Going Viral Symposium: Welcomes (Friday)

>> WELL, GOOD MORNING AND THANK YOU, ALL OF YOU WHO WERE HERE YESTERDAY IT WAS SUCH AN ENERGIZING DAY AND I’VE HEARD SO MANY POSITIVE COMMENTS I REALLY WANT TO THANK EVERYBODY WHO HELPED COULD I JUST ASK MEMBERS OF THE PLANNING COMMITTEE WHO ARE HERE TO STAND UP SO THAT WE CAN RECOGNIZE YOU [ APPLAUSE ] >> TO HAVE THIS KIND OF AN INTER DISCIPLINARY AGENDA REALLY TOOK AN INNER DISCIPLINARY PLANNING COMMITTEE TO HELP CONNECT US ACROSS THE UNIVERSITY AND BEYOND. I APPRECIATE ALL THEY DID TO HELP US GET THERE TODAY WE’RE GOING TO CONNECT WITH TOM FRIEDEN WHO NOW RUNS A NEW ORGANIZATION CALLED RESOLVE WE’RE HOPING IT ALL GOES WELL WE’VE TESTED THE CONNECTIONS WE’LL PLAY IT BY EAR IF IT DOESN’T AND WE’LL ASK THE PANEL, THE TWO PANEL MEMBERS AND JANE TO GET STARTED A LITTLE EARLIER IF THAT SHOULD FALL THROUGH WE’RE VERY OPTIMISTIC WE’RE GOING TO LOOK, AFTER TOM, WE’RE GOING TO LOOK AT ISSUES OF AFRICAN AMERICANS AND MINORITIES REALLY EXCITED ABOUT THAT PRESENTATION AND THEN THERE WILL BE A VERY PRACTICAL SESSION ON BEST PRACTICES IN PREVENTION AND PREPAREDNESS AND RALPH BARIC IS GOING TO GIVE THE WRAP-UP TALK AND TELL US HOW BAD IT CAN BE AND HOW WE CAN AVOID IT I THINK IT’S GOING TO BE A REALLY INTERESTING AND FAST-PACED SESSION THIS MORNING I WANT TO CALL ON TWO OF OUR CO-SPONSORS TO WELCOME EVERYBODY THIS MORNING STARTING WITH EVELYN COSTAR AND SOME OF YOU MAY HAVE SEEN THE BOOK AT THE BOOK TABLE YESTERDAY THAT TALKED ABOUT THE ROLE OF REALLY THE MODERN ROLE OF MUSEUMS AND THEIR ROLE AS COMMUNITY PARTNERS AND EVELYN WROTE ONE OF THE CHAPTERS IN THAT AND IT’S BEEN REALLY INTERESTING TO SEE HOW A MUSEUM CAN PARTNER WITH A UNIVERSITY AND THE BROADER COMMUNITY I’VE BEEN REALLY EXCITED ABOUT IT AND MIKE COHEN WHO IS THE DIRECTOR OF THE INSTITUTE FOR GLOBAL HEALTH AND PROBABLY THE BEST WAY YOU KNOW MIKE IS BY FOUR LETTERS PREP; RIGHT? WE’RE REALLY GLAD TO HAVE MIKE AS A COLLEAGUE, AS ONE OF OUR FACULTY MEMBERS SHARED WITH THE SCHOOL OF MEDICINE AND THEN LEAH DEBLIN AND FORMERLY HEAD OF THE HEALTH DEPARTMENT IN NORTH CAROLINA WILL COME UP RIGHT AFTER THEM SO THANK YOU, ALL, FOR BEING HERE AND REALLY LOOKING FORWARD TO THE PRESENTATIONS SO EVELYN, I WILL CALL YOU FIRST >> GOOD MORNING, LADIES AND GENTLEMEN THANK YOU TO OTHERS WHO HAVE BEEN INSTRUMENTAL IN THE ORGANIZATION AND REALIZATION OF GOING VIRAL I SAY THANK YOU I HAVE THE PLEASURE OF SAYING A COUPLE THINGS ABOUT THE CONTEXT OF THE INTEREST AND PARTICIPATION OF THE NORTH CAROLINA MUSEUM OF NATURAL SCIENCES WHICH YOU SEE HAS AN LOGO ON THE BOTTOM OF THE SCREEN AND TO INTRODUCE THE NEXT GENTLEMAN IN THE PROGRAM YOU MAY KNOW THE NORTH CAROLINA MUSEUM OF NATURAL SCIENCES BEEN AROUND SINCE 1879 JUST 20 YEARS AFTER DARWIN PUBLISHED THE ORIGIN OF SPECIES GOING STRONG AND EXPANDING AND WITH A MISSION THAT SAYS THAT WE ARE IN THE BUSINESS OF ILLUMINATING THE NATURAL WORLD BY ASKING QUESTIONS OF WHAT DO WE KNOW, HOW DO WE KNOW, WHAT’S HAPPENING NOW AND HOW CAN THE PUBLIC PARTICIPATE? MUSEUMS ARE UNIQUE AGENCIES IN THE SERVICE OF SOCIETY IN THE ENVIRONMENT FOR TOO LONG, THEY’VE ONLY LOOKED BACK IN TIME WE ARE COMFORTABLE AT SORT OF EMBRACING THIS IS A CRITICAL MOMENT IN THE CONTINUITY OF TIME PAST, PRESENT AND THE FUTURE I HOPE THAT YOU — IF YOU HAVEN’T COME TO KNOW US, YOU WILL DO SO IT’S THE MOST VISITED MUSEUM IN NORTH CAROLINA THE MOST ABUNDANTLY USED FIELD TRIP DESTINATION I’D ALSO SAY WHEN WE CAME TO KNOW THAT UNC CHAPEL HILL AND THE GLOBAL SCHOOL OF PUBLIC

