SEAside Webinar – September 6, 2018 – Preparedness and Response for Public Health Emergencies

>> OKAY, GOOD AFTERNOON, EVERYONE, WELCOME TO THE WEBINAR, DISASTER PREPAREDNESS RESPONSE, MISSION OF THE ASSISTANT SECRETARY OF PREPARENESS AND RESPONSE MY NAME IS AMY GOGAN, THE DATA COORDINATOR FOR THE ATLANTIC SOUTHWESTERN REGION BEFORE WE BEGIN, THERE ARE A FEW THINGS I WILL RUN BY YOU ALL I HAVE SOME QUESTIONS I PUT IN ON THE SLIDE IF YOU WANT TO ANSWER THEM, IF YOU WANT TO SHARE ACTIVITY YOU HAVE DONE TO BE UTILIZED IN THE BATCH PREPAREDNESS, FEEL FREE TO SHARE THOSE IN THE CHAT BOX ALSO I AM HERE SHARING QUESTIONS IN THE CHAT BOX SO PLEASE BE SURE THAT THE COLLEAGUES CAN SEE ALL THE QUESTIONS AND THINGS YOU SHARED AND WE WILL ALSO HAVE TIME FOR QUESTIONS AT THE END OF THE PRESENTATION IF YOU NEED THE CLOSED CAPTIONING, I AM GOING TO PUT THE LINK TO THAT IN THE CHAT BOX RIGHT NOW AND THEN A SHORT BIO THE SENIOR SCIENCE ADVISOR TO THE ASSISTANT SECRETARY OF DISASTER RESPONSE AT THE DEPARTMENT OF HUMAN HEALTH AND SERVICES, A POSITION HE HAS HELD MUCH UP TO THE TIME OF 2009 HE ALSO SERVED IN 2017 AS ACTING ASSISTANT SECRETARY FOR DISASTER PREPAREDNESS RESPONSE AND ACTING ASSISTANT SECRETARY IN 2011 HE HELPS TO COORDINATE AND OVERSEE THE U.S. GOVERNMENT PUBLIC HEALTH EMERGENCY MEDICAL COUNTER MEASURES AT HHS HE PRESENTLY LEADS ON A NUMBER OF NATIONAL AND GOVERNMENT COMMITTEES UNDER THE WHITE HOUSE NATIONAL SECURITY COUNCIL AND NATIONAL SCIENCE TECHNOLOGY POLICY HE IS ALSO CO-CHAIR OF THE EXPERT ADVISORY PANEL AS WELL AS CHAIR OF THE FEDERAL COURT FACILITY THE FACILITY INVENTORY AND COMMUNICATIONS UNDER THE OFFICES OF THE WHITE HOUSE NATIONAL SCIENCES AND TECHNOLOGY COUNCIL HE HAS BEEN A VISITING PROFESSOR IN THE DEPARTMENT OF MICROBIOLOGY AND IMMUNOLOGY JOHN HOPKINS FOR PUBLIC HEALTH AND RETIRED FROM THE U.S. ARMY MEDAL DEPARTMENT IN 2008 WITH THE RANK OF COLONEL HE ALSO SERVED A NUMBER OF POSITIONS IN THE ARMY INCLUDING ARMY SURGEON GENERAL OF INFECTIOUS DISEASE AND CHEMICAL AND BIOLOGICAL DEFENSE PROGRAM HAS APPEARED IN NUMEROUS JOURNAL ARTICLES ON COUNTER MEASURES AND SERVED ON COMMITTEES INCLUDING THE NATIONAL ACADEMY OF SCIENCES, INSTITUTE FORUM ON MICROBIAL QUESTS AND ADVISORY BOARD HIS TRAINING SPANS A NUMBER OF FIELDS WITH A PHD FROM THE JOHN HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH I AM SO PLEASED HE IS ABLE TO BE WITH US TODAY SO THANK YOU VERY MUCH AND EVERYONE BLESS WELCOME THE DOCTOR AND I WILL HAND THE BALL OVER TO YOU RIGHT NOW SHOULD BE READY TO GO >> THANK YOU, AMY A PLEASURE TO BE HERE WOW, I WOULD LIKE TO MEET THAT GUY THERE IS A LOT OF STUFF THERE AS I LOOK BACK, I SAY YEAH, YOU KNOW, THAT HAPPENED OVER A PERIOD OF TIME BUT I AM REALLY HAPPY THAT I AM ABLE TO COME TO YOU TODAY IN OUR CURRENT ROLES OF SENIOR SCIENCE ADVISOR SO I WILL DISCUSS A BIT OF WHAT THAT POSITION DOES AND HOW WE HANDLE RESPONSE ACTIVITIES AND ASK HOW I ADVANCE THE SLIDES HERE >> THE LITTLE BOX, OKAY

>> SHOULD BE A BOX AND A CARROT TO THE RIGHT OF IT? >> LOOKING, LOOKING, DON’T SEE A CARROT BOX OKAY, I WILL ADVANCE FOR YOU AND THEN SEE WHAT IS GOING ON >> SO WE HAVE SEEN A NUMBER OF EVENTS AND WE RESPOND TO NATURAL DISASTERS, THINGS LIKE HURRICANE HARVEY AND MARIA LAST YEAR, SANDY IN 2012, EARTHQUAKES AND FLOODS AND NUCLEAR POWER DISASTERS, WE WERE PART OF THE RESPONSE TO THE FUKOSHIMA RESPONSE IN JAPAN A COUPLE OF YEARS AGO AND ALSO OTHER MANDATES, DEEP WATER HORIZON IF THAT IS IN YOUR MEMORY BUT ALMOST ALL OF THESE EVENTS HAVE A PUBLIC HEALTH OR MEDICAL IMPACT OR CONSEQUENCES SOMEWHERE ALONG THE LINE AND REALISTICALLY, THE FUTURE HOLDS YET MORE SURPRISES IN STORE WHEN WE THINK OF CHEMICAL, BIOLOGICAL, RADIOLOGICAL AND NUCLEAR OR NATURAL THREATS AS WELL AS THREATS EMERGING FROM INFECTI BELIEVE OUS DISEASES OR MAYBE EVEN ENGINEERED PATHOGENS SO IT IS A WORLD THAT HAS A LOT OF DANGERS BUT ON THE FLIP SIDE, THERE ARE A LOT OF THINGS THAT HAVE GONE WELL AND WITH TECHNOLOGY IS MOVING US FORWARD IN WAYS WE WILL BE ABLE TO ADDRESS SOME OF THESE THREATS NOW, IN THE WAKE OF HURRICANE KATRINA, THIS WAS CREATED UNDER THE LEGISLATION CALLED THE PANDEMIC AND ALL NATURAL PREPAREDNESS ACT AND WAS DESIGNED TO LEAD ALL MEDICAL RESPONSES TO NATURAL DISASTERS IT WAS MODIFIED AFTER THE NICHOLS GOLD ACT BRINGING ALL THE BRANCHES OF MILITARY UNDER A SINGLE CHAIN OF COMMAND AND IMPROVING COMMUNICATION SO THAT WAS CONGRESS’S ATTEMPT TO PROVIDE A UNIFIED EFFORT AND TO INTEGRATE THESE ELEMENTS INTO AN EFFECTIVE RESPONSE SO THAT THERE IS ONE COMMAND STRUCTURE WITH A COMMON PURPOSE AND COMMON VISION