was asking him when he was bringing him to sleep. Okay. It's the woman on the top right. It's Liliana Ves from Magic the Gathering. She's a planes walker, so her basic ability is to walk between different planes. So she's the one most likely to be able to come here. And then if you see her call the gate watch, please. Anything else? We have the Eurovision Song Contest. This is not playing now. Hold on. Wait a second. What did I do? Okay. Yeah. Eurovision Song Contest. Lordy. Hard Rock. Hallelujah. It's actually my favorite part in the video. You have this, this is poor heavy metal fan who get dissed by everyone and now she's getting her own zombie entourage from the cheer leaders. And this clearly shows that heavy metal can create zombies. So heavy metal as a threat, it's not an international health regulation. So we have two series fails here. And the score is now a little bit better for the zombies. And it's a bit of a joke, but I have to introduce you into a very important rule, the Beamt Regel Nummer 1, Zuständigkeit prüfen. And this is part joke, but serious. But when you work as a Beamter, like like I do, very often people want something from you, people want you to work. And if you can somehow make the point that it's not your your department, it's not your jurisdiction, it's not your Zuständigkeit. Well, you know, you would like to help but not my Zuständigkeit. So translating this to the international health regulations, the chemical, biological, radiological zombies are covered. But the necromantic and the heavy metal zombies are not covered. And translating this into a real world, a problem is the current invasion of the Asian tiger mosquito in Germany. It's an important disease vector. And it's a little mosquito, which is right now invading Germany. And you have the environmental agencies who are usually in charge of, well, like like rats and animals and also mosquitoes. And they keep saying, well, it's not our business, because it's a health problem. So it's the the health department's problem. The health department's problem says, Well, no, it's an environmental problem. So in the end, nothing gets done really. And it's a really, it's a real problem of agencies not cooperating and not working with each other. And so yes, Zuständigkeit prüfen is a problem. Let's talk about this algorithm on page 43 in NX2 of the International Health Regulations. And it basically determines whether or not you need to make a notification to the WHO. So all these algorithm, all this algorithm comes down to a yes, no decision, shall I notify WHO or not? If the answer is yes, you have a nice notification form. You will see this as a German form. And that is because, as I said earlier, every nation state has the responsibility to translate the International Health Regulation in national law. In Germany, it's called International Gesundheitsvorschriften Durchführungsverordnung or Gesetz. No, I think it's a Gesetz. And you can say, Well, yes, you know, here we have the other threat, so it's not smallpox, it's zombie apocalypse, and you can say something and you have to fax it. There's a fax number. And I think the fax number is hooked up to some email account, but the German law stipulates well, if you trigger a notification, you need to fax it to them. And it's not the commoners who send it, it's the health departments who send it. And the new algorithm is almost backwards compatible. You see the yellow diseases which were also present in the version two. This is International Health Regulation version three. It also has plug-ins. SARS is in it now. But most importantly, they added something, health threats of unknown courses, courses or sources or other events. So this would be the algorithm for zombies. It's a, I can't read it. Yeah, we have an event detected. And it's an unknown course. It's, yes, it's serious health impact, having zombies coming to your home. It's unusual and unexpected. So, yes, we need to notify it. However, that's not always the case. In World of Warcraft, under city, that's the place where it's a scourge, isn't it? The undead live there. So, I mean, zombies are undead and undead living in undead cities, nothing unusual. So it's not unexpected. And let's just assume for a second that all the undead of World of Warcraft stay there and they don't impede travel or trade. Then the notification is not triggered because it's nothing unusual. A real-world example would be measles. In the Ukraine, measles is, they have so many measles cases. It also has to do with the Civil War in Ukraine. But they have so many measles cases that if you were traveling by plane to the Ukraine, you would not trigger the international health regulations. However, if you were traveling to the United States, which are certified measles-free, they have an official certification as a measles-free, not region, but state, yes. This would trigger a notification. And the United States will lose their measles-free certificates this October, most probably, because they have an ongoing measles outbreak which is now ongoing for over a year. And it certainly does not help that President Trump is an anti-vaxxer. And yes, so let's talk about zombies crossing at points of entry. There is a paragraph 20 which says that the state parties, which means the governments, need to tell the WHO where they port, so the shipping ports, international shipping ports, and international airports, which of those airports have the capabilities to deal with a highly infectious disease case. The same is for ground crossings, but let's focus on the planes, on the airports, and on the ports. This is again an example from Germany. And as I said before, the international health regulations are about capacity building. So these are the airports in Germany which have this capability and the ports. And should you be anywhere in the world and have a highly infectious disease which could wipe out humanity, the best thing would be to jump into an active volcano. If we were married and I wanted you to survive, I would recommend that you book a plane ticket to Frankfurt and just like, you know, sit in the far corner of the airplane. And before you land, like three hours before you land, you tell the stewardess that you just came from a tropical region and then you have like high fever and you're not feeling well and you think you might have something really serious. That gives them enough time to get ready and to put you into their biosafety level four hospital there. The hospital is really, really good, but it took so long to build and it was built for smallpox eradication, but it had so much red tape and it took so long to build that once