HEALTH WAS CONTEMPLATING COMMEMORATING IF THAT’S THE RIGHT WORD, SUCH A TERRIBLE DISASTER AFTER THE FIRST WORLD WAR, I THINK THROUGH LEAH WHO I HAD MET SHE INVITED US TO COME AND HAVE A CLOSE LOOK AND IT SEEMED TO ME THAT THIS EVENT SHOULD HAVE A PUBLIC FACE AS WELL THIS CONVENING SO TOMORROW AT THE MUSEUM IN DOWNTOWN, THERE IS SORT OF A CONTINUATION OF PUBLIC VERSION OF WHAT YOU ARE TALKING ABOUT HERE WITH SEVERAL OF THE SPEAKERS AND WE APPRECIATE THAT’S BECOME OUR OPPORTUNITY AND WE’RE DELIGHTED TO BE IN THE PROFILE WITH THIS EVENT ALONGSIDE WITH OUR COLLEAGUES MY PLEASURE TO INTRODUCE TO YOU MYA COHEN, MD WITH HIS EDUCATION COMING FROM THE UNIVERSITY OF ILLINOIS FROM THE RUSH MEDICAL CENTER FROM THE UNIVERSITY OF MICHIGAN AND YALE DR. COHEN IS DISTINGUISHED PROFESSOR IN E PID EMIOLOGY AND THE SCHOOL OF MEDICINE DIRECTOR OF THIS UNIVERSITY INSTITUTE OF GLOBAL HEALTH AND INFECTIOUS DISEASES AND HE IS AN ASSOCIATE VICE CHANCELLOR FOR THIS UNIVERSITY FOR GLOBAL HEALTH HE IS A RENOUND SPECIALIST, RESEARCH SPECIALIST CAREER LONG IN THE FIELD OF AIDES AND WAS — HIS WORK IN THIS WAS RECOGNIZED AS THE ACHIEVEMENT OF THE YEAR, THE BREAKTHROUGH OF THE YEAR BY SCIENCE MAGAZINE WHICH WE ALL KNOW TO BE ONE OF THE WORLD’S PREMIERE JOURNALS OF SCIENCE PARTICULARLY, CONNECTED TO MY WORLD SINCE I WORKED WITH THE STATE GOVERNMENT AND THE DEPARTMENT OF NATURAL AND CULTURAL RESOURCES WHICH ADMINISTERS THE ANNUAL AWARDS FOR EXCELLENCE BY THE STATE, DR COHEN WAS RECOGNIZED IN 2011 WITH THE PREMIERE AWARD FOR SCIENCE IN THE STATE OF NORTH CAROLINA SO PLEASE WELCOME TO THE PODIUM DR. COHEN [ APPLAUSE ] >> ONE OF THE FIRST RULES OF PUBLIC SPEAKING IS NEVER FOLLOW SOMEONE WITH A BRITISH ACCENT YOU NEVER CAN SOUND — IT’S IMPOSSIBLE YOU HAVE SUCH A HUGE ADVANTAGE THANK YOU FOR THOSE KIND WORDS AND LET ME INDICATE AS WAS NOTED, I DIRECT THE GLOBAL HEALTH AND INFECTIOUS DISEASE ORGANIZATION DESIGNED TO AMPLIFY HEALTH SCIENCE SCHOOLS AND ACROSS THE CAMPUS I HAVE THE PRIVILEGE OF WELCOMING YOU ON BEHALF OF THE UNIVERSITY OF NORTH CAROLINA TO WHAT IS GREAT SIMPOSIUM AND LET ME THANK THE SPEAKERS WHO WERE TERRIFIC YESTERDAY AND GREAT AGAIN TODAY AND A DURABLE AUDIENCE I WAS SHOCKED TO SEE THIS NUMBER OF PEOPLE ON DAY TWO DAY TWO CAN BE A DRAMATIC DISAPPOINTMENT AND SO THANK YOU FOR YOUR DURABILITY MY FRIEND BARBARA RIMER ASKED ME TO OFFER A FEW COMMENTS WHICH IS GOING TO BE A FEW OPINIONS SHE ASKED ME TO TRY AND MAKE THEM VAGUELY RELEVANT THEMSELF I’M AN HIV SPECIALIST WE’VE HEARD ENOUGH ABOUT INFLUENZA TIME TO TURN OUR ATTENTION TO HIV ONE CAN ONLY TALK ABOUT WHAT THEY KNOW ABOUT SO I HAVE NO CHOICE BUT IN A MORE SERIOUS NOTE, I THINK IT’S AN OPPORTUNITY TO TALK ABOUT THE KIND OF BIGGER ISSUE OF MICROBIAL THREATS REALLY EMERGING PATHOGENS AND MICROBIAL THREATS I WOULD ARGUE WE’VE LEARNED REALLY CRITICAL LESSONS FROM INFLUENZA AND HIV AND OTHER EMERGING PATHOGENS PROBABLY THE MOST CRITICAL LESSON IS WHEN WE’RE FACED WITH AN EMERGING PATHOGEN IT REQUIRES SIMPLICITY AND FOCUS THOSE ARE THE KIND OF CRITICAL THINGS AND THERE ARE THREE THINGS — FOR ANY THREAT THE THREE THINGS WE HAVE TO DO FIRST, WE HAVE TO KNOW HOW TO PREVENT THE INFECTION AND RISK AT ITS INCEPTION SECOND, WORK ON SOME WAY TO MANAGE THE INFECTION OR TREAT THE INFECTION WE HEARD ABOUT RESPIRATORS AND LASTLY, FOR INFECTIONS THAT ARE CHRONIC, WE HAVE TO FIGURE

