on c-span and online at c-span.org. if ♪♪ >> c-span is your with unfiltered view of government. we're funded by these television companies and more including charter communicationings. if. >> charter is proud to be recognized as one of the best internet providers, and we're just getting started building 100,000 miles of new infrastructure to reach those who need it most. >> charterommunications supports c-span if as a public service along with with these other television providers, giving you a front row seat to democracy. >> next, a look at current health threats from global outbreaks and lessons learned from the covid-19 pandemic. we'll hear from senior cdc officials and the agent she is' former direct. the center for strategic and international studies hosted this event.

[inaudiblele conversations] >> good afternoon, everyone. welcome to this csis discussion. i'm very pleased to honor our guests here today, and i'll introduce them in a moment. but we are going to be discussing cdc's global mission and the integration of a more global strategy that the agency is leading. i'm julie, i am currently the

president and ceo of the foundation for the nih, but i'm wearing a different hat in this meeting as the co-chair of the csis bipartisan alliance on global health securities. my co-chair and i, i welcome you, and and i will make sure we have time for questions -- [inaudible] if prepared for that, and is we'll invite you to the microphone to participate in the conversation. we also welcome our online guests and hope that you enjoy this discussion. so why are we here? well, we're here because we are operating under the basic premise that biosecurity is national security and that cdc has an absolutely critical troll play in that. bipartisan a aligns -- [inaudible] in helping the cdc build its capacity in this regard and really look at what is necessary for the cdc to, in a sense,

recover from some of the issues that emerged during the global pandemic. we had a wonderful working group under the auspices of the alliance led by steve morrison and tom ingles by from johns hopkins university that really examined what was going on at a cdc, what were the opportunities for improvement, what were the strengths, where wereim investments needed both actions by cdc, but actions on behalf of cdc to really respond to what i think was found by some of the working group's report, the cdc is in peril. and yet it isor so important to our i national security that it was an urgent priority to step forward and try to understand what could be done. so in january of 2023, csis published a report building the cdc the country needs. there were many stakeholders and and experts who participated in this working group report, and one of the things that you'll

hear today if you saw that report is that our leaders from the cdc have already taken steps to respond to some of recommendations in the a report. particularly two recommendations that specifically address global health issues. first and foremost, what really was the best way to integrate cdc's global health work with it domestic biosecurity agenda. and then second, what were the investments, the budget, the work force, the practical policy, etc., that cdc really needed to acquire in order to successfully fulfill its global mission. in the time since that report, there has been significant progress. i just want to fake a moment to highlight -- taken a moment to highlight some of those areas of progress. in mar, the cdc director has been very visible globally as

have some of the cdc leaders who are here today. regional offices have been opened around the world to try to coordinate cdc's agenda, particularly its global security agenda. and specific investments have been made, but i think what is probably most exciting for us is really the recognition that the whole is greater than the sum of the parts. and by coming together as a whole of cdc, we can really build on the vertical strengths and capabilities of the agency but move them in a direction where we have a more powerful, a more visible and i think a more successful global agenda. so let me introduce our panelists. first, i'd like to start by introducing kayla who's the heae global health center at cdc. sitting to her left is dr. dan jump began who's the director of the zoo nottic and infectious diseases. and doas you pronounce that --

[inaudible] [laughter] >> [inaudible] [laughter] just checking. and then sitting next to dan, on dan's left, is dmitri who's the director of the national center for immunization and rest rah pa story can diseases -- respiratory diseases and a leader particularly in the hiv arena and someone who i've long held in highest esteem. and then finally at the other end of the panel is henry wok who's the director of the office of readiness and response, someone who was in the hot seat during covid but continues to provide a really unique frame of leadership for the cdc. so what i'd like to do is just maybe give our panelists a chance to say a few words really focusing not so much on what's ahead in the context of this strategy, but what's already been accomplished. what a actions have you taken since, maybe since january of 2023 when the report came out in

but in the recent months that really are kind of moving us in a new direction. so, kayla, i'll start with you because i know if you have probably the overview of the overall strategy. >> great. thank you so much. can and thanks to everyone for being here and everyone who's online. today we wanted to talk talk a little bit about a sort of a unifying strategy, unifying if framework for cdc's global health work. and it really fits in to the cdc director's 2024 prior des of readiness and response -- priorities -- to really look at a data infrastructure and modernization, lab quality and safety and overall risk-based pathogen priority station. so this global framework really fits into those larger 2024 priorities. and we've learned a lot other the last few years -- over the few years especially from covid both domestically and globally, and we wanted to put it all together in our global work.

