 Let me give you a couple of quotes from Nora Gat. She was a plins of prize winning journey. And she said, the tranquil days since the discovery of antibiotics, I've got the message is clear, we must drop our complacency and learn from the past epidemies or face the consequences. So that was a pretty... I mean then? Wydda i'r brolon yn y bydd i'r coronavirus 1972 yn y lleidio'r dysgu i'r byw口 ar gau'r bobl o'r informaeth o'i gweithio'r byw i'r bobl o'n datblygaethau penodol yn ypeth yysgol, sy'n bod yn ddigon o'r cyfnod o'i ffrifio'r ardal. Reitio y bydd? Dylai, ffotiu be? I think there's probably a bit of truth on both sides. Interestingly, since the last quote in 1972, we've seen around 30 totally new undone diseases, including such quite interesting ones as SARS, HIV, Mipovirus, which suddenly have got livened up the headlines, livened up the lives of people in Hong Kong who, during the SARS epidemic, one in three thought they were very likely to get us. A 75% said they would die. What about, you say both are true, okay, so that one is, why is the other one true? The other one is true that infectious disease, given even with all these plagues and rumours of plagues, I mean we're still in a world which has 6 billion people, we're still only talking about 50 million deaths a year. So they say, I mean, if you haven't, you want about 50 million, of course it's pretty rough. I think that's the point. The important point of the demographic terms that we have to put it in that context. Jeff, have you got any comment on those two? Yeah, I think both statements are true. Certainly HIV is the big lesson that an emergency disease can really become a world problem and shape how societies are living today so we can't ignore them. Definitely infectious disease is not a problem that's solved. I think the AIDS epidemic kind of put that theory to the rest, you know, we're facing things like cancer as a big problem. So no, it's infectious disease is still a big problem. I think there is an element of height, especially with birth, where there's people trying to mobilize resources and use some of these things to mobilize resources. It becomes difficult to predict, you know, just how big a threat is birth, so we know it's possible for it to evolve into a human pandemic. It could be a terribly infectious virus of people. On the other hand, it may evolve into something more like SARS, which is only violently transmitted to people and can be contained easily. Okay, we'll come back to Berkeley. What do we mean by a plague? What do we mean by a plague? If this word is used and used, it's sort of a scary word. What do we mean by a plague? Well, originally a plague was something sent, a pestilence, something sent from the gods which killed lots of people. So I think in terms, now in terms of people talk more about emerging infectious diseases and pandemics and epidemics. So an endemic is a disease which is there at a certain level. An epidemic is when it flares up and goes into new places. Okay, why do pandemics happen? And pandemics... I keep interrupting you, I'm going to keep doing that. Because you've got all these prepared speeches in the back of your head. It all depends. Well then, to sort of wriggle around the question again, it all depends. Because if there are different pandemics, they happen for different reasons. The HIV pandemic transmission was linked to things like global movements, changes in behaviour, human behaviour. Basically I think if we look at all the big pandemic complaints that there is one key factor and that's humans. Humans living in groups. Okay, are they more frequent now than they were? Probably they have a bigger impact, they affect more people but that's because there are more people around to be affected. But less frequent. Jeff, do you look puzzled? You don't look as if you're agreeing with that. No, I think actually you might be a point in your question and I think the way globalization, the way the world's changed. Transport is much more rapid. Things are moving around the world more quickly. People are moving around more or less. So there is I think an increased threat that these things can spread very very fast across the globe. But it serves a pandemic. 100,000 years ago probably the first epidemic of measles emerged from Rindepest possibly. And that must have caused quite a little flurry in the news media of the day. So it's not new, it's the context of our communication. Is it? In part it's also communication. And I get to the element of height I think in the developed world there is a understanding that people shouldn't have to die from infectious disease anymore. So when they hear that an infectious disease in the developing world might come into Europe and the United States. That's especially concerning. And TV and all this different media have a part in that creating a hysteria. If bird food got to the States now, a chicken died, I think you'd see everyone stay home from work for two months. That would be the real impact. Well, not only the height. Wyson McMichael would talk about these four phases. Four historical transitions in infectious disease. The one of the measles emerging from 10,000 years ago on. The extensions that happened in classical times when people started having battles and training. The explorations and colonization extensions. And now we're in the fourth historical transition which is globalization. Are you do agree with that? Is that a sort of reasonable description? Yes, I think yes. The plague probably started with the agricultural revolution which was 