OUT A WAY TO CURE THESE SO LET’S TALK FOR A MOMENT ABOUT HIV WHICH I’M GOING TO USE AN EXAMPLE OF THE CHALLENGES OF AN EMERGING PATHOGEN PREVENT THE INFECTIOUS AGENT THAT REQUIRES WE KNOW THE RULES THAT GOVERN THE AGENT THE RULES, THE RULES, THE RULES FOR HIV, WE SPENT MORE THAN A DECADE WANDERING AROUND IN A WILDERNESS BECAUSE WE DIDN’T UNDERSTAND THE INFECTION AND LED TO THE CONSEQUENCES OF STIGMA AND FEAR AND THOSE ARE WITH US TO THIS DAY IN TERMS OF TRYING TO MANAGE THIS PANDEMIC WE HAD VERY INEFFECTIVE PREVENTION POLICIES BUT THEN, AFTER MAYBE 15 YEARS OR SO, WE BEGAN TO UNDERSTAND THE RULES THAT GOVERN THE TRANSMISSION OF HIV BEGAN TO UNDERSTAND THE DISEASE ITSELF MUCH BETTER AND THAT ALLOWED US TO HAVE TARGETED ACTIVITIES THAT ARE VERY SUCCESSFUL AND LIFE-SAVING TREATMENT THAT HAS EVOLVED TO ONE PILL A DAY AND NORMAL LIFE SPAN FOR PEOPLE WITH HIV INFECTION THIS SUCCESS WAS NOT FAST IT TOOK MORE THAN 15 YEARS TO GET TO THE POINT I JUST DESCRIBED AND WE’RE STILL MISSING AN HIV VACCINE AS WE TALK ABOUT UNIVERSAL FLU VACCINES AS AN ASPIRATION, IT MAY BE A LONG TIME IN THE MAKING TO REALIZE THAT GOING BACK TO INFLUENZA YESTERDAY, WE HEARD THE REMARKABLE STORY ABOUT THE RECONSTRUCTION OF THE 1918 INFLUENZA VIRUS AND HEARD FROM THE SCIENTIST THAT CONDUCTED DIFFICULT EXPERIMENTS HOW THEY WERE ABLE TO UNDERSTAND THE RULES THAT GOVERN THE TRANSMISSION OF HIV, THE 1918 STRAIN OF INFLUENZA AND PATHOGENESIS 100 YEARS AGO THAT ORGANISM CAUSED A CRISIS THERE’S BEEN TREMENDOUS FEAR THAT CRISIS WOULD BE REVISITED IN ORDER TO DEAL WITH THE CRISIS, THE SCIENTISTS WHO WERE WITH US YESTERDAY EMPHASIZED WORK THAT LED TO UNDERSTANDING THE RULES THAT GOVERN THE AGENT IT’S ALWAYS THE RULES, THE RULES, THE RULES WHEN YOU DEAL WITH THESE INFECTIONS AND RALPH WILL TALK LATER ABOUT SOME OF THESE AGENTS AND I’M SURE HE’LL GET INTO HIS WORK THAT LEADS TO UNDERSTANDING THE RULES SO IT MUST BE OBVIOUS THAT IT TOOK 15 OR 20 YEARS FOR HIV 100 YEARS FOR INFLUENZA NOW, WE’RE IN A DIFFERENT ERA THE TECHNOLOGICAL ADVANCES THAT HAVE COME ABOUT CHANGE THE WAY WE DEAL WITH EMERGING THREATS FROM YEARS TO UNDERSTANDING TO LITERALLY WEEKS TO UNDERSTANDING WHEN WE’RE CONFRONTED WITH EBOLA OR NEW AGENTS THAT WE’RE NOT FAMILIAR WITH, THE TECHNOLOGY THAT’S BEEN DEVELOPED REALLY CHANGES HOW WE THINK ABOUT EMERGING PATHOGENS AND I WOULD EMPHASIZE BECAUSE WE TALKED ABOUT THE OUT BREAK NARRATIVES I DON’T SEE THE TECHNOLOGICAL ADVANCES AT THE EXPENSE OF SOCIETAL AND BEHAVIORAL ISSUES IT IS THOSE ADVANCES THAT ALLOW US TO GIVE THIS INFORMATION TO THE PUBLIC WHICH CALMS A RATIONAL FEAR IT’S THE RULES THAT SET YOU FREE AS WE DEAL WITH EMERGING PATHOGENS FOR HIV AND ANY PATHOGEN, THE GREATEST FEAR WAS AIRBORNE SPREAD THAT DRIVES EVERY SCARY MOVIE THERE’S NO SCARY MOVIE I HAVE THE TRAILERS FOR OUT BREAK THERE’S NO SCARY MOVIE THAT DOESN’T HAVE YOU BREATHING AIR THAT MAKES YOU SICK AND ONCE AIRBORNE SPREAD HAS BEEN ELIMINATED, THERE’S A CERTAIN CALM THAT SPREADS OVER THE POPULATION BUT HIV TAUGHT US ANOTHER LESSON AN INFECTIOUS AGENT THAT IS FOREVER TRANCE MISSABLE AND CHRONIC AND HIDDEN CAN SUSTAIN MASSIVE DEVASTATING EPIDEMIC SO WHILE I THINK IT’S IMPORTANT TO EXCLUDE AIRBORNE SPREAD, ONE SHOULD NOT IGNORE THE OTHER CONSEQUENCES OF SOME OF THESE PATHOGENS SO THIS MORNING WE’RE