it was finished, smallpox was eradicated already. But it's still there and they have really nice tools and the local health department in Frankfurt, they are hard as nails and they're really one of the best. So what happens when you have zombies on a plane, on the passenger locator card? Let's say you have an event or you have someone with an infectious disease in an airplane, you get these cards for contact tracing. So all the passengers will get these cards so that you can follow them up. The only question is whether the zombies will eat you before or after they got these cards. But contact tracing is really important. It's actually one of the most important tools on the top left. You see the contact tracing that was done by my colleagues Lutz and Maya during a LASA incident in Germany. It was the first LASA transmission outside of Africa. And the goal is to trace the contact, to get them into, to observe whether or not they get sick, to get them to give them treatment and to make sure that you don't get more infectious contacts. The graph on the top right is our tuberculosis outbreak from 2007. But the more important graph is the one on the bottom. It's the Ebola outbreak in 2014 in Nigeria and let me just very quickly say that nobody so far was able to do what Nigeria did. It was absolutely amazing. You have 190 million people a country. You have an ill person with Ebola who against the advice of the doctor came to a 21 million people city. And the person lied about his Ebola exposure. And the Nigerian epidemiologists, they had over 18,000 visits. They had over almost 900 contacts. And they found 20 cases. Unfortunately, eight cases died. But within almost only a month they managed to stop Ebola in their country. And this is absolutely fantastic. And yes, let's quickly talk about the travel and trade loophole. Because you know, the moment you avoid restrictions, you see this point in the flow chart. The moment you are able to avoid restrictions and you avoid notification. And when you take a closer look at the paragraph 43, it basically says that you as the sovereign state are allowed to make your own laws, as long as your own laws are not more restrictive than reasonably available alternatives that would achieve the appropriate level of health protection. What is reasonably available, what is appropriate? And if you are a good lawyer, you can help this in an infinite loop. So my final verdict is a draw between zombies and the international health regulations. And if you really want to hack the international health regulations, you should either establish a cross-border trading empire, zombie organs, for example, and hire many, many lawyers. You could also take up necromancy lessons. Usually in death magic, the first spell is always raise dead. And there are a lot of instructions on the internet. Or you could just join a heavy metal band. And yes, again, special thanks to Dan from team 23 here. Yeah, that was it. Florian, that was quicker than expected, which gives us some more time for the Q&A session. So hopefully your friends in the Robert Koch Institute found the chat button and will come up with some serious difficult questions now. Do we have something from the internet? I don't see a signal over there, no. Do we have questions here from the people in the tent? Hi. You mentioned the heavy metal example, but you could also see it as the anti-vaxxers movement that goes from state to state. I didn't get your question. The anti-vaxxers movement. Yes. That is also popular culture, in a sense, that moves from state to state. Yes, that's true. You said the anti-vaccination movement. This is a threat. It's a threat for vaccine preventable diseases. Nobody in the Republic of Congo is arguing about the Ebola vaccine. That's what my knowledge is. But you are right that the anti-vaxxing movement in especially rich countries like the United States, also like Germany, that this leads to the lack of herd immunity. And if you do not have herd immunity, then those people who cannot get vaccinated, like children under one year, like people with immune diseases, like older people, like people with organ transplants, but basically probably everybody knows one of the few people in that category, they can't be protected. So yes, it's a threat to public health. And it would be very easy and very simple to mitigate this. Thank you. Thanks for your question. We're going to head over to the next question. Yes. So the question will start out crazy and when you get serious. So are zombies still considered to be human beings with all rights in some studies? Yes. Yeah and the serious part is have there been countries who are considered to remove human rights from people who suffered from some illnesses, some infectious diseases? That's a very good point because as I said here the purpose is to protect human dignity and human rights and I was very closely following in 2014 the Ebola outbreak and here it depends on your nationality. And I couldn't, I remember this example, I couldn't find the source but there was a person from I think Bangladesh and he was traveling from a non-Ebola country but nevertheless and that person was basically quarantined for a very very long time and his nationality was Bangladeshi. I'm very sure if that person had been European or if that person had been United, had a United States citizenship, he would not have been quarantined for such a long time. Then the human rights issue, it's self-defeating if you do not respect the human rights because in rich countries you wouldn't need the international health regulations because frankly our public health system is very strong but it's a catch-22 when you have poorer countries like civil war, countries with civil war, with a lot of corruption, with a lot of unfair with trade imbalances, people lose trust in the government and this happened in the Ebola 2014 situation and the epidemiologists who were very technical could not solve the problem and only when you had the anthropologists coming in and saying well wait a second these people have burial rites you can't just go there take them away. What would you do if somebody with a mask comes to your place takes away your child? Respecting human rights and respecting the dignity is the only way you can create trust in such a situation. What they did for example is they made the fences lower so you could actually see from the treatment areas they could see each other it's like you would have two tents there. They gave them free cell phones so they could call them so you must maintain dignity in human rights for cooperation even if you do not believe in human rights. I mean we all