10,000 years ago and people first started to live with animals. The first agriculture revolution. Because that was the big neolithic agricultural revolution. I'm sort of playing down the 60s on or even the livestock revolution. Which may have gotten bigger in some of those factors. But I mean that brought humans and animals together. And of the emerging infectious diseases now, 75% are still hypnotic. So the biggest route to plague into people is from animals. What role has better diagnostics played? We now can do all sorts of things that we could never do even a few years ago. Maybe not the right person to ask that. Because I think better. More on the active surveillance side. It's more about finding the cases in these recent events. How do you pass diagnostics? But I don't think the limiting factor in instances today. Especially in development where we have very good diagnostics. It's finding the cases, getting the chemicals in to be tested. Okay, but has it changed our perception with all these new tools? We're finding things that may or may not be a problem. But I think we're finding things that we're able to distinguish between different forms of disease to see that there's a greater diversity in agents causing diseases young. That's true. Okay, looking at our target regions of South Africa and Asia. What are the greatest risks for these regions in terms of emerging infectious diseases? Both for humans and livestock. Well, I mean, there is going to be a pandemic flu at some stage. That is inevitable, almost inevitable. You think so? Unless we have another pandemic in the meantime, which decreases the population to such a level. I remember that the Italy which you attended, Roger Morris said that on a scale of 0 to 10, that his estimation of the possibility of a pandemic had gone up from 3 to 4. Well, I'm not saying it's high on that. Maybe a different perspective on the information, which is the historical, which is the past is the best guide to the future. It's not a perfect guide, but it's the only one we have. And since the 18th century, in the past 300 years, I mean, there has been an average of one pandemic every 30 years. So these pandemics come pretty regularly. And we don't really see why they should stop now, especially as a lot of the risk factors are actually getting worse, you know, in terms of poultry populations, vulnerable people, all the rest of it. And I think, as they say, any given year, there's about, just on historical evidence, there's about a 3% chance that this year will be the pandemic year. So it's going to come, but maybe not now. Well, what are the major dangers? I mean, clearly the ecosystem changes, and as you pointed out, human population growth and ecosystem interactions and urbanisation centre. So how do they rate versus the specific species dangers? So acquiring new infections from bats, for example. Bats are not nice things. Well, maybe if you're a bat. Yeah, I mean, the viruses, for example, I mean, we talked about diagnostics, but the problem is therapeutics. We've got great diagnostics. If they're healthy, they're sick and they're going to die. But in most of these viruses, we actually don't have any treatments, and that is a big stumbling block. Or the treatments are not, you know, the treatment may be like tamiflu, that may help the virus, but what about the cytokine storm, so that they're not effective? But you didn't quite, you're going back down. You didn't answer my question. Bats, I mean, we've got SARS, Nipah virus, Henry virus, I mean, bats are the nasty ones there. Here we've got the McCuller and Newman Harbour that are lurking about to emerge. Is that true? I mean, do you think bats are a little dangerous? I don't think there are a danger in comparison to any other species that have received another virus as covalent recently. I mean, AIDS was supposed to come from monkeys, wasn't it? So that seems to be a much bigger issue. I don't think bats are nice. What about the, you're at both epidemiologists, but we haven't got the balance here, because all virologists feel that new diseases are going to emerge as a result of mutations and genetic issues, whereas epidemiologists say that they're going to be from different post-agent environment interactions. Who's right? I think it's the same issue. I mean, what causes evolution? The new viruses are selected for by these different post-agent environment interactions. I think one of the trends we're seeing in making things more dangerous besides the mobility dimension is the density. A population density is going up, and in some parts of the world, the degree of human contact with animals and feral animals is increasing. So can these diseases be predicted? Can we predict when you knew of the easy emerging diseases? Can we predict that there will be the emerging diseases? We can't predict which ones. I mean, to go back to the bats. I got a quote from, I don't know who it was, and they are written down, but we must expect the unexpected. Is that what you're saying? In terms of pathogens in wildlife, a lot of these latest have come from, be it HIV or SARS or NEPA, they have come from wildlife. If I can cause another random statistic, they reckon of all the pathogens in wildlife, we know about, we have characterised about 1%. So 99% are uncharacterised. And there is nobody who is doing this in a systematic way. So out of that 99% we can be pretty sure of some. I mean, but come on. I said, can they be predicted? Not can we go and find the other 99%. We don't know whether they are ever going to emerge. Can you predict