TO THAT POINT, IT HAS EVOLVED INTO AN ORGANIZATION THAT COLLABORATES WITH A VARIETY OF STAKEHOLDERS, HOSPITALS, HEALTHCARE COALITIONS, BIOTECHNOLOGY COMMUNITIES, STATES, LOCAL, TRIBAL, A VARIETY OF PARTNERS ACROSS THE COUNTY AND INTERNATIONALLY AS WELL TO IMPROVE CAPABILITY SO OUR MISSION IS QUITE SIMPLY STATED AS A WAY TO PROVIDE ASSISTANCE IN THREATS AND THE KIND OF CONDITIONS WE RESPONDED TO, YOU CAN SEE ABOVE THE TIME LINE, SORT OF THE POLICY INVESTMENTS THAT HAVE HAPPENED WE TALKED JUST A MOMENT AGO ABOUT THE PANDEMIC PREPAREDNESS ACT BUT THERE HAVE BEEN A VARIETY OF OTHER POLICY DOCUMENTS AND AUTHORIZATIONS ALONG THE WAY TO EMPOWER US TO CARRY OUT THE MISSION MORE RECENTLY AND VERY SOON, PROBABLY NEXT WEEK, YOU WILL HEAR ABOUT THE RELEASE OF THE NATIONAL BIODEFENSE STRATEGY FROM THE ADMINISTRATION WE HAVE BEEN WORKING ON THIS DOCUMENT FOR ALMOST TWO YEARS AND LAYS OUT SPECIFICALLY FOR DEFENSE THE TYPES OF ELEMENTS THE U.S. GOVERNMENT HAS TO BE ABLE TO CARRY OUT AND AND SO THERE IS THE CALL AND RESPONSE AND OPERATED UNDER CONGRESS IT REALLY DOES INCLUDE ALL HAZARDS PRINCIPLES HERE SO THE THINGS WE LEARN AS WE RESPOND TO CHEMICAL, RADIOLOGICAL AND NUCLEAR THREATS, ALSO HAVE APPLICATION WHEN WE LOOK AT OTHER THREATS, FOR EXAMPLE, PAN DEM CHICAGO AND INFLUENZA

PREPAREDNESS OR WHEN WE LOOK AT WHAT THE FUTURE MIGHT HOLD WITH NEWLY EMERGING DISEASES THEY ALL HAVE THEIR PRINCIPLES BUT HOW WE LOOK AT THESE THINGS FROM THE FULL LIFE CYCLE MANAGEMENT OF THE PRODUCTS FROM REQUIREMENTS, WHAT DO WE NEED, WHAT TYPES, HOW MANY AND HOW WE’RE GOING TO USE THEM ALL THE WAY THROUGH RESEARCH AND DEVELOPMENT, STOCKPILING AND USE OF THE END PRODUCT IN THE INTERFACE WE HAVE SET A SERIES OF PRIORITIES IN BUILDING THIS READINESS FOR THE NEXT CENTURY SO THE OVERARCHING THEMES YOU SEE HERE ARE HARKENING TO THE INTENT FOR VERY STRONG LEADERSHIP ACROSS THE GOVERNMENT AND IN PARTICULAR, ACROSS THE DOMAIN OF PUBLIC HEALTH AND RESPONSE SO IMMEDIATE ABILITY TO MOBILIZE A RESPONSE TO AUGMENT GLOBAL CAPACITY THE COUNTER MEASURE ENTERPRISE AND I WILL SPEND A GOOD AMOUNT OF TIME ON THIS TO BE ABLE TO CREATE THESE PRODUCTS WE NEED FOR VERY SPECIFIC THREATS AND THEN FINALLY JUST PUBLIC HEALTH SECURITY CAPACITY, WHAT OTHER THINGS NEED TO BE PART OF THE ENVIRONMENT SO THAT WE CAN ADDRESS NOT JUST THE KNOWNS BUT HAVE FLEXIBILITY FOR SOME OF THE UNKNOWNS AS WELL IN ADDITION TO EMERGENCY RESPONSE CAPABILITIES, THE HEALTH AND HUMAN SERVICES SECRETARY EMERGENCY OPERATIONS CENTER IS ACTIVE 24/7, 365 DAYS A YEAR AND TIES IN WITH THE OTHER OPERATION CENTERS ACROSS THE DEPARTMENT SO HHS IS OVERSIGHT FOR EMERGENCY FUNCTION WHICH IS THE PUBLIC MEDICAL AND EMERGENCY RESPONSE WITHIN THE NATIONAL FRAMEWORK AND OUR CENTER HELPS TO COMMUNICATE TO STAKEHOLDERS NATIONALLY AND INTERNATIONALLY BASED ON THE NATURE OF THE TYPE OF RESPONSE OR THINGS WE NEED TO DO SO WE ALSO OVERSEE DON’T NEWS OF OPERATIONS FOR PEOPLE IN GOVERNMENT YOU WILL UNDERSTAND A CONTINENTAL OP OPERATIONS TAKES PLACE OVER HERE SO THERE WILL ALSO BE INFORMATION ON HOW THE HEALTH SERVICES PLAN AND USE THOSE LOCATIONS NOW, THIS REQUIRES CONSTANT INVESTMENT INTO PEOPLE, FACILITIES, MEDICAL MATERIAL, SO THERE IS AN EXPENSIVE INVESTING IN RESOURCES AND LOGISTICS AND THEN FINALLY WE HAVE BUILT OVER THE COURSE OF THE YEAR, THE NATIONAL DISASTER MEDICAL SYSTEM AND THIS IS COMPRISED OF A LARGE NUMBER OF TEAMS LOCATED ACROSS THE STATES AND WITHIN THE REGIONS AND THEY ARE CONFIGURED TO PROVIDE FROM DAYS TO SEVERAL WEEKS OF AUGMENTATION OR ABSCESS REMEDICAL RESPONSE CAPABILITY OR LOCAL CAPABILITY IN SHORT PERIODS OF TIME SO WE HAVE THE MEDICAL ASSISTANCE TEAMS THAT PROVIDE HEALTH AND EMERGENCY RESPONSE WE HAVE SEVERAL NATIONAL VETERINARY TEAMS THAT PROVIDE SIMILAR SUPPORT TO VETERINARY POPULATIONS THERE ARE MORTUARY ASSISTANCE TEAMS AND THEY ASSIST JURISDICTIONS OR OTHER LOCAL NEEDS AT THE CORONER LEVEL WHEN THERE IS AN OVERWHELMING LEVEL OF MORTALITY FOR AN EVENT IN ADDITION TO THIS, WE ASK FOR ALSO THE MEDICAL RESERVE CORPS WHICH IS A NETWORK OF UNITS ESTABLISHED BY ORGANIZATIONS TO SERVE THESE COMMUNITIES AND INCLUDES THOUSANDS OF MEDICAL COMMUNITY SO NURSES, PHYSICIANS, PARAMEDICS, MENTAL HEALTH WORKERS, PRACTITIONERS, TRAINERS, OTHER ADMINISTRATIVE SUPPORT PERSONNEL AS WELL SO LITERALLY THOUSANDS OF PEOPLE PARTICIPATE IN THE RESPONSE AT THAT LEVEL THE OTHER ASPECT OF THE EMERGENCY OPERATIONS HERE ARE FOR OPERATORNESS IN TERMS OF RESILIENCE AT THE COMMUNITY LEVEL I MENTIONED ALREADY THE MEDICAL RESERVE VOLUNTEER CORPS WITH OVER 200,000 INDIVIDUALS THAT NEED TO BE COORDINATED BUT WE ALSO PROVIDE MONEY TO STATES THROUGH THE HOSPITAL PREPAREDNESS PROGRAM GRANTS THAT IS ACROSS THE STATES AND AWARDED THROUGH HEALTHCARE