we know that in order to protect the u.s., to protect the work and our lives here we need to be working globally to do that.. and our global work leverages many of the platforms that we work in overseas, much of the work that we do with pepfar or the president's ma a lair ya -- malaria work or any of the work in influenza. all of that global work with leverage both for those vertical programs, but also horizontal ally to build systems to have system strength for our global work. and so when we work overseas, we have 20, we have over 60 country offices and 6 regional offices. and we really work shoulder to shoulder with ministries and with government and with the community in the countries where we are. and we really have is are a trusted pickup -- have a trusted partnership. and we are, for that reason, the first call when something happens. and we've seep that repeatedly and especially since covid.

but that has been going on for decades. so it's really important that we with frame our worth: and so we've put together a global strategicc framework which its elements are are not new, and its core capacities and the mission have the -- and the vision is are not new. but the framework is a new way of frame thing, and it's a way of insuring that across the entire agency, across all our different programs and centers, in our country offices and in our regional offices we're all a working together kind of in the same, pushing in the same way, pushing in the same lanes to be the most effective, to be the most efficient and to have the most impact. and the framework really has four major goals to why we're working overseas. the first goal is to stop health risks at hair source. and that's cdc's really fundamental goal,ir stopping outbreaks at their source so they don't move anywhere or to the u.s. the second is to prevent or

contain disruptive outbreaks. this isth the dengue, this is te cholera that may not move, but it's very disruptive to societies, to economies, to the health of nations. and it's very important to work on that. the third goal is really around global knowledge and and how we can use it both globally and domestically, and that's something like our influenza strains that we know from around the world that help go into our vaccine. and that global knowledge of disease elsewhere and how we use it domestically is very important.gl so that's the third goal. and the fourth and final goal is really the platforms that we built that really prevent morbidity and mortality. again, that's the pepfar or the malaria or the flu or the antimicrobial-resistant platforms that reduce morbidity and mortality but also serve as a platform where we build system strength so we can then respond to outleak breaks. we are working in clinics and

training, and those help in all of our work overseas. and there are six pillars that get us to those goals, data and surveillance, laboratory, prevention and response, innovation and research, work force and institutions and communication, policy and diplomacy. so through all those pillars of work, we reach those goals. and so what we want to do today is to share with you some of the ways in which the most recent outbreaks are really showing how we'ree using that framework, we're working within that a frame if globally and how it connects to our domestic work and vice versa. >> so, kayla, what i'm struck by in your conversation here is that none of this has a decide name, right? >> that's right. >> we're talking about the cost-cutting capacities and capabilities that really

distinguish cdc's expertise that you can apply to whatever the threat is whether it's a domestic threat or a global threat. and we certainly have plenty of those in play right now. so i thought maybe i would ask dan to start by talking a little bit about -- [inaudible] and how that's playing out and and how this approach is illustrated in the context of this arguably primarily global outbreak but certainly with u.s. implications as well. >> sure. m poxox is one of the pathogens that sits within the national center for -- and infectious diseases. but to your point, it requires the all-agency activity force the really respond to it. we did have cases of the clay 32v which is the case we had previously, 30,000 in the united states. what we have right now is something happening in the democratic republic of the congo called clay 1m pox which has higher severity, higher

transmissibility. we're seeing about 4,000 cases from the first part of this year. and p it really demonstrates the threats that we have with emerging infections. the world is more connected than it ever was, so you can get from democratic republic of congo anywhere inn the world within r incubation period. the world's more crowded than ever before, and the worlds of animals and humans are really converging like they never have before. and right now m pox is showing that, row dents giving it to kids, kids getting it within the family, it can is sexual transmission outside the drc. so we will be able to have that capability within the united states to havee the diagnostic test,s to have the right -- and in this helpswo us to say what data do we need in the united states, in the dc, what's the coordination between the team, the folk ifs being deployed, the laboratories that we have in the

united states. we need to think of this across the spectrum from domestic all the a way to global so that we're not inhibited in one place or the other, but thinking across that spectrum and how do we use the full breadth of all the different capabilities we have across these different certains and across -- in order for us to have the most optimal response and keep m pox from coming in and causing another is set of cases in the u.s. >> potentially even worse. >> yeah. >>of yeah. so in thinking about how you actually implement that response, one of our greatest strengths globally is the pepfar platform. so i don't know, dmitri, can you with say a little bit about how that vertical gets leveraged in the context of this new strategy? >> sure. i'll say that, one, i think it was remarkable seeing pepfar in action in cambodia with when we went for to our visit there. it was really important to see sort of how that is leveraged