GOING TO HEAR FROM GREAT SPEAKERS THEY ARE GOING TO FOCUS ON STRUCTURAL INTERVENTIONS AT THE LEVEL OF SOCIETY I WOULD ONLY ASK YOU REMEMBER FROM MY POINT OF VIEW AND OUR GROUP’S POINT OF VIEW ALL THE RESPONSES DEPEND ON UNDERSTANDING THE RULES OF THE AGENTS IT’S THE RULES, THE RULES, THE RULES AND THAT HAS TO DRIVE — THE SCIENCE DRIVES ALL OF THE INTERVENTIONS AND ACTIVITIES THAT TRANSPIRE SO KNOWING THE RULES AND OUR ABILITY NOW TO LEARN THE RULES MORE QUICKLY USING THE TECHNOLOGIES THAT WERE DESCRIBED YESTERDAY OFFER US TREMENDOUS ADVANTAGES OVER PAST GENERATIONS AND SOCIETAL ADVANTAGES AS WELL THIS MORNING WE’LL MOVE FROM THE SCIENCE THAT WE HEARD YESTERDAY MORE TOWARDS THE INTERVENTIONS

OF EMERGING PATHOGENS THE RECONSTRUCTION OF FLU AND THE EXPERIMENTS THAT WERE DESCRIBED YESTERDAY FROM OUR COLLEAGUES THAT WERE REALLY KIND OF BREATHTAKING SCIENCE, THAT DEMONSTRATES THE KIND OF FUTURE OF OUR APPROACH TO MICROBIAL THREATS THANK YOU FOR BEING HERE FOR THE SECOND DAY AND I HOPE YOU’LL ENJOY THIS MORNING THANK YOU [ APPLAUSE ] >> THANK YOU, DR. COHEN, DR COSTER I’M LEAH AND I’M DELIGHTED TO BE BACK HERE WITH ALL OF YOU TODAY I WANTED TO JUST DRIVE HOME THE POINT AGAIN ABOUT HOW THIS EVENT HAS BEEN DEVELOPED BY OUR PARTNERS AND THAT’S THE HALL MARK OF HOW WE WORK TOGETHER IN PUBLIC HEALTH IN NORTH CAROLINA THROUGH PARTNERSHIPS AND THROUGH COLLABORATION I’LL BE MODERATING TODAY’S VERY EXCITING SESSION FEATURING TOM FRIEDEN JOINING US FROM DELI P.M. IN THE EVENING WE REMEMBER WHEN HE WAS HERE WITH US IN PERSON AT OUR SCHOOL OF PUBLIC HEALTH AND SPOKE TO HUNDREDS OF OUR STUDENTS AND FACULTY AND IT WAS INCREDIBLY INSPIRING WE’RE STILL TALKING ABOUT IT WE’RE DELIGHTED TO HAVE HIM BACK WITH US AGAIN TODAY WE ARE PRIVILEGED TO HEAR HIS PERSPECTIVE AS ONE OF THE WORLD’S TOP PUBLIC HEALTH EXPERTS IN THE WORLD ON HOW STRONG POLICIES CAN MAKE US SAFER AROUND THE GLOBE STRONG POLICIES NOT JUST IN THE UNITED STATES BUT IN OTHER COUNTRIES PARTICULARLY FOCUSING ON MIDDLE INCOME AND LOW INCOME COUNTRIES AROUND THE WORLD WE WILL HAVE TIME FOR QUESTIONS SO PLEASE BE THINKING OF HOW YOU WANT TO ENGAGE AND COME TO THE MICS QUICKLY AFTER HIS REMARKS MANY OF YOU KNOW DR. FRIEDEN FROM HIS WORKS AND AROUND THE GLOBE I HAD THE OPPORTUNITY TO GET TO KNOW HIM WHEN HE WAS THE NEW YORK CITY HEALTH COMMISSIONER HE AND HIS AMAZING TEAMWORKED ON SO MANY IMPORTANT PUBLIC HEALTH ISSUES AND WITH SUCH EFFECTIVENESS HE LED TO A RAPID INCREASE IN LIFE EXPECTANCY IN NEW YORK CITY NOW, THOSE OF YOU WHO KNOW HIM WELL PARTICULARLY FROM OUR INFECTIOUS DISEASE COMMUNITY KNOW THAT HE HAS MADE HIS MARK ALSO IN TUBURCULOSIS CONTROL HE HAS LED THE INVESTIGATION OF THE OUT BREAK OF THE LARGEST MULTI-DRUG RESISTANCE EFFORTS IN OUR COUNTRY AND HE ALSO WAS FOUNDATIONAL IN ESTABLISHING THE LARGEST TB CONTROL PROGRAM IN THE WORLD IN INDIA SO HE’S COME FULL CIRCLE THIS MORNING PROBABLY HIS MOST VISIBLE ROLE FOR ALL OF US HAS BEEN AS THE DIRECTOR OF THE CENTERS FOR DISEASE CONTROL PREVENTION FROM 2009 TO 2017 BECAUSE OF HIS WORK THERE, AMERICANS, ALL OF US, ARE SAFER FROM ANTIBIOTIC RESISTANCE, FOOD BORN AND HEALTHCARE ASSOCIATED INFECTIONS, HEART ATTACKS, STROKES, CANCER AND EXPOSURE TO DANGEROUS PATHOGENS INCLUDING DR. COHEN, HIV, AND FOR THIS MORNING’S PURPOSE, PANDEMIC FLU BUT MANY OTHERS HE CONTINUES TO BE AN ADVOCATE FOR A STRONG CENTERS FOR DISEASE CONTROL AND PREVENTION HE IS CURRENTLY THE PRESIDENT AND CEO OF RESOLVE TO SAVE