COALITIONS, HOSPITALS AND OTHER PROVIDERS THEY ARE VERY ACTIVE WITH THE FEMA REGIONAL COORDINATORS, INVENT OUR OWN COORDINATORS FOR THOSE RESPONSES IN THOSE REGIONS AND TO SUPPORT ALL THIS, WE HAVE A TRAINING CENTER IN ALABAMA THAT HELPS KEEP SKILLS SHARP FOR PEOPLE IN THE LOOP AS WELL AND THEN RESPONSE AND RECOVERY OPERATIONS THAT CAN BE DEPLOYED WHEN NEEDED SO I THINK THAT WILL COVER FOR THE MOST PART JUST A QUICK FLAVORING OF THE EMERGENCY OPERATIONS WITHIN THE ORGANIZATION WHAT I WANT TO SWITCH IS TO THE COMPONENTS OF WHAT WE DO AND WHAT THE PUBLIC TELLS THE COUNTER EMERGENCY ENTERPRISE IS IN TERMS OF COORDINATING ALL THOSE RESPONSES FOR THOSE CAPABILITIES SO THIS IS JUST SOME THINGS THAT I TOOK OUT OF LOCAL HEADLINES OVER THE LAST SEVERAL MONTHS AND IT REALLY ADDRESSES BIODEFENSE WHICH IS A MAJOR ELEMENT OF OUR PLANNING AND RESPONSE BECAUSE OF THE NATURE OF INFECTIOUS DISEASES WHICH CHANGES OVER TIME AND BECAUSE BIOTECH LODGE WALL ADVANCES CREATE BOTH OPPORTUNITIES TO BENEFIT MANKIND AND ALSO CREATES THE POTENTIAL FOR HARM WHILE WE DON’T THINK ABOUT ANTI-MICROBIAL RESISTANCE AS A MEASURE OF HARM, IT DOES DEPEND ON HOW WE ADDRESS THE THREAT, MENTALLY, GLOBALLY, IN TERMS OF SECURITY AND THAT IS WHAT IT IS ALL ABOUT, WHAT KINDS OF THINGS MUST WE THINK ABOUT IN TERMS OF OUR OWN HEALTH SECURITY AND HAVING OR LOSING THE ABILITY TO HAVE EFFECTIVE ANTIBIOTICS TO TREAT INFECTIONS AS A I WILL SHOW YOU IN THE NEXT SLIDE ENTERS INTO THE NUMBER OF THINGS YOU SEE THERE, GLOBAL DEFENSE MARKET, BIOTERRORISM, THE POX VIRUS FROM A FEW YEARS AGO WITH A NUMB OF OUR COLLEAGUES IN CANADA WHO INTENDED ORIGINALLY TO DEMONSTRATE THE ABILITY TO CREATE A FULL LENGTH POX VIRUS FROM A SYNTHETIC UNDERPINNING AND THEN OF COURSE IT WAS A VIRUS UNTO ITSELF BUT THEN THE IMPLIED THREAT HERE IS WELL IF WE CAN CONSTRUCT THAT, SOMEONE COULD CONSTRUCT SMALL POX AND THAT CAUGHT INTERNATIONAL ATTENTION AND THEN IN D.C., LOOKING AT HOW THE U.S. WOULD RESPOND OR WHAT WOULD BE OBSTENSIVELY THE TYPE OF CONCERNS SHOULD WE SEE A BIOENGINEERED PANDEMIC THREAT THAT SWEEPS NOT JUST THE UNITED STATES BUT THE WORLD SO A LOT OF CONSIDERATIONS THERE ON HOW THE U.S. GOVERNMENT AT THE CABINET LEVEL WOULD DEAL WITH THOSE TYPES OF EVENTS IT HAS BEEN IN THE NEWS BY WAY OF SOME OF THE EXOTIC TYPE OF THINGS DESCRIBED IN THAT SLIDE BUT IT IS ALSO IN THE NEWS WITH THE POLICIES BECAUSE THIS SLIDE IS NOW A LITTLE DATED FROM THE TIME I PUT IT TOGETHER IN THE SPRING AND THE DRC HAD A PARTICULAR EVENT IN THE WESTERN PART OF THE REPUBLIC OF CONGO AND THAT HAS BEEN REPLACED BY YET ANOTHER OUTBREAK WHERE THE SITUATION NOW COMPRISES ABOUT 124 CONFIRMED AND SUSPECTED CASES OF EBOLA INCLUDING IMPACT ON LOCAL HEALTHCARE WORKERS AND HERE WE HAVE A THREAT THAT IS JUST A DEFENSE PROBLEM THAT WE THOUGHT ABOUT FOR YEARS AND LIKE THE SPRING, HOW TO PROVIDE SUPPORT BUT IN THE CONTEXT, WE HAVE MOBILIZED THE THERAPEUTICS AND OTHER THINGS DEVELOPED IN OUR AGENCY TO ATTACK THIS OUTBREAK AND YOU CAN SEE FROM THIS PARTICULAR SLIDE, ALL A THE VARIOUS OUTBREAKS WE HAVE SEEN FROM EBOLA VIRUS SINCE 1976 AND SO WHEN THESE EVENTS HAPPEN, THEY SHOULDN’T TAKE US BY SURPRISE, THEY ARE JUST PART OF

THE NATURAL ECOLOGY OF THESE LOCATIONS AND STILL WITH INTERNATIONAL TRAVEL BEING WHAT IT IS, THE WORLD GETTING TO BE A SMALLER PLACE, MORE CONNECTIVITY AND IN 1976 WHAT WE HAD SEEN AS PRETTY EXOTIC AND REMOTE ARE NOW CONSIDERED TO BE A LOT MORE IMMEDIATELY CONCERNED AND AS YOU RECALL, THE EVENTS OF 2014, THE WORLD WATCHED THIS MUCH LARGER POPULATION THAT HAD TO DEAL WITH EBOLA AND THE CONSEQUENCES ELSEWHERE AS CASES WERE TRANSPORTED FROM AFRICA TO OTHER COUNTRIES SO LET ME TURN QUICKLY THEN TO MEDICAL PRODUCTS BECAUSE I MENTIONED THEM A FEW TIMES SO WHAT DOES IT REALLY MEAN TO MAKE A MEDICAL PRODUCT? WE CALL THIS THE HURRICANE CHART IN A SENSE AND ALL IT MEANS IS THAT IN ORDER TO GET ONE LICENSED PRODUCT, YOU HAVE TO START OFF WITH A WHOLE LOT OF CANDIDATES THAT WENT WAY BACK IN THE PIPELINE OF CONCEPTS ABOUT HOW TO DEAL WITH A PARTICULAR ISSUE AND WHAT YOU SEE HERE OVER TIME AND AT GREAT EXPENSE, YOU START DELISTING BECAUSE YOU ELIMINATE, THINGS THAT JUST DON’T WORK OUT, MAYBE THEY HAVE OTHER SAFETY OR PRODUCTION CONCERNS BUT FOR A SERIES OF MULTIPLE STEPS OVER THE YEARS AND DOLLARS INVESTED, AT THIS POINT I THINK THAT OVERALL THE AVERAGE AMOUNT OF MONEY SPENT ON THE MEDICAL PRODUCTS ARE MOVING FROM CONCEPT ALL THE WAY