these, the emergence and what sort of tools have we got with our disposal? Go on. I don't know if we can predict emergence, but we can do a better job of early detection and carry the response. And I think that's the key lesson that we need to do. Certainly we can postulate and theorise and I think somebody said green and technicolor about new possible agents coming up, but the key that's predictable is some to enhance surveillance systems around the world to enhance sensitivity that these things are going to happen and that we need to deal with them in a logical and sustained fashion, not as one-off, let's rush and do the emergency type thing. OK, we can come back to that. I want to stick on the prediction. The Medical Research Council in the UK has just set up this centre for outbreak analysis in Neil Ferguson as the head of that. What are they going to do? What do you think they're going to do? What do you think they should do? Well, I would hope that there would be early responders to try and actually work out what's going on on the grounds at some of these events. They're going to model them. What will happen when they come in presumably taking all the food to the mouth and maybe food is not what they're going to do. Modeling is also an important tool if you look at like AI modeling informs us that if a truly pandemic human virus comes out, we've got about two weeks to contain it before it globalizes, and that means we're not going to contain it. So modeling can play a very important role. Do we have the right models? There's one from the Max Planck Institute along with the University of Santa Barbara that's been just published as one on banknotes tracking that they thought it would be a very useful way of understanding the United States. Most banknotes travel a very short distance but a few let long distances and they are trying to use this to calculate probabilities. Is that a reasonable technique I think there's quite a variety of models around. It always becomes a debate which one is the right model and I think the best way you can do that is to utilize them and compare them to the field data that's available. The problem is that many of these events the field data that we actually have is very sketchy when we get down to it. The actual information, the hard information about what Burt's who has done or how these outbreaks have evolved has often made a goal with that information. Okay, let's move on to the impact of these emerging human ailments and plagues on our target populations the poor. What has been you have described on alien food keeping away from alien food let's take Rift Valley Fever in this region. What has been the impact? There I think a lot of the impact has not been, I mean it's like many of these scare diseases the actual impact in mortality and morbidity is quite low. Rift Valley Fever has got a case fatality rate of only about one to two percent but the major impact is the panic because when people panic then they stop buying meats they stop buying... Which is maybe good for some people's waistlines but on the other hand it's very bad for the butchers and traders and pastoralists and people who depend on livestock and it's often the responses too sometimes even if you removed all external agents if you removed media, government, NGOs communities might be able to cope with these. What a thought, what a thought! But these are the people who are here to solve problems and make things better and actually it's what they're doing which is causing all the problems. Ficking up on that point how do these diseases then taking the example of Rift Valley Fever how do they rank the more endemic diseases that we have to deal with in sub-Saharan Africa and Asia today how do they rank in terms of our ability impact on... We do these pathways our markets, livelihoods and productivity does that help to start thinking about that? Certainly on the human health side the impact is the direct impact is not extensive for the ones that I've been involved in recently HIV-AIDS course is the exception but even if you look at burglue Indonesia has been 80 deaths or something 80 cases so that's an extremely rare disease but it has a tremendous impact because people worry about it in the cities and the price of poultry can fall in half based on a ruler in a country but the actual death loss and man is very small same with Rift Valley Fever the big impacts are on the markets that are in the Rissa that shut down the pastoral economy and all the spin-off effects like the schools couldn't beat the kids because the pastoral students didn't pay the school fees so they didn't commission a happy time money for that I'll change the subject yesterday we heard quite a bit about climate change and the impact of climate change and we didn't talk about it the impact on disease my reading is that the west is really worried that climate change is going to expand the distribution of vector-borne diseases what are you going to do here? I think we've already seen at Rift Valley Fever expressed through the region of becoming more of a problem over the last 10 years reaching the Middle East and Saudi Arabia blue tongue spreads throughout Europe becoming a European disease those kinds of things but those are all El Nino-associated sub-mosellation-associated genome, right whereas filled data on southern Africa shows that the event of the growing period is going to drop dramatically isn't that going to make the risk of that to all diseases best? if things became drier cooler I would suspect so but I think the general trend