LIVES 225 MILLION FIVE-YEAR INITIATIVE THIS EFFORT IS FUNDED BY BLOOMBERG PHILANTHROPIES, THE GATES FOUNDATION AND THE ZUCKERBERG INITIATIVE FIRST IS TO LITERALLY SAVE 100 MILLION LIVES OVER FIVE YEARS BY IMPLEMENTING PROVEN SOLUTIONS TO PREVENT HEART DISEASE AND STROKE WHICH ARE THE WORLD’S LEADING CAUSES OF DEATH THE SECOND AIM OF RESOLVE IS TO PREVENT THE NEXT DISEASE OUT BREAK BY CATALYZING URGENT COUNTRY ACTION AROUND THE WORLD TO DETECT EARLY RESPOND RAPIDLY AND EFFICIENTLY TO AN EMERGING OUT BREAK EITHER A TRIED AND TRUE PATHOGEN OR A NEW EMERGING ONE IF ANYONE CAN SAVE 100 MILLION LIVES, IF ANYONE CAN BUILD CAPACITY IN COUNTRIES AROUND THE WORLD TO STRENGTHEN PUBLIC HEALTH SYSTEM, IT IS DR. TOM FRIEDEN WE LOOK FORWARD ON HIS REMARKS AND THE DISCUSSION HE WILL HAVE WITH YOU THE REMOTE MICROPHONE FROM INDIA IS NOW YOURS >> THANK YOU VERY MUCH IT’S GREAT TO BE THERE WITH YOU FIRST, LET ME ASK IF YOU CAN HEAR ME ALL RIGHT >> YES >> GREAT WHEN I DO THIS CAN YOU SEE MY SLIDES? >> YES >> FANTASTIC DESPITE A BIG STORM OUTSIDE AND MANY THOUSANDS OF MILES, I FEEL LIKE I’M THERE WITH YOU AND REALLY DO APPRECIATE THE CHANCE TO SHARE WHAT I THOUGHT I WOULD DO IS SPEAK PRETTY QUICKLY ABOUT SOME OF THE KEY ISSUES AND OPEN IT UP FOR DISCUSSION AND, OF COURSE, AS WE ARE IN 2018, WE THINK BACK 100 YEARS AND I’VE SEEN YOUR PROGRAM, IT’S VERY IMPRESSIVE REMINDS ME OF A RETREATY WENT TO WITH CONGRESSMAN YEARS AGO WHERE AT THE END SOMEONE SAID EVERYTHING I WANTED TO SAY HAS ALREADY BEEN SAID BUT NOT BY ME SO I’M GOING TO SAY IT AND I’M AFRAID I MAY BE REPEATING THINGS YOU’VE ALREADY HEARD I’LL GIVE YOU A SENSE ON MY TAKE WHERE WE ARE WITH INFLUENZA BUT VARIETY OF HEALTH THREATS THE SLIDES ARE UP WITH YOU? >> YES >> GREAT AND I’LL FOCUS ON THE WORD POLICIES FOR A MOMENT POLICY IS THE ROYAL ROAD [INAUDIBLE] PROGRAM TENDS TO GET THE ATTENTION AND THE FUNDING BUT OFTEN POLICIES ARE WHAT DRIVE MORE RAPID HEALTH PROGRESS AS YOU ALL KNOW, THE GLOBAL PANDEMIC FROM 100 YEARS AGO KILLED PROBABLY MORE THAN 50 MILLION PEOPLE WORLDWIDE LOOK AT THAT GRAPH ON THE BOTTOM RIGHT THE DRAMATIC DECLINE IN U.S LIFE EXPECTANCY AND IT KILLED MORE PEOPLE IN 24 WEEKS THAN HIV KILLED IN 24 YEARS AND MORE THAN THE BLACK DEATH KILLED IN THE CENTURY MOST OF THOSE KILLED WERE HEALTHY AND HEALTH SYSTEMS WERE OVERWHELMED HAVE WE LEARNED LESSONS? IN 1918 THERE WERE NO FLU VACCINES TO PREVENT INFECTION THERE WERE NO ANTIVIRAL DRUGS I THINK YOU SAW MY INVITATION TO PLAY SQUASH SORRY ABOUT THAT [ LAUGHING ] >> THERE WERE NO ANTIVIRAL DRUGS NO MECHANICAL VENTILATORS OR INTENSIVE CARE UNITS AND NO MODERN PROTECTION DEVICES TO REDUCE TRANSMISSION NOW, WE MADE ADVANCES IN EACH ONE OF THESE FIVE AREAS BUT STILL IN EACH ONE OF THEM AND IN OTHERS THERE ARE REAL PROBLEMS THERE IS AN INCREASED GLOBALIZATION INTER CONNECTEDNESS THE DISEASES SPREAD A LOT FASTER NOW THERE ARE NO PATHOGENS ON AVERAGE ONE YEAR CAN TAKE MONTHS TO DEVELOP, DISTRIBUTE AND ADMINISTER AND HAVE LIMITED EFFICACY LET ME SAY I’M DELIGHTED NIH HAS SIGNIFICANT FLU VACCINE IT’S MUCH NEEDED HOWEVER, THAT IS A LONG WAY AWAY AND WE COULD PROBABLY DO A LOT OF GOOD IF WE RIGOROUSLY STUDIED THE FOUR VACCINE TYPES ON THE MARKET FIGURED OUT WHICH WORKED BEST AND USE THAT INFORMATION TO OPTIMIZE VACCINE DEVELOPMENT PANDEMICS WILL OVERWHELM EVEN