TO LICENSURE, 1.3 TO $1.4 BILLION SO VERY EXPENSIVE AND RISK-LADEN THE OTHER THING THAT SLIDE IS MEANT TO SHOW IS IT TAKES A NUMBER OF YEARS TO GET THERE, THAT THERE HAS BEEN TRADITIONALLY THIS THEORY IN THE MIDDLE CALLED THE VALLEY OF DEATH WHERE THE TYPES OF RESEARCH NEEDS BECOME MUCH MORE EXPENSIVE WITH MEDICAL TRIALS, LARGE NUMBERS OF PEOPLE AND THESE STUDIES CAN RUN IN THE TENS OF MILLIONS TO HUNDREDS OF MILLIONS TO PERFORM AND THE OTHER AS A EXPECT AS YOU LOOK AT THE PHASES OF THE PRODUCTS DELIVERY, WE HAVE A WAY IN THIS GOVERNMENT OF DIVIDING THE PRINCIPLE ACTORS OR RESPONSIBLE PARTNERS ACROSS THIS TIMELINE OR PHASE LINE SO EARLY ON WITH THE HELP OF HUMAN SERVICES, NIH PROVIDING SOME OF THE BACKDROP ON EARLY STAGE CANDIDATE DEPARTMENT, BUT AS THINGS MATURE, THIS WAS DEVELOPED OR DESIGNED TO ADDRESS THIS VALLEY OF DEPTH PRIOR TO ITS EXISTENCE THIS IS LARGELY UNCHARTED TERRITORY AND YOU KEPT YOUR FINGERS CROSSED THAT MAYBE SOME COMMERCIAL PARTNER WOULD FIND SOME INTEREST IN A PRODUCT YOU ARE DEVELOPING AND THAT WAS DEVELOPED INTO PROJECT BIOSHIELD TO PROVIDE TEN YEARS OF FUNDING FROM 2003-2013 AND THEN SUBSEQUENT AMOUNT OF MONEY HAVE BEEN PROVIDED BUT THIS IS AN OUTLAY OF ABOUT FIVE TO SIX $000 MILLION OF WHAT A COMPANY HAS RECOGNIZED ARE IMPORTANT TO MOVE FORWARD SO ONCE THEY WERE PROCURED, MET THEIR MILESTONES, THEY WERE PICKED UP AND PUT IN THE NATIONAL STOCKPILE SO THIS SLIDE TELLS YOU THEY ARE VERY EXPENSIVE, RISKY AND THERE ARE MULTIPLE AGENCIES THAT HAVE TO DEAL WITH THIS SO COMPLEXITY IS THE NAME OF THE GAME IN TERMS OF MAKING MEDICAL PRODUCTS SO HOW DID WE ADDRESS THAT AT THE FEDERAL LEVEL? WELL, WE ENGAGED ALL THESE ORZATIONS IN — ORGANIZATIONS AND THEN HOW THE PRODUCTS GET USED FOR THE PATIENTS’ BENEFIT AND THE AGENCIES RESPONSIBLE FOR THAT SLICE OF THE PIE AND THEN IN THE GREEN CIRCLE, YOU SEE THE OTHER FEDERAL AGENCIES, DEPARTMENT OF HOMELAND SECURITY, VETERANS ADMINISTRATION, USDA AND QUICK LENT NEEDS AND OTHER PARTS OF STAKEHOLDERS SO WE PULL ALL THESE TOGETHER AND THAT AREA OUTSIDE THE CIRCLE IS THE REST OF THE STAKEHOLDS, GOVERNMENT, INDUSTRY, ACADEMIA

AND SOCIETY SO THIS IS THE MODEL WE USE TO BRING OR MOVE THESE PRODUCTS FORWARD SO WHEN I MENTIONED REQUIREMENTS, WHAT DOES THAT LOOK LIKE? SO BY LAW, FOCUSING ON VERY SPECIFIC EMISSIONS AND PATHOGENS PREVIOUSLY RECOGNIZED IN THE PROCESS AS NATIONAL SECURITY RISKS BY THE DEPARTMENT OF HOMELAND SECURITY SO THEY TAKE OTHER INFORMATION, MAYBE INTELLIGENCE INFORMATION OR OTHER MATERIALS THAT THEY HAVE AT THEIR DISPOSAL TO IDENTIFY WHAT SPECIFICALLY COULD BE CAUSING THE LARGESCALE PUBLIC HEALTH EVENTS IN THE UNITED STATES AND THEY ISSUED SOMETHING CALLED A MATERIAL THREAT DETERMINATION YOU CAN SEE THE TYPES OF THREATS ON THE VERY FAR LEFT AND WHEN THE FTD’S WERE ISSUED AND THAT IS THE STARTING POINT FOR HHS TO BE ABLE TO THEN SAY ALL RIGHT, WE’RE GOING TO PUT TOGETHER WHAT WE KNOW ABOUT PLAGUE AND FIGURE OUT HOW WE’RE GOING TO MAKE MEDICAL PRODUCTS FOR PLAGUE SO WHAT KIND OF PRODUCTS MIGHT WE NEED FOR PLAGUE? WELL, PROBABLY BECAUSE WE DON’T IMMUNIZE PEOPLE FOR PLAGUE GENERALLY, WE ARE REVIEWING AN EVENT THAT HAPPENS AFTERWARDS AND WOULD NEED ANTIBIOTICS FOR BODIES SO EVERY ONE OF THESE PARTICULAR PATHOGENS YOU SEE, WE DO AN INDEPTH PUBLIC HEALTH ASSESSMENT ON WHAT IS NECESSARY TO TREAT POPULATIONS, WHAT SIZE LEVEL, WHAT KIND OF SCENARIO AND THEN ARE THERE SPECIAL NEEDS FOR SPECIAL POPULATIONS LIKE PEDIATRIC POPULATIONS OR IMMUNOCOMPROMISED POPULATIONS THAT CAN’T BE MET WITH JUST A GENERAL APPROACH FOR ADULTS WHO ARE GENERALLY HEALTHY AND SO HOW WELL HAVE WE DONE OVER THE COURSE OF THE YEARS IN TERMS OF INVESTMENTS AND KIND OF PAO ELING BACK WHERE — PEELING BACK WHERE OUR RISKS ARE? BEING ABLE TO DEVELOP AND SUPPLY AND HAVE AT OUR DISPOSAL A LARGE STOCKPILE OF MATERIALS TO DEAL WITH THOSE KINDS OF THREATS AND OF COURSE WE CAN NEVER HAVE ENOUGH MONEY AND TIME TO DO EVERYTHING SIMULTANEOUSLY SO THE THINGS YOU SEE GOING CLOCKWISE AROUND, THE RADIOLOGICAL EVENTS, IN PRETTY GOOD SHAPE AND WE HAVE SOME COMPONENTS FOR NERVE AGENTS BUT AS A YOU MOVE OUT, MAKING PROGRESS AND I AM THINKING THEY ARE STARTING TO TURN FROM THE YELLOW COLOR BUT WE STILL DO HAVE A LOT OF CHALLENGES ON SOME OF THE CHEMICAL THREAT BECAUSE OF THE COMPLEXITY OF DEALING WITH A VERY RAPIDLY DISTRIBUTED OR DELIVERED THREAT FOR THOSE SUBSTANCES BUT THIS IS A DEMONSTRATION THAT OVER THE COURSE OF THE YEARS HAS BEEN PROGRESS ON PRESENT THREATS OR THINGS WE HAVE BEEN CONCERNED ABOUT AND SO MOST OF THIS HAPPENED BECAUSE FLORIDA HAS BEEN RESPONSIBLE FOR