globally. and really that was t also reflective of how the work happened domestically during the outbreak. and i think sort of thinking about that very clear equivalent is f ryan white. and so i think very sort of similar lessons from the sort of global and the domestics were converged and in that looking at the sort of hiv platform global arely and domestically to really reach communities that needed to be reached but also address some of the gaps that are the well known inss hiv treatment and prevention and how that would exactly sync to the populations that were having the worst outcomes for m pox. so i think it is sort of in the image of this framework where we're in a disease-agnostic way stepping back and saying what can be leveraged and how far can with we push it. and i think that's some of the great leadership sort of shown in bringing this all together to work onn this framework demonstrates the importance of really saying where can we leverage, where do we have sort of infrastructure like influenza

which is now the center that i look over, how do you leverage that not only for our seasonal flu, but also more emergent pathogens that we're seeing and also many a more pan-respiratory fashion. so thinking about the lessons, it really is a pathogen-agnostic strategy where how can you leverageag the platforms, look t the laboratories, the relationships, the diplomacy, you know, the data and make those systems work together to achieve a better public health outcome. >> i think we all realized in covid how important the pepfar investmentsco were as well as global fund investments mt. countries -- in the countries that had an infrastructure for laboratory and surveillance and the capacity to understand -- and convert it into tools for covid, etc. that's kind of a cult knowledge because most americans

understand that that was incredibly important in supporting outbreak response many many countries. and it was a value from that investment c that i don't thinke predicted back when george bush invented pepfar. so -- or when that leveraging a capability really gets us far more than we bargained for. we'll come back to this whole issue of funding and budgets where both verticals and horizontals. but i want to bring henry into this conversation a little bit. so we have another very worrisome situation emerging in the u.s., and that, of course, is the avian influenza. if you're a bird, it is a pandemic e, right in. [laughter] -- right? and certainly even this week we learned that pigeons, which were thought not to be susceptible to h5n1 now at least, i think, in michigan have been shown to have been infected. but i want to talk a little bit about dairy cattle, because i know that's what's on people's minds. you're the head of the i

preparedness and response center at cdc. what's going on in your center domestically and internationally in this context of this outbreak? >> right. well, you know, domestically we, cdc, are trying to coordinate together across multiple certains. stood up, actually, it was in dmitri's center where we stood the up a management system to help coordinate if all the activities. there has been one case in texas, human case, so far. certainly, we're detecting it in multiple herds across the u.s. which requires that collaboration with other sectors, usda a, basically, and fta within hhs to make sure that milk is safe. so this is an interagency collaboration ase. not only an hpai, this particular outbreak, but as it was in ebola, as informs zika, as it was -- it was in zika, as it was in m.-pock, it's not just cdc coordinating within it, but across hhs and coordinating

across the interagency. if so domestically usda has the lead on the animal if side. wele obviously have a lead, a competing role on the domestic side. we continue to try to investigate if potential cases on farms, but it's actually been quite difficult to get access to some of those farms and understand understand the epidemiology and where the missing is. so we are -- risk is. so we are supporting the states, supporting this migrant population that's actually working on the farms. it's a difficult population to reach, so we're working with various partner organizations to try to gain that type of trust. so with we actually can do more ofs those epidemiological investigations. fda is responsible for the milk, for the quality of the mil, and so we're working quite closely with fda. and you'll see a lot of information coming out around pasteurization of milk. yes, the milk is safe.

don't drink raw milk. it's not just h5 you have to be concerned doesn't ash a. [laughter] >> thank you. >> so i think within cdc certainly we have multiple groups engaged in including dmitri's center. we have our one health group is dan's center that's e engaged. and we have, actually, a forecast in analystics as well to try to predict if this does take off, you know, what does the future hold. fortunately, now our vaccines, candidate vaccines will work, our anti- our laboratory testing, we can pick up this particular strain of h a 5, and our therapeutics as well also work. so it's very reassuring at the moment. we are -- we need to learn more about where the risk is on these farms. if then lock term -- long term is our sur vale lance in these cattle. is it milk if surveillance, is it herd surveillance, there's a

number of -- >> or wastewater. >> and, of course, there's wastewater. and you'll see some more results coming out, actually fairly sooa dmitri -- [laughter] >> around waste water. >> so, kayla, or right now we're kind of managing this as a u.s.-centric situation although h5n11 is not just a u.s.-sent reck problem. -- centric problem. but yet communication has to be relevant globally. and i'm sure there's a lot of anxiety on the part of the food production industry in terms of trade and the global impact of concern about the safety of our cattle industry, etc. so how are you managing the global communication around this kind of unfolding? this is the hardest part of an outbreak, is the early days when there's soth much uncertainty. how bad is it, how bad will it be, who's affected, how far will it go? you just don't know.