THE BEST HEALTHCARE SYSTEMS AND I RECALL LOOKING AT SINGAPORE DEALING WITH SARS AND THINKING WOW, IF THE SINGAPORE HAS PROBLEM WITH THIS, IMAGINE WHAT WOULD HAPPEN ELSEWHERE? THE GREATEST MOMENT OF TERROR IN THE EBOLA EPIDEMIC WAS WHEN IT ALMOST GOT OUT OF CONTROL IN LAGOS MOST OF THE WORLD REMAINS UNPREPARED FLU VACCINES ARE STILL NOT GOING TO BE HERE ON TIME IN MOST OF THE SCENARIOS OF A PANDEMIC ANTI-VIRAL DRUGS ARE HERE BUT HAVE LIMITED IMPACT HARD TO GET PEOPLE TO USE THEM ANTIBIOTICS THAT TREAT INFECTIONS FLU CAN KILL FROM VIRAL INFECTION AS WELL AND THE MECHANICAL VENTILATOR CHALLENGE IS NOT A SMALL ONE WHEN I WAS AT NEW YORK CITY IN THE HEALTH DEPARTMENT AND CDC, I WAS CONCERNED VENTILATORS WERE THE LOWEST COMMON DENOMINATOR FOR EMERGENCY PREPAREDNESS THE NATIONAL STOCKPILE IN MY TIME GREATER INCREASED THE NUMBER OF VENTILATORS WE LOOKED AT WHAT WE CAN DO TO INCREASE PREPAREDNESS NOT JUST THE MACHINE BUT THE RESPIRATORY THERAPIST AND HOW YOU SCALE THAT UP IN AN EMERGENCY A LOT MORE NOW ABOUT TRANSMISSION OF FLU NEW STUDIES SHOW, FOR EXAMPLE, SOURCE CONTROL COVERING THE MOUTH OF THE PERSON WHO IS SICK MAKES A REALLY BIG DIFFERENCE AND THE TRADITION IN ASIA OF WEARING A MASK WHEN YOU ARE SICK HAS A LOT TO COMMEND IT AS LEAH MENTIONED, I’M CURRENTLY HONORED TO LEAD A GLOBAL INITIATIVE CALLED RESOLVE TO SAVE LIVES OUR GOALS ARE TO PREVENT 100 MILLION DEATHS AND TO MAKE THE WORLD SAFER FROM EPIDEMICS WE’RE DELIGHTED TO HAVE THE DONORS THAT LEAH MENTIONED WE HAVE CORE ORGANIZATIONS THAT WE SUPPORT AROUND THE WORLD TO ESTABLISH PARTNERSHIP ON EACH OF THESE TWO AREAS AND I WON’T TALK MUCH ABOUT THE CARDIOVASCULAR INITIATIVE SINCE WE’RE FOCUSING ON FLU FLU INCREASES HEART ATTACKS WE HAVE A SIMPLE FORMULA 50 PLUS 30 PLUS 0 EQUALS 100 THE WAY THAT WORKS IS IF WE INCREASE GLOBAL CONTROL OF BLOOD PRESSURE TO 50% INCREASE SODIUM AND ELIMINATE TRANS FAT, WE WILL GET TO 100 MILLION LIVES SAVED IN ABOUT 30 YEARS WOULD BE THE FIRST GLOBAL ELIMINATION OF A NONCOMMUNICABLE DISEASE THE WORLD HEALTH ORGANIZATION CALLED FOR IT AND I LOOK FORWARD TO SEEING REAL PROGRESS ON THAT IN THE MAKING THE WORLD SAFER WE’RE FOCUSING ON CORE SYSTEMS, THE CORE FOUR OF TRACKING SYSTEMS, TRAINED EPIDEMIOLOGISTS, STRONG LABORATORY NETWORKS AND RESPONSE TEAMS THAT CAN STOP OUT BREAKS QUICKLY DISEASE OUT BREAK ANYWHERE IS A HEALTH THREAT ANYWHERE CAN TRAVEL ACROSS THE WORLD IN JUST 4 TO 6 HOURS AND THERE ARE LOTS OF REASONS WHY EPIDEMICS ARE MISSED AND HOW THEY ARE FOUND FOR EXAMPLE, WE KNOW THAT IT ALWAYS OR JUST ABOUT ALWAYS BEGINS WITH AN ALERT CLINICIAN THE ALERT CLINICIAN NEEDS TO HAVE ACCESS TO A GOOD LABORATORY NETWORK ON-GOING RELATIONSHIP WITH LOCAL HEALTH DEPARTMENT THERE NEEDS TO BE A TRACKING SYSTEM THAT CAN TELL IF SOMETHING UNUSUAL IS HAPPENING THERE NEEDS TO BE TRAINED EPIDEMIOLOGISTS WHO CAN ANALYZE THAT LOOKING AT THE LABS AND THERE NEEDS TO BE POLITICAL COURAGE TO SAY EVEN WHEN IT’S NOT DEFINITE, THERE MAY BE AN OUT BREAK AND WE’RE GOING TO TAKE APPROPRIATE ACTION AND THIS ALWAYS COMES UP ALWAYS A VOICE THAT SAYS OH, BUT MAYBE IT’S NOT REAL BUT WE’RE GOING TO HAVE ECONOMIC LOSSES TOURISM WILL BE DOWN ALL OF THESE THINGS ARE NECESSARY FOR EPIDEMICS TO BE FOUND OR REASONS WHY THEY MAY BE MISSED THE WORLD HEALTH ORGANIZATION HAS INTERNATIONAL HEALTH REGULATIONS THESE WERE UPDATED AFTER THE SARS EPIDEMIC AND FUNDAMENTALLY THEY TALK ABOUT PREVENTING AVOIDABLE OUT BREAK AND RESPONDING RAPIDLY AND EFFECTIVELY I’M EXTREMELY EXCITED ABOUT THE JOINT EXTERNAL EVALUATION PROCESS THIS IS THE FIRST TIME EVER THERE’S BEEN A GLOBAL ACCOUNTABILITY FRAMEWORK AND IT TELLS YOU VERY SIMPLY