is towards warmer and I think it's going to be quite complex I think what we'll see is the range of vectors changing over the years and diseases that were problems in some areas that have become problems really may disappear from other areas well I think the vector-borne disease obviously if it gets hotter and drier vector-borne diseases will be less of a problem but the main problem is not the actual disease it's the change because whenever you get change you get expansion whenever you get expansion you get movement into immunologically naive populations so whatever happens I'm going to say that ok now we're going to want to what can Illry do about this what can we do, escape the Rithvallifee that you talked a little bit about what can we do what can we do now back in when Glyn Davis who was at the vet lab in Narrowby years and he must have left 15 years ago and Ken Linsicum who was operating out of Forteatrix they did all this satellite prediction of when Rithvallifee was going to come in I mean did we have we really developed that we did we thank you very much but it actually tells me exactly if I've got 11 minutes this has been in place for ages I don't see it being used effectively so my question is one is the technology and two is what else can Illry do in that sort of way I think the technology is good but one of the problems with the technology for predicting Rithvallifee is that it's not it's a little bit too sensitive I mean even a broken clock is right twice a day and these people predict Rithvallifee quite a high number of years and sure enough they've got it right this year but they've got it wrong in the past and that made people a little bit less willing to jump up and take action but also it's very arguable it's very likely that even if we had 100% precision in prediction I think we still have an incredible challenge in delivering preventative and doing something about epidemics outbreaks in these remote isolated areas of minimal infrastructure and basically self-governing We've got the unexpected and we've got the ones that are expected but every few years how could you you mentioned earlier on this morning about having response mechanisms that are more generic could you elaborate a bit on that? It's too related we've got a plethora of early warning systems not just for Rithvallifee and I think people are recognizing us we have alphabet soup of early warning systems but no one is listening decision makers aren't taking the decision even when the information is there how do we change that? We have to look at what's the decision maker was driving him the policy maker and then try to find the information that will actually get him to take action and I think that's true whether it's a drought or a famine or rural valley fever on the system side we need good accurate information on what's actually happening in these remote areas as Rithvallifee has said I just want to get back to your your alien food that you were talking about one thing you didn't there was a paper game out from Alex Berman and colleagues a couple weeks ago which I think you saw the new paradigm of controlling alien food what is the new paradigm? I don't know the new paradigm I do know that the thinking is shifting to the disease that we're going to have to live with and that we're going to have to be thinking about ways to suppress the disease to reduce the risk of a virus infecting man because that's the event that's high risk when the virus could evolve to a pandemic strain so I think there's a hardship in thinking about what kinds of interventions can work and that one of calling and vaccination operations aren't going to do anything but really looking at how can we suppress the disease while preserving people's livelihoods and live with the disease until hopefully it evolves away there's going to be another food epidemic it may not be H.I. then one but there's going to be another one that's the everything in all of the disease so do you think what's a new paradigm in your youth in H.9 and 2 is just as likely to work I think one new paradigm as a time is probably enough so I'll stick with Jeffs and agree that a lot of these we have to live with but also we have to I mean it's sort of symptomatic of most human diseases that the things we fear and the things that kill us are completely different so people panic over B.S.E they stop playing hamburgers they get rid of the ministry of livestock over B.S.E which is basically what happened in the UK but then when they're out panicking they have a couple of beers to relax themselves and a couple of cigarettes then they calm down so I think we need a whole new way of dealing of understanding particularly I think we're very vulnerable because the major media and in the West the people are at great risk of these movement of disease and the rest and yet the situation for our clients is quite different last question how are you going to do that what is going to be your major new initiative to change that perspective how are you going to do it what is the risk based approaches so this is moving away from the presence of hazards from just the pathogen is there help run for the hills what is the risk to human health and what is the likelihood of it happening so first of all how many people are going to die what is the probability of this and what can be done about it and this is a much more rational and useful way of looking at disease the problem is communicating that and trying to make this a more common way of looking at disease ok Dya and Jeff thank you very much indeed very good