ASSUMING THE MANTEL AND MOVING SOME OF THESE PRODUCTS FORWARD BY WORKING WITH INDUSTRIES IN A KEY ASPECT OF SUCCESS THAT I WILL SHOW YOU IN A MINUTE SO THE PRIORITIES RIGHT NOW IN THAT HAZARD SPACE I SHOWED YOU BEFORE, BETTER AND FASTER FLU VACCINES, VACATING OR OBTAINING A DOMESTIC MANUFACTURING CAPACITY FOR FLU AND NOT BASED SOLELY ON EGGS SO LOOKING AT DIFFERENT MECHANISMS TO PRODUCE AND TO SUSTAIN THE PRODUCTS MADE UNDER THOSE BIOSHIELD PRODUCTS WHICH I TALKED ABOUT BEFORE AND MAKING SURE THAT WE ESTABLISH THIS MARKET INDUSTRY THAT WAS A PART OF THE ORIGINAL ARCHITECTURE UNDER THE RESERVE FUND THAT YOU SEE HERE, SRF WE’RE ALSO COMMITTED TO LOOKING AT THINGS LIKE PREPAREDNESS WITH DRUGS FOR PATHOGENS AND THAT ADDRESSES THE IMPENDING OR EXPANDING CONCERNS WITH REGARD TO ANTIBIOTIC RESISTANT BACTERIA AND THEN FINALLY I WILL TALK A LITTLE BIT ABOUT WATCHING A BRAND-NEW INITIATIVE CALLED DRIVE WHICH STANDS FOR THE DIVISION OF INNOVATION AND VENTURE AND I WILL COVER ALL OF THOSE HERE IN THE NEXT SEVERAL SLIDES WHAT IS THE DEMONSTRATION THAT WE HAVE BEEN SUCCESSFUL? THIS IS A TIME LINE OF FDA APPROVALS, LICENSURES AND CLEARANCES FOR A VARIETY OF PRODUCTS OVER THE 12 YEARS AND YOU CAN SEE WE HAVE DEVELOPED A PORTFOLIO OF LICENSED PRODUCTS TO ADDRESS

THESE THREATS AS YOU LOOK, MANY OF THE EARLIER PRODUCTS WERE AIMED AT INFLUENZA AND THAT IS PARTIALLY TO A REAL CONCERN IN 2005 OVER THE H5N1 BUT REASONABLE THE LONG-TERM INVESTMENT HAS PAID OFF OVER SUCCESSFUL PRODUCTS FOR ANTHRAX, SMALL POX, NERVE AGENTS AND THE LIKE AND NOW BEGINNING TO SEE ANTIBIOTICS THAT ARE COMING TO MARKET THROUGH LICENSURE OF SOME OF THE INVESTMENT THAT HAVE BEEN MADE RECENTLY SO THIS IS A LIST, A VERY IMPRESSIVE LIST OF APPROVALS THAT WE HAVE HAD A HAND IN AND ALONG THOSE LINES AT THIS POINT, THE TAIL OF THE TAPE HAS BEEN WE SUPPORTED SUCCESSFULLY, I THINK, 40 DIFFERENT PRODUCTS THROUGH LICENSURE OR THROUGH APPROVALS WITH FDA AND THIS IS NOT JUST REFLECTIVE REALLY OF THE EFFORTS JUST FROM US, IT IS ALSO CONCERTED EFFORTS WITH OUR COLLEAGUES, FOOD AND DRUG ADMINISTRATION, CDC, NIH AND THE DEPARTMENT OF CENSUS HAS BEEN VERY ACTIVE AS WELL IN DOING SOME OF THE STUDIES OR PROVIDING OTHER ASSISTANCE AS THESE PRODUCTS MOVE ON THROUGH BUT I WOULD BE REMISS IF I DIDN’T POINT OUT THE HUGE IMPACT THAT PARTNERSHIPS HAVE WITH RESPECT TO OUR INDUSTRIAL PARTNERS AND BART HAS SPENT A LOT OF TIME NURTURING THOSE RELATIONSHIPS BECAUSE THOSE PARTNERS ALSO BEAR THE BRUNT AND RESPONSIBILITY FOR THE WORK THAT GOES INTO ALL A THE COMPONENTS OF MAKING THOSE VACCINES AND DRUGS AND DYING NOT STICKS AND MOVING THEM TO THE LICENSURE OF FDA SO WE ARE HERE TO HELP THEM THROUGH THIS BUT THEY REALLY ARE THE KEYSTONES FOR HOW SUCCESS HAS HAPPENED SO HERE IS ONE EXAMPLE THAT HAPPENED RECENTLY, IT WAS INITIATED AS A POTENTIAL TREATMENT FOR SMALL POX AS FAR BACK AS A THE LATE 1990S OR EARLY 2000’S AND ENGAGED THE EFFORTS OF THE CDC AND DEPARTMENT OF INFECT SHOULD DISEASES WAY BACK WHEN I WAS A COMMANDER THERE, I REMEMBER SOME OF THIS WORK GOING ON BUT ALSO FROM OUR PARTNERS OF TECHNOLOGY, ONE EXAMPLE, EFFORTS WITH EFFICACY OF ANIMAL MODELS AND THROUGH MANY YEARS OF DATA GATHERING, DEMONSTRATING THE SAFETY OF PRODUCT IN HUMANS AND ANIMALS AS WELL AS SURROGATE EFFICACY AGAINST SMALL POX USING OTHER ANIMAL MODELS SO THIS IS SOMETHING CALLED THE ANIMAL MODEL ROLE, A WAY THAT WE WERE ABLE TO PROVIDE OR CREATE A MEDICAL PRODUCT FOR SMALL POX WHICH OF COURSE DOESN’T EXIST ANYWHERE IN THE WORLD IT WAS ELIMINATED BACK IN THE LATE 70s SO BEING ABLE TO DEMONSTRATE TO THE FDA THAT YOU HAVE A PRODUCT INTENDED TO BE EFFICACIOUS AGAINST A NOW-DISTINCT VIRUS IS A VARIETY OF OTHER WAYS IN THE REGULATORY REALM TO DEMONSTRATE SAFETY AND EFFICACY SO THIS IS ANOTHER SUCCESS STORY BECAUSE WE WERE ABLE TO USE THE OTHER MEASURES TO GET APPROVAL AND IT DEMONSTRATES THE COMMITMENT BY THE UNITED STATES GOVERNMENT TO FULFILL PROMISES WE MADE BOTH NATIONALLY AND INTERNATIONALLY TO BE ABLE TO DEVELOP PRODUCTS OF THIS SORT BECAUSE IF WE WERE TO EVER SEE SMALL POX SHOW BACK UP AGAIN AND OF COURSE I MENTIONED THE HORSE POX A FEW SLIDES BACK, IF WE WERE TO EVER SEE THIS AGAIN, THE WORLD WOULD NEED THESE TYPES OF PRODUCTS TO BE ABLE TO RESPOND SO TO KIND OF WRAP UP SOME OF THE WORK THAT WE DO ON A ROUTINE BASIS, I DID MENTION THE FIRST PORTFOLIO FOR THE PERSISTENT THREAT OF INFLUENZA ON AN ANNUAL BASIS WE HAVE 12 TO 25,000 CASES ANNUALLY IN THE UNITED STATES OF DEATH DUE TO INFLUENZA SO WE HAVE INCREASED THE NUMBER OF DOSES OF VACCINE THAT ARE PRODUCED IN THIS COUNTRY FOR INFLUENZA AND THEY HAVE INVESTED IN MUCH MORE RAPID DIAGNOSTIC CAPABILITY FOR TREATMENT AND THEN A COMPLEX NEED FOR DEVELOPING NEW ANTIVIRALS BUT RECENTLY, FOR INSTANCE, THERE IS A NEW THING ON THE MARKET, MOST

OF THE CURRENT INFLUENZA IN THE MARKET IS BASED ON NEUROBASE INHIBITORS THAT ESSENTIALLY BLOCK THE PARTICLES OF VIRUS AS THEY MATURE BUT A NEW DRUG DEVELOPED IN JAPAN, A DIFFERENT MODE OF ACTION USING AN INHIBITOR AND ALL A KINDS OF STUFF THERE AND THEN THE DEVELOPER HAS BEEN INITIATING SOME DISCUSSIONS WITH US SO WE WILL BE LOOKING AT A WAY TO FUND NEW TRIALS FOR THERAPEUTICS AND SEE IF WE CAN’T SOMEHOW INCREASE OUR OPPORTUNITIES TO HAVE A NEW ANTIVIRAL HERE FOR INFLUENZA IN THIS COUNTRY NOW, OUR MODEL HAS BEEN USEFUL AND VERY SUCCESSFUL BECAUSE THEY DID SPEND A LOT OF TIME IN PUBLIC-PRIVATE PARTNERSHIPS WITH INDUSTRY AND HERE ARE SOME OF THE THINGS THEY HAVE DONE TO WORK MORE EFFECTIVELY EVEN THOUGH THE SCIENCE IS IMPORTANT, JUST AS IMPORTANT ARE THE BUSINESS ELEMENTS OF THINGS AND WE HAVE BEEN ABLE TO USE OTHER TRANSACTIONAL AUTHORITIES TO WORK WITH BUSINESSES THE WAY THAT OTHER BUSINESSES WORK WITH BUSINESSES SO RATHER THAN A VERY COMPLEX CONTRACTING PROCESS USING THE FEDERAL ACQUISITION REGULATIONS, WE HAVE WAYS OF WORKING DIRECTLY AND MUCH MORE EFFICIENTLY WITH BUSINESSES TO PRODUCE CONTRACTS AND OBTAIN WORKFORCE, THINGS WE WOULD LIKE BUT TO DO IT IN A MUCH MORE FLEXIBLE FASHION LIKE SITTING ON THE BOARD OF DIRECTORS DISCUSSING THE TYPE OF PRODUCTS WE MAY BE WORKING ON AND HAVING INFLUENCE ON DECISIONS MADE THERE BY VIRTUE OF OUR INVESTMENT THE MULTI-YEAR FUNDING PROVIDED BY US, GETTING THINGS WE NEEDED WE HAVE ENTRUSTED IN THESE COMPANIES AND HAVE A NUMBER OF PEOPLE WHO HAVE BEEN IN INDUSTRY AND BECAUSE OF THAT EXPERIENCE, ABLE TO TALK THE LANGUAGE WITH THESE COMPANIES SO THAT THEY FEEL COMFORTABLE THAT WE UNDERSTAND WHAT THEY ARE TALKING ABOUT AND WE HAVE ALSO DEVELOPED SOME OTHER INTEGRATIVE CAPABILITIES FOR PRODUCT DEVELOPMENT FOR INSTANCE, THE FOOD AND DRUG ADMINISTRATION HAVING A GOVERNMENT PARTNER TO HELP UNDERPINNING DISCUSSIONS WITH THE FDA AND IT IS AN IMPORTANT COMPONENT OF SOME OF THE SUCCESS, I WOULD SAY WE HAVE INFRASTRUCTURES WE BUILT FOR MANUFACTURING, A COUPLE OF THEM AROUND THE COUNTRY AND WE CAN PROVIDE SUPPORT SERVICES ACROSS THE COUNTRY FOR THINGS LIKE ANIMAL VIRALS, BECAUSE WE HAVE ORGANIZATIONS THAT CAN WRITE A CONTRACT FOR AND GET PRODUCTS FILLED AND FINISHED IF THE MANUFACTURER OF THAT PRODUCT DOES NOT HAVE THE CAPACITY INTERNALLY SO THE LAST COUPLE OF SLIDES THAT WE WILL TALK ABOUT ARE TALKING ABOUT THE FUTURE AND WHAT WE SEE HAPPENING SO OVER HERE YOU SEE ALL THE CHEMICAL THREATS, BURNS, RADIATION, FLU, EBOLA, ANTHRAX, ALL RESULTING IN RESPIRATORY DISTRESS, CUTANEOUS ISSUES, THINGS AFFECTING WHITE BLOOD CELLS, FEVER AND AS WE DEVELOP THESE VERY SPECIFIC PRODUCTS TO ADDRESS THESE THREATS, WE HAVE SECONDARY ISSUES THAT WE HAVE TO DEAL WITH AND SOMETIMES THOSE ARE IN THE REALM OF OPPORTUNISTIC INFECTIONS SO WE TREAT PEOPLE IN HOSPITALS OR OTHER COMMUNITY LOCATIONS AND NOW THEY HAVE INFECTIONS THERE NORMALLY AND BECAUSE OF SOME OF THIGHS CIRCUMSTANCES ARE COMPROMISED AND HAVE SOME INSULT THAT REDUCES THEIR ABILITY TO BE RESISTANT, WE NOW CAN HAVE THE CHANCE THAT WE WIN THE BATTLE AGAINST THE INITIAL THREAT BUT LOSE THE WAR AGAINST KEEPING THESE PATIENTS ABLE TO SURVIVE BUT ULTIMATELY, AS THEY GO ON TO SEPTIC SHOCK, EVERYTHING THAT WE HAVE INVESTED IN ALL COMES CRASHING DOWN BECAUSE OF OTHER EVENTS AND KINDS OF RESPONSES THAT WE NEEDED TO CONSIDER FOR THESE PATIENTS SO THAT WAS ONE OF THE RATIONALES WHY IT WAS STARTED IN DEPTH AND WITH RESISTANT ORGANISMS OUR PORTFOLIO HAS A NUMB OF SPONSORS WITH THESE

ANTI-MICROBIAL COMPOUNDS ONE WAS JUST AWARDED APPROVAL YOU CAN SEE THE BIODEFENSE PROFILE IS FOR A VERY SPECIFIC PATHOGEN AND COMMERCIAL OBLIGATIONS WITH THE TYPES OF THINGS ON TOP OF INFECTIONS OR OTHER RESISTANT SECTIONS OF SOFT TISSUE, ET SO IT IS A TWO-FER BECAUSE WE GET SOMETHING FROM A BIODEFENSE PROFILE AND A REAL MEDICAL NEED AT THE COMMUNITY LEVEL THIS IS A PUBLIC-PRIVATE PARTNERSHIP WHERE WE COMBINE EFFORTS WITH THE TRUST, INVESTED COMBINED ABOUT $450 MILLION BETWEEN THE TWO ORGANIZATIONS WE WORK WITH A PRIME VENDOR IF YOU WILL OUT OF AUSTIN UNIVERSITY TO SCOUT THE VARIOUS OPPORTUNITIES IN THE MARKETPLACE PEOPLE APPLY FOR GRANTS OR SPECIFIC ACCESS TO FUNDS AND BY THE NUMBERS, YOU CAN SEE WE HAVE HAD 20 DIFFERENT PROJECTS TARGETING VARIOUS BACTERIA ACROSS MULTIPLE COUNTRIES, NEW ANTIBIOTICS AND NEW TARGETS BUT WE ALSO EXPAND TO DIAGNOSTICS AND THE MOST IMPORTANT AS A EXPECT OF THIS IS THAT FOR EVERY DOLLAR THAT THEY DO, WE ARE SEEING A 7 1/2-FOLD RETURN FROM THE PRIVATE SECTOR TO SECURE THOSE PARTICULAR INVESTMENTS SO THAT IS A WAY TO LEVERAGE PUBLIC AND PRIVATE FUNDS TO ACHIEVE A NET GOAL WHERE EVERYBODY BENEFITS FROM SOME OF THESE INVESTMENTS SO THE LAST LITTLE PHASE OF THIS, I AM GOING TO TALK ABOUT THIS VENTURE FOR RESEARCH INNOVATION AND CAPITAL THIS IS THE DRIV AND AS YOU CAN SEE, IT IS BRAND-NEW AND SOME OF THE EARLY STAGE OF LOOKING WHAT IS OUT THERE IN TERMS OF TECHNOLOGY OR TYPES OF OPPORTUNITIES WE MAY WANT TO THINK ABOUT THAT ARE NOT REALLY SPECIFICALLY RELATED TO A PATHOGEN OF CONCERN BUT HAVE MUCH BROADER APPLICATION AND THEN DEVELOPING A SYMPTOM ACCELERATE INVESTMENTS IN KEY AREAS AND ULTIMATELY TO BRING SOME OF THESE MUCH MORE TANGIBLE OR MORE PROMISING INVESTMENTS INTO A STRATEGIC SUSTAINMENT BY LOOKING AT VENTURE CAPITAL, BY DOING WHAT VENTURE CAPITAL DOES, CREATING AN ABILITY TO INCREASE THE LEVEL OF INVESTMENT UP THROUGH THESE TYPE OF APPROACHES SO THE RESPONSE FRAMEWORK WE’RE LOOKING AT HERE FOR THESE KINDS OF EVENTS PRETTY MUCH FOLLOWS WHAT WE HAVE TALKED ABOUT IN TERMS OF HOW TO DEVELOP END-TO-END ARCHITECTURE, IDENTIFYING ISSUES, DESIGN WHAT WE MIGHT WANT TO DO TO RESPOND TO THOSE, VALIDATE THE THINGS THAT WE’RE THINKING ABOUT ARE CORRECT AND THEN BEING ABLE TO PRODUCE THOSE THINGS QUICKLY AND DISTRIBUTE THEM QUICKLY SO WE HAVE A WAY TO RESPOND MORE EFFECTIVELY TO NOVEL THREATS AS THEY COME UP WHAT AM I TALKING ABOUT WHEN I SAY HOW ARE WE REALLY APPROACHING THIS? ONE THING, WE HAVE SET UP THE U.S. HUB OF INNOVATION THAT IS GOING TO HELP US LOOK ACROSS THE VARIOUS OPPORTUNITIES IN INDUSTRY AND ACADEMIA, PUT OUR FEELERS OUT THERE SO IF WE SAY WE WANT SOMETHING FOR XYZ, OUR PARTNERS WORK WITH US TO FIND ARE THERE PEOPLE MAKING INVESTMENTS IN THIS AND WITH WHOM WE SHOULD HAVE CONVERSATION TO EXPLORE A LITTLE MORE WHAT OPPORTUNITY ARE OUT THERE AND OUR INITIAL EMPHASIS ON DRIV WILL BE THE FOLLOWING WE HAVE STARTED TO ENGAGE IN TECHNOLOGY TO HELP SOLVE SEPSIS BECAUSE YOU RECALL FROM THE OTHER SLIDE, ONE OF THE THINGS WE WORRY ABOUT IS THE RESPONSE CAPABILITY BUT WE’RE ALSO LOOKING AT SOMETHING WITH EARLY NOTIFICATION TO TREAT AND THESE WOULD BE WEARABLE, PRESYSTEMATIC DIAGNOSTIC CAPABILITIES TO HELP US DETERMINE, WELL, BEFORE YOU GET A FULL-BLOWN CASE OF INFLUENZA AT WHICH POINT MAY NOT BE ABLE TO USE THE ANTIVIRAL, CAN WE SHORT TEN THE TIME FRAME THAT THE PHYSICIANS HAVE TO BE ABLE TO EFFECTIVELY USE SOME OF THE MEDICAL PRODUCTS WE HAVE SO THESE ARE SOME OF OUR FUTURE AREAS THAT WE HAVE STARTED TO INVEST IN AND THAT LITTLE THING THERE IN THE BOX AT THE BOTTOM, I WILL DESCRIBE THAT IN A

MINUTE, PRIORITY MEDICINES ON DEMAND AND WITH THE REMAINING TIME I HAVE GOT, A FEW MINUTES, I WANT TO TALK ABOUT THE GENERAL PROBLEM OF SEPSIS AND SAY IT IS A HUGE ISSUE IN TERMS OF COST IN THE UNITED STATES FOR TREATING THESE POPULATIONS AND WHAT WE HAVE DONE IS BROUGHT TOGETHER SUBJECT MATTER EXPERTS IN SEPSIS TO LOOK AT WHERE ARE THE TOUCH POINTS AND WHERE WE THINK WE CAN HAVE A BIG INFLUENCE TO REVERSE OR REDUCE, BY LET’S SAY 25 PERCENT, THE NEGATIVE IMPACTS OF SEPSIS AT THE POPULATION LEVEL SO IN TERMS OF LOOKING AT THE FAILURE POINTS, WE HAVE IDENTIFIED IN THIS PARTICULAR AREA USING THE SUBJECT MATTER EXPERTISE THAT WE WILL BE INVESTING IN ACQUIRING A DATABASE WITH PATIENT OUTCOMES WHICH WILL ALLOW US TO GENERATE REALTIME ANALYTICS AND PROGNOSTIC CAPABILITY THAT WILL HOPEFULLY PROVIDE TO THE ATTENDING MEDICAL STAFF, THE MOMENT BY MOMENT EXPERIENCE AND RECOMMENDATION AT THE LEVEL OF SPECIFICITY OF THAT PATIENT BUT BASED ON INFORMATION GATHERED FROM THOUSANDS OF THOUSANDS OF OTHER CASES SO THAT IS ONE AREA WE SEE WHERE WE MIGHT BE ABLE TO HAVE SOME IMMEDIATE IMPACT IN TERMS OF THE CURRENT FAILURE POINTS AND PRACTICES ON SEPSIS OKAY, SO THE LAST SLIDE OR TWO, LAST SLIDE WE’RE LOOKING AT HERE, THIS IS A PHARMACY ON DEMAND WE WILL HAVE A SUMMIT HERE SHORTLY BRINGING TOGETHER A NUMBER OF OTHER SUBJECT MATTER EXPERTS ON HOW WE MIGHT BE ABLE TO REDUCE TO A VERY SMALL FOOTPRINT, SLUG MANUFACTURING THINK ABOUT IT, ALMOST IN THE EQUIVALENT OF — ALMOST AT THE CORNER STORE, WHAT YOU NEED TO BE MANUFACTURED THERE IN A VERY SHORT PERIOD OF TIME AND THAT BECAUSE IT MIGHT BE THERE, WE MIGHT BE ABLE TO REVERSE WHAT WE HAVE CURRENTLY OR WITH REGARD TO HAVING THIS PURCHASE THEM AT THE STORE, LARGE NUMBERS OF MATERIALS THAT MAY NEVER GET USED BUT LOOKING AT IS THERE ANOTHER SOLUTION OR APPROACH WE CAN HAVE TO PROVIDE