do but even on a purely technical ground you must respect human rights to get cooperation otherwise it doesn't work. Thanks. Thanks for your detailed answer. The signal angel was signaling therefore we have a question from outside the tent. Hi FG32 surveillance asks how well is the Berlin airport prepared for some innovation? I didn't get it. There was something with the Berlin airport can you can you just repeat it again sorry. Sorry how well in your opinion is the Berlin airport prepared for some innovation? Okay how well is the Berlin airport prepared for circumstances like that? I guess that one airport is really well prepared for that but are we gonna detail for that airport that we haven't used at the moment? It's I mean we are in Germany we love rules it's and the the international Gesundheitsvorschriftengesetz is quite old it's from 2012 I think and the country the no I think it's 11 and you must be prepared and you you people want money and and if you say look we have new obligations this is this is a federal law we have new obligations we need to do something so we we need to hire somebody so I'm I'm very sure that the Berlin airport is prepared very well and the thing is you need a hospital that can treat highly infectious diseases and the Charité in Berlin can do that then you need a good transport there and you need a laboratory the Robert Koch Institute has a biosafety level 4 laboratory that is 24 hours to 24 7 and all this stuff costs a lot of money and people were actually really keen to implement it because they they they but to answer your question Berlin is prepared yes no I mean seriously you you have a new law and and the first thing the administration does oh we have Neue Aufgaben we have new duties and for that we need new money and if it is a federal law there's nothing you can do against it you know it's like I really need new money and Munich for example Munich for example my Bavarian colleagues they they they got I think six six positions which do deal with international health regulation but at the same time they strengthen the normal surveillance and I'm really sad that my country my state Rheinland-Pfalz doesn't have a international point of entry so we we didn't get the money the Bavarians got all right thanks for that answer and thanks for the question we're gonna head over here to the tent microphone I think unfortunately you forgot one vector which is computer viruses jumping the air gap to the user so uh is it then four to three for the zombies maybe um so wait a second hold on hold on um so you you uh hold on where are we here so for that to work you you would need a computer vector which creates human zombies well okay I mean if you play too much computer you yeah I actually you're right I mean yeah yeah no I didn't think of that well it's not a health risk it's not a health free oh yeah that's the point it's not a health risk because it does not okay you have international spread uh yes you have international spread you have an international health actually yes you're right you're right I mean I was I was hoping for somebody to point out that Michael Jackson had a lot of zombies and Michael Jackson is not uh heavy metal but it doesn't work there there yeah if you can kill him with proper for this not a zombie say yeah yeah he's not a zombie no so that was the famous so do we have another question from the internet we don't do we have someone queuing up over here I can't really see that no we don't therefore we're gonna end up six minutes earlier than expected oh no there is one question oh yeah we're not gonna finish that and for you guys please queue up behind the microphone so we here we go hello thank you very much for your talk I was wondering if you could say a few words about how the monitoring is done at national and international level and how does big data come come in and briefly your pros and cons maybe um thank you you have to make a distinction you have to distinguish between low resource countries and the more the richer countries um the the low resource countries when they um a lot of them have the symptomatic surveillance um you do not have the interest the infrastructure of having a laboratory having a doctor everywhere and I'm not so sure whether our western model of having a doctor in a hospital everywhere is suits everywhere um but there you would have um symptomatic um surveillance for example for polio you have the acute acute flaccid paralysis surveillance uh everywhere in the world which um the the surveillance is when you have a lot of children all of a sudden who have a flaccid paralysis then you basically detect that and then you you jump in you you make an intervention you find out what's happening there um the the um the richer countries like uh Germany for example we have this mandatory disease notification and um if if we were uh getting diarrhea we were having a having an outbreak here um the local health department would get all our personal data which is also good because they are the ones who need to make he need to do the contact tracing they enter the data with your personal data into a uh central electronic system which is called surfnet and from that moment on um it it gets transmitted but it's transmitted anonymously so I'm working at a state level um health department and we only get the month of birth the the the the uh gender and the year of birth and and and the land crisis so um there is very strong data protection uh there and not even the robot core institute is um since we are the ones who transmit this data we don't have this data they can have this data either there is a very interesting development called demis um and I will I see my friends from the robot core institute cringe a bit um which is reforming the the the whole process but uh that's a different story and I cannot comment on other countries like um uh uh UK or like like France but in Germany it's it's very good that your local health department knows everything and um they are the ones you interact with they're the ones you build a trusted relationship they are the ones who go into your kindergarten when there is an outbreak they're the ones who go to the schools and and they are the ones who actually do the most important public health work work I'm only crunching numbers Florian from the looks like that also last question no one is queuing over here sure or did I miss someone no I didn't so three minutes to go three minutes we're gonna close earlier Florian thanks for explaining all the zombie apocalypse and the international health regulation that is your applause thanks for your time and thanks for answering all the questions