WHETHER COUNTRIES ARE READY AND WHAT WE KNOW IS WE’RE DOING A PRETTY GOOD JOB AT ASSESSMENT BY THE END OF THIS YEAR MORE THAN 100 COUNTRIES WOULD HAVE GONE THROUGH THIS AND VERY FEW — WE’VE BEEN TRYING TO SEE IF WE CAN LEVERAGE RESOURCES TO FIX GAPS IN THOSE CRITICAL AREAS OF TRAINED EPIDEMIOLOGISTS, LABORATORY NETWORKS, RAPID RESPONSE CAPACITY, SURVEILLANCE SYSTEMS THIS IS SOME OF THE RESULTS OF THE JOINT EXTERNAL EVALUATION PROCESS YOU CAN SEE IN AFRICA, THERE’S NOT A SINGLE COUNTRY YET DOCUMENTED AS BEING READY SOME HAVE WORK TO DO SOME ARE NOT READY AND THE ONES THAT ARE BLANK HAVE NOT EVEN ASKED FOR AN ASSESSMENT YET RESOLVE WILL HELP TO ASSESS AND TRACK PREPAREDNESS TO ADDRESS CRITICAL GAPS MOST COUNTRIES HAVE THE ATTENTION AND DETERMINATION TO PREPARE FOR EPIDEMICS BUT NOT ADEQUATELY PREPARED YET WE’RE FOCUSED ON THESE FOUR AREAS WE’VE ALREADY BEGUN WORK PARTICULARLY IN NIGERIA WHERE THERE’S A NEW GOOD PUBLIC HEALTH INSTITUTE THEY ARE RESPONDING EFFECTIVELY TO A LARGE OUT BREAK OF FEVER AND MULTIPLE OUT BREAKS WHAT WE SEE THERE IS WHAT WE SEE IN MANY PLACES THE BETTER PROGRAMS YET, THE MORE OUT BREAKS THEY FIND THE MORE BUSY THEY ARE DEALING WITH OUT BREAKS THE MORE BUSY THEY ARE, THE LESS ABLE THEY ARE TO IMPLEMENT THE SYSTEM THAT WILL PREVENT THOSE OUT BREAKS IN THE FIRST PLACE WHETHER IT’S VACCINATION OR IDENTIFICATION OF RISK FACTORS OR MITIGATION OF RISKS FROM FOOD AND WATER WHAT WE HOPE IS THAT STRENGTHENING ALL OF THESE SYSTEMS WILL NOT ONLY STRENGTHEN THE RESPONSE TO UNUSUAL EMERGENCIES BUT PERHAPS MORE IMPORTANTLY [INAUDIBLE] I’LL COME BACK TO THAT IN A MOMENT EPIDEMIC PREVENTION IS SMART SPENDING THE COST OF THE PANDEMIC IS MANY TIMES HIGHER THAN THE COST OF PREVENTING THAT PANDEMIC WE ESTIMATE IT’S ABOUT $1 PER PERSON PER YEAR TO ESTABLISH THE BASIC CORE REQUIREMENTS FOR DISEASE PROTECTION THAT MONEY ISN’T FORTHCOMING I’M PLEASED THAT THE CURRENT ADMINISTRATION — THE CURRENT CONGRESS, I SHOULD SAY, FUNDED THE GLOBAL HEALTH SECURITY PROGRAM AT CDC EVEN THOUGH THAT PROGRAM HADN’T YET RUN OUT OF MONEY VERY ENCOURAGING CONGRESS PUT $50 MILLION MORE THIS YEAR THEY’VE BEEN RUNNING 150 TO $200 MILLION A YEAR PROGRAM IT WILL EXPIRE NEXT YEAR SINCE THE CONGRESS PUT $50 MILLION THIS YEAR AND $100 MILLION NEXT YEAR THEY’LL MAKE THIS PROGRAM A STABLE PROGRAM AS YOU KNOW, DISEASES KNOW NO BORDERS WE WON’T BE SAFE UNTIL OTHER COUNTRIES ARE SAFER WE WON’T BE SECURE AT HOME UNTIL COUNTRIES ARE SAFER ABROAD AND THAT ESSENTIAL CONNECTION OF THE WORLD IS NOT GOING TO CHANGE AND BECAUSE OF THAT, IT IS NOT ONLY THE RIGHT THING TO DO BUT IN OURSELF INTEREST TO HELP OTHER COUNTRIES BECOME BETTER PREPARED IN RESOLVE TO SAVE LIVES, WE HAVE THREE KEY PRINCIPLES: SIMPLICITY, SPEED, SCALE WE’RE DELIGHTED TO HAVE GREAT SUPPORT FROM OUR DONORS AND DELIGHTED TO PARTNER WITH GROUPS AROUND THE U.S. AND AROUND THE WORLD TO PROMOTE PREPAREDNESS IN ANY WAY WE CAN I’LL JUST END WITH ONE THOUGHT THE SYSTEMS THAT WORK MOST EFFECTIVELY ARE SYSTEMS THAT NOT ONLY CAN BE HELD UP IN EMERGENCY BUT SYSTEMS THAT WORK WELL EVERYDAY SYSTEMS THAT CAN IDENTIFY A PROBLEM, RESPOND TO IT PROPERLY, ANALYZE THE SITUATION AND SCALE UP