THESE MEDICINES THAT MIGHT BE NEEDED FOR VERY SHORT-TERM AVAILABILITY FOLLOWING AN EVENT SO WHERE YOU CAN FIND US IS ONLINE, PUBLICHEALTH EMERGENCY, PHE.GOV, ON THE WEB, SOME OF THESE OTHER COMPONENTS, FACEBOOK, TWITTER, ET CETERA AND WITH THAT, THANK YOU FOR YOUR TIME AND HAPPY TO TAKE SOME QUESTIONS >> THANK SO YOU MUCH FOR A FABULOUS PRESENTATION SO IF ANYONE IT HAS QUESTIONS, PLEASE PUT THEM IN THE CHAT BOX AND I WILL RELAY THEM WE DO HAVE TIME FOR QUESTIONS IF ANYONE HAS ANY, PLEASE THROW THEM IN THE CHAT BOX AS I GIVE YOU A SECOND TO THINK OKAY, HERE IS A QUESTION FROM CAROLYN SHE ASKS HOW IS LAW ENFORCEMENT INVOLVED IN INSURING SECURITY WITH EXPANDING THE PUBLIC-PRIVATE PARTNERSHIP? >> OH, GREAT QUESTION WE DO WORK A LOT WITH OUR LAW ENFORCEMENT COLLEAGUES FOR ME PERSONALLY, A LOT OF THAT IS WITH THE DEPARTMENT OF JUSTICE AND F.B.I AND PROBABLY THE BEST WAY TO DESCRIBE THIS IS THE NEXUS IN TERMS OF HOW THEY WOULD RESPOND TO WEAPONS OF MASS DESTRUCTION EVENT SO I AM USING WMD AS KIND OF A DISCUSSION POINT OR THE OP OPPORTUNITY WHEN OR IF WE SHOULD HAVE AN EVENT, THE JURISDICTIONS BECOME CLEAR UNDER THE EMERGENCY SUPPORT FRAMEWORK IF IT IS CRITICAL, THE DEPARTMENT OF JUSTICE, F.B.I., FORENSICS, ET CETERA, THEY HAVE CONTROL OF THE CRIME SEEN, GATHERING INFORMATION AS EVIDENCE BUT SOME OF THE EVIDENCE THEY MAY NEED TO GATHER IS ACTUALLY EPIDEMIOLOGICAL EVIDENCE AND SO THEY HAVE PARTNERED WITH LIKE THE CDC AND WITH US TO TRY TO IDENTIFY IN ADVANCE HOW THE RESPONSES ARE GOING GO TO RUN AND WHO THE CENTRAL EXPERTS ARE SO AT THE NATIONAL LEVEL OF LAW ENFORCEMENT, THOSE ARE IMPORTANT AT A LOCAL LEVEL, THE COLLEAGUES IN OUR LAW ENFORCEMENT TAKE SOMETIMES A DIFFERENT FORM

SOME OF THEM MAY BE PART OF A CRIMINAL INVESTIGATION BUT SOME OF IT IS GOING TO BE IN TERMS OF MASS CONTROL AND SUPPORT TO A PUBLIC HEALTH RESPONSE SO THINK OF WHAT SECURITY MEASURES AND HOW THE LOCAL COMMUNITY MAY REQUIRE POLICING AND OTHER EMERGENCY RESPONSE TO BE ABLE TO DEVELOP A DISTRIBUTION CENTER TO HAND OUT PILLS FOR INSTANCE, IF WE NEEDED TO DO THAT SO AS I SAID BEFORE, A LOT OF THESE THINGS HAVE A MEDICAL AND PUBLIC HEALTH INSTANT APPLICATION, MANY OF THEM ALSO HAVE THE COMEBINANT RESPONSE AT THE SITE OF PUBLIC SAFETY AND LAW ENFORCEMENT >> GREAT, THANK YOU SO MUCH ANY OTHER QUESTIONS FOR GEORGE? GO IN MORE IN THE CHAT BOX ALL RIGHT, WELL, AGAIN, THANK YOU SO, SO MUCH I REALLY APPRECIATE IT THANK YOU EVERYONE FOR ATTENDING TODAY’S PRESENTATION BEFORE WE GO, SEPTEMBER IS DISASTER PREPAREDNESS MONTH I WOULD LIKE TO SHARE SOME INFORMATION FROM THE NATIONAL DISASTER INFORMATION MANAGEMENT RESEARCH CENTER SO MAKE SURE THAT YOU TURN TO THEM FOR TOOLS AND RESOURCES ON PREPARING FOR AND RESPONDING TO DISASTERS THEY FOCUS ON PROVIDING SUPPORT FOR DISASTER WORKFORCE, PUBLIC HEALTH DEPARTMENTS, EMERGENCY RESPONDERS, LIBRARIANS AND OTHERS WHO FIND THEMSELVES INVOLVED IN DISASTER AND PUBLIC HEALTH EMERGENCY RESPONSE EFFORTS PLEASE CHECK OUT THEIR WEBSITE IF YOU HAVEN’T BEEN THERE IN A WHILE OR HAVE NEVER BEEN THERE A GOOD PLACE TO START IS THE INFORMATION GUIDE THEY HAVE GUIDES ON TOPICS LIKE HURRICANES, FLOODS, WILDFIRES, AND YOU WILL ALSO FIND SPECIAL TOPIC GUIDES LIKE ON EBOLA, COPING, CHILDREN AND DISASTER AND MORE AND ALSO THE DISASTER DATABASE WHICH THEY MENTIONED EARLIER IN THE CHAT BOX, THE DATABASE FOR DISASTER MEDICINE OF PUBLIC HEALTH AND PUBLIC HEALTH DOCUMENTS THEY ARE ALL AVAILABLE ON THE WEBSITE AT NO COST INCLUDING EXPERT GUIDELINES, RESEARCHERS, PROCEEDINGS AND MORE AND FINALLY YOU CAN STAY IN TOUCH WITH THEM BY SUBSCRIBING TO E-MAIL UPDATES, FOLLOWING THEM ON TWITTER AND ATTENDING THEIR WEBINARS THEY HAVE ONE COMING UP ON SEPTEMBER 20TH CALLED PLANNING FOR DISASTER, AND YOU CAN FIND THIS INFORMATION ON THEIR HOME PAGE SO AS A REMINDER, TODAY’S PRESENTATION WAS RECORDED AND WILL BE POSTED ON THE YOUTUBE PAGE AS SOON AS POSSIBLE WE WILL ALSO BE HOSTING A PDF OF THE SLIDES AND A LINK TO THE RECORDING ON THE ARCHIVE AND YOU CAN SEE THAT IN THE CHAT BOX RIGHT NOW OUR NEXT WEBINAR IS ON THURSDAY SEPTEMBER 27TH AT 1:00 P.M EASTERN AND WHY LIBRARY PARTNERS ARE CRITICAL TO THE PROGRAM, DETAILS ON REGISTERING ARE ONLINE AND FINALLY, TO EVALUATE TODAY’S WEBINAR AND RECEIVE YOUR CREDIT, PLEASE VISIT THE WEBSITE I AM POSTING IN THE CHAT BOX AS WE SPEAK I WILL ALSO SEND IT TO YOU ONCE THE RECORDING IS POSTED AND THANKS AGAIN, EVERYONE, FOR ATTENDING TODAY’S WEBINAR AND I REALLY THANK YOU DOCTOR FOR BEING HERE TODAY IT WAS AN EXCELLENT WEBINAR THANKS VERY MUCH >> THANK YOU VERY MUCH, TAKE CARE, EVERYBODY >>