how areu you handling that tha? >> yeah, thank you. so a couple things we've done so far, obviously we have, you know, everything we have on cdc, you know, web sites are pushing out to all of our partners, all of w our global parking lotter ins, but also we -- partners, but also we just did a webinar with our country and regional or, you know,. >> cdc teams to make sure everybody was fully informed, had a chance to ask questions with. we just met with state department and talked about ways in which we can push out, you know, another seminar and webinar to get everybody sort of up-to-date and aware of what's happening and make sure that questions are answered, keeping that awareness very high. if countries are interested in getting engaged or looking at a surveillance, we want to be able to support that. right now it is mostly domestic, as you said, but we are insuring that all of our partners' global offices, everybody is aware and ready is and watching so that in case anything, you know, is needed, we're right there. but for avian enflew went sa in cambodia, a different plague,

our teams there were right on those cases. itit just happened recently. in fact, a couple happened right as we were there. and so there our teams are well trained and ready to respond and did respond quite quickly and with the sort of capacity that they have from the work we've been doing there for years and also in the whole region. so, again, that was sort of a u.s. global sort of link between all of this. in one of the strengths of cdc is the international work force, although t not as optimized as i think it could or should be, and that t was one of the findings f the csi commission report, that there's been credible investment in talent and public health -- that we have is still not managed as a global asset. it's managed as often they are putinic area or -- therapeutic area or an assignment on a

temporary basis with no career development and career planning. will this strategy be able to help address that opportunity to really strengthen the work force internationally? enter so, you know,re one of the strongest parts of cdc work force overseas is, is a locally employed staff, right? almost 2,000 locally employed staff around the world, and we end isn't, you know or a lot of -- spent a lot of energy and investment to insure great training amongst the staff whether they're trained in epidemiology, in the laboratory, response. and now we're having more and more punts -- opportunities for those staff to move from country to country, to move assets from country to country. andro so the development of the local input staff staff is extremely important. and on top of that we have the field epidemiology training programs and we have the emergency managementve training, we have laboratory training. so we are building the work force overseas through all these different methods bringing people to atlanta for training,

for sort of rotations throughout cd can c, throughout washington sometimes the -- cdc. so we're really trying to build up that work force and also have that cross-communication with the work force overseas. >> dan, prior to your current role as the -- i'm not going to try tong say it -- [laughter] [inaudible conversations] >> i, you had responsibility for data modernization efforts, were very much involved in that effort. tell us where that plays into this global strategy. >> yeah. i think kayla mentioned the different pillars that are let'sed in this framework, the first being data and surveillance. and so really we see that as having an interoperability desire, a component. we want the data to be able to be shared. so if you have collecting informationn through dhis or one of the systems used in country, it's able to be shared with other countries but also shared

with the u.s. and and other partners as well. newe want, that information to e used for making decisions too. and so having that data available so that the you can get the right policies developed from that quickly, that's an important part of thatkl data ad surveillance part as well. i think other thing that is we want are the ability to have that data available to the informed people as well. so right now we've got an emerging problem with den guy in the united states -- excuse me, in puerto rico, as well as in central and south america with lots of cases likely to occur. we wan to be able to have that data from el salvador, honduras or wherever with, be able to be presented so that people around there can see, oh, it is increasing. we need to take care to make sure that we're looking out for those cases, get them in the hospital, etc., and that we can monitor that in the united states to see what's happening and likely may happen in puerto rico, which we think is the case as well.

interoperability for decision making can be seen and lead people to do the right thing. >> so, or you know, when you lookt at the strategy and the x pillars, who could argue with the importance of the six pillars? but they cost money, and we're dealing with a very difficult budget situation across the board or in the u.s. government but particularly as it pertain it is the -- pertains to the cdc and some of our other agencies. so, you know, went you think about the pepfar e authorization challenge and the fact that pepfar wasas only reauthorized r one year, that was -- it felt ominous, to me. what is that saying about the perspective of our government on our global health investments and the long-term value that we've been able to deliver that not only in terms of human health and the incredible impact on -- [inaudible] but also on health diplomacy and the respect and trust that the united states has earned internationally in many

countries as a result of those investments. rso so here we are now. we've got old ideas about how to do a better job with our global biosecurity, and yet i don't think you have a big budget line for this particular effort. so how are we going to get the story out there? how are you approaching the importance -- and maybe i'll ask all four of you to answer that, because you're probably all playing a role in that. what can be done to make sure that people understand the central and the importance but also the opportunity that this strategy really presents for the u.s. government and our national security? .. if and preparedness for unexpected events like bovine transmission

of h5n1. i think that is part of the storytelling. i think we can tell the story of cambodia to the work that happens in cambodia and really i think remarkably these visits in the bingley were because our director can speak about it very clear terms and we can speak about an clear terms. in cambodia you actually saw the cdc infrastructure in action and nowtu that mattered months later when we had some of the outbreak of h5. seeing what happened in the village where we had the kids and other moves into the clinical relief that is supported by the ta that's so important cdc and that support the care of individuals diagnosed with it in cambodia. then moved into the laboratory where after identification of the case you had sequence at that told you exactly what you did with, let you assess what, the risk is, , think about

antiviral, think about adaptation also think about the vaccine candidates that we have. so i think sort of thinking that's far away, but we did the same thing in texas, and sort of making the point that train the system to allow us come the global work that was not only creating the security and understanding of what is circulating in the world so we can build better vaccines next back season and have better vaccines in baking casee that surprises. the other piece was an exactly train the system which we were able to go from there is a human with conjunctivitis in texas to 24-36 hours later having a risk assessment about the sequence up and available for all the world to see, really creating both appropriate concern and adequate reassurance of where we were that day. part of it is making sure we tell the story and that we

connect the global into the domestic and the domestic into the global sense though i think repartition it, some ways because the way things are funded. ultimately the wayar we're actig at cc for that to flow from domestic to global and global twos domestic in a seamless way. >> if i could jump in. a couple examples. what comes to mind is in pox with healthcare workers actually, translation of the work led to the use of the vaccine in the u.s. but that story is not told. so telling that story, the work they're doing an ally after an other countries really, telling the string translating it to the american people andnd for congress.

i can think of the work of ebola, for example, in uganda. a lot of work done in uganda. this is ebola sudan. we have been working with the ugandan public health for the last copiers and have the capability, the government stood up and contain the outbreak. based on some of the work we've done in the lab in uganda a decade prior. the work that was done in equatorial guinea, that was a nice collaboration with usa and department of state and the cdc getting people underground in a very difficult environment to contain the outbreak. but part of the issue here is that we invest in laboratories, invest in people, we invest in surveillances, and early detection and containment. it's hard to describe prevention. it's hard to show the success of what we have prevented. but talking more about it, talking about the counterfactual, for example, of what would've happened actually if we do not have triticum didn't have laboratory testing,

have not done workforce training, i think that's important as well. >> we are in an environment where trust is not high in any institution is not hight but trust in the cdc is probably still on the low side from everything that i've read. well, there's some partisan dimensions to that of course. so t dan, you've been at the cdc for a long time. you were there when trust was very high and you are there would trust was very low. when you are thinking about how to get the word out about the value of cdc, who are you going to talk to, and what do you think is the most important thing for a budget decision maker to understand? >> this is a great question. there are several angles to that but in terms of us speaking more. we need to communicate moree clearly, more often. we need to be transparent in what we're saying. we also need too able to listen as well. i think we really learned that

over the last several years especially the last year for me, just that there are things that we say, individual out there they don't hear it the way i think i'm saying it. so it really is on us to be able to understand where people are coming from, listen to them and adapt that message to get the highest amount of people being able to do the right thing to protect their own health. of communication is needed if we're going to build that trust back. >> we are going to take one store you would like to tell, what would be the story? >> from the global standpoint? sure, one comes to mind is antimicrobial and resistanc. this is an issue, think of it at a hospital thing on long-term care facility thing but it's really emerging across the globe in the community as well as healthcare facilities to the point where we will not have any antibiotics to treat people. so in the united states we

actually, to your point about having networks and laboratory capability and epidemiologic capability, we were able toto pk up infection in the eyes of some long-term care facility residents where they were getting passed in the eyes. i for completely opaque and having really bad infections.r it led to send that off to laboratory got to a public health laboratory where because of antimicrobial resistant support and genomic sequencing support they were able to actually say that that was a suit in almost which is a kind of soil bacteria. that was resistant to 12 different antibiotics. that's a really bad bug. we also found there were several of the cases in the united states. it turned out those individuals have opened using artificial tears which used to whet your eyes when you have a problem with your eyes. but we found out in fact, it was

from india and it was an affection but not seen in the united states. that particular pattern that resistance that was only seen in india, we are able to find that, stop it at the source, and didn't prevent the that tran from happening in the united states.s. but we still have bacteria that's periodically showing up in some places. itit just shows the domestic and global are highly connected, lots of ways itdo can get there. the world being more connected, convergent, all those things are happening now and went to work together for us to be able to address those problems and stop things like the eyedrops problems. >> kayleigh, i knew you served in india for many, many years and had a very pivotal role there in terms of building a partnership within the alliance's with public health in india and the cdc perspectives. that kind of diplomacy is really

critical for help, but it's also critical for broader national security, global security issues. issues. can you talk a little bit about how the strategy reinforcesou that? >> if you look even at that last pillar which has diplomas in its name, communication policy and diplomacy. really the fundamental backbone of everything we do is diplomacy and health is diplomacy. so working in government, working next to somebody, often our offices are actually in the ministry of health so we we'e working really closely with the ministry of health. that creates those partnerships, creates the trust you are asking about, and it needs we can bring in our scientific expertise. we can support. we work together. when something happens and we are not there or not in that place at that time, we are the first call. if something like this could happen, any of it, we get that

call first. we can either people in country or go there and we are trusted to go there, where trusted to be able to support and help. that diplomacy is with the backbone of all of the work we do. really pepfar, going back to question mark pepfar, pepfar built that over decades. that kind of relationship, that kind of trusted partnership. all of the examples we just heard about all those different outbreaks, all built on pepfar, on the platform of pepfar and all that laboratory surveys and sedated. those platforms are what allow those outbreaks to get identified and and responded to. it's both diplomacy and it's also the system strengthening that gives us that kind of relationship and our ability to respond. >> we also have to sort of think if we're not they're doing this, who will be there? and will theyy have the same relationship with the u.s.

government that we would like to have with our allies? so there's a global competition for allies at the moment, as we all know, and that's another dimension of this that doesn't really seem at face value like a public health issue the openstep way from it is. in a couple of of minutes ongoing open this up to questions from the audience so be thinking that your question. i think the microphone is over in a corner so we will ask you to step to the microphone and please just may be fine if so we can go quickly to the questions. we will probably ask a few questions and give the panel a chance to respond. but before he moved there i just want to remember that a strategy is a grand thing. it has to be budgeted. it has to be socialized and that's what we're doing today is getting input and feedback. but it also step measures of success.

in one short kind of soundbite, how would you know your successful and what are you most interested, say in three years, what do you want to make sure has gotten accomplished? i'll start with you, henry. >> first of all, but he say that we do need to measure our accomplishments and we are working on performance metrics as part of the strategy, trying to dig deep into the six pillars and across the four goals. one of the ways from the least is stopping outbreaks at the source. that's a fundamental piece of this, helping countries where we see an event as an emerging threat, how are we cdc and just government able to contain that either within the country or within the region very quickly? that can be one of our successor. >> i would say just to build on that, measuring those pillars. those are the things that will get us to those goals. so where are we in each of those areas and how to identify gaps

and then how do we intervene? and measure our progress. so those pillarin metrics are important too build the system. >> do you have a favorite pillar? [laughing] >> data and surveillance. >> i knew it. >> army i think if we have in place in strategic locations capable laboratories i can do genomic sequencing quickly, that would be a success we can identify. identifyen emerging pathogens quicker there, they get that information quicker. we will have it and we can act on it quickly as well. >> its foundational. >> absolutely. >> i'm going to echo what dan said which is really about how the laboratory interacts with surveillance to accelerate what happens on the ground. so that for me would be probably the strongest mentor, which i think frankly blends some of the

pillars into this event is peace and the lab peace and efficiency. you go from there someone who is sick too like we have a problem, should we have response. >> so the field of epidemiology laboratory training programs really build the capacity locally because it's one thing to set up a lab. it's another think it would operate it and maintain it. so it gives us hope. those are concrete things. let's move to the microphone and have q&a. >> my name is jerry martin. i am currently faculty at the school of veterinary medicine at tufts but prior to that i ran a series of avian influenza control programs funded by usaid called stop ai, and unity based avian in indonesia. and other programs including directing the preparedness and response program. so the purpose for that