AN EFFECTIVE RESPONSE SYSTEMS LIKE THAT NEED TO BE USED EVERYDAY THEY CAN’T BE FIRE ALARMS THAT YOU BREAK THE GLASS WHEN THERE’S AN EMERGENCY THERE’S SYSTEMS LIKE THE VACCINES FOR CHILDREN PROGRAM THAT CAN BE SCALED UP SYSTEMS LIKE DISEASE REPORTING ELECTRONIC DEATH REGISTRATION WHICH WOULD BE ENORMOUSLY IMPORTANT TO TRACKING TREND WHAT WE HAVE TO DO BOTH IN THE U.S. AND GLOBALLY IS NOT ONLY BUILD PROGRAMS AND DEVELOP NEW TOOLS BUT BETTER APPLY CURRENT TOOLS TO BE USED EVERYDAY TO IMPROVE RESPONSE AND IN THAT REGARD I THINK THIS IS A CRUCIAL LESSON FROM THE 1918 PANDEMIC THAT IS AS RELEVANT TODAY THAN 100 YEARS

AGO THANK YOU VERY MUCH [ APPLAUSE ] >> THANK YOU YOU NEVER FAIL TO INSPIRE AND STIMULATE OUR THINKING ON WHAT WE ALL CAN DO TO HELP WITH THIS AMAZING GLOBAL MISSION THAT YOU HAVE UNDERTAKEN THANK YOU SO MUCH SINCE YOU ARE NOT HERE, I JUST WANT TO NOTE WE HAVE AN AUDIENCE THAT INCLUDES RESEARCHERS FROM ALL OVER THE COUNTRY WE HAVE PRACTITIONERS, WE HAVE FACULTY TRAINING THE FUTURE PUBLIC HEALTH WORKFORCE AND A FEW PEOPLE FROM THE CORPORATE SECTOR HERE TODAY I DON’T THINK THERE’S GOING TO BE A LOT OF SHYNESS IN THIS GROUP WE’RE CUEING FOR QUESTIONS SAY YOUR NAME AND WHERE YOU ARE FROM AND ASK A QUESTION >> SURE THIS IS ZACH MOORE STATE EPIDEMIOLOGIST IN NORTH CAROLINA IT’S TO YOUR LAST POINT THAT MY QUESTION RELATES AND THAT’S, I THINK, MANY PEOPLE GET FRUSTRATED AT THIS CYCLE OF EMERGING THREAT, POLITICAL ATTENTION, FUNDING THREAT IS ADDRESSED SUCCESSFULLY AND THE FUNDING GOES AWAY AND IT’S FORGOTTEN AND DOESN’T LEAD TO ANY LASTING INCREASE IN CAPACITY FOR THE NEXT THREAT IN MANY CASES SO I JUST WONDER IF YOU HAVE ANY OTHER THOUGHTS HOW WE SHIFT THAT NARRATIVE TOWARDS BUILDING THE FUNDAMENTAL CAPACITY AND SORT OF RECOGNIZING WHAT ENABLES US TO DEAL WITH THIS THREAT IS IN MANY WAYS WHAT ENABLES US TO DEAL WITH FUTURE THREATS >> THAT’S A GREAT QUESTION I DON’T HAVE A PERFECT ANSWER BUT PART OF THE ANSWER IS GOING TO HAVE TO BE OUTSIDE OF THE GOVERNMENT TO ENCOURAGE THE GOVERNMENT TO DO THE RIGHT THING WHEN I WAS APPOINTED ASSISTANT COMMISSIONER OF HEALTH IN NEW YORK CITY AND DIRECTOR OF THE TB CONTROL PROGRAM, I GOT ADVICE FROM THE LEADING SCHOLARS OF GOVERNMENT WHAT HE SAID WAS YOU WON’T SUCCEED AND YOUR PROGRAMS WON’T BE SUSTAINED UNLESS YOU HAVE GROUPS OUTSIDE OF THE GOVERNMENT PUSHING FOR YOU TO DO THE THINGS THAT NEED TO BE DONE AND THAT’S A VERY IMPORTANT LESSON I ALSO LEARNED A LOT FROM A SENATOR WHO HAS BEEN CHAIRMAN OF THE APPROPRIATIONS COMMITTEE WHO WHEN I ASKED THIS QUESTION SAID TO ME DON’T TELL US THE GOOD THINGS THAT WILL HAPPEN IF WE GIVE YOU THE MONEY TELL US THE BAD THINGS THAT WILL HAPPEN TO US IF WE DON’T GIVE YOU THE MONEY SO I THINK A COMBINATION OF THOSE APPROACHES IS IMPORTANT ALSO HAVE TO GET BETTER AT COMMUNICATION MAKING CLEAR THAT PUBLIC HEALTH IS ABOUT PROTECTING EVERYONE THERE’S A MISCONCEPTION ABOUT WHAT PUBLIC HEALTH IS ABOUT A LOT OF THINGS THAT PUBLIC HEALTH DOES PEOPLE DON’T REALIZE PUBLIC HEALTH IS DOING WE HAVE TO TRY TO MAKE THAT MORE VISIBLE EVERY OPPORTUNITY WE HAVE TO DO THAT WHETHER IT’S A FLU SEASON OR AN OUT BREAK OR A DATA RELEASE IS AN OPPORTUNITY TO BUILD MOMENTUM AND BUILD SUPPORT WHEN I WAS AT THE CITY HEALTH DEPARTMENT WE RELEASED MONTHLY REPORT IT GOT A LOT OF COVERAGE ON A VARIETY OF HEALTH ISSUES TO BE EFFECTIVE WITH IT IS NOT EASY BUT IT’S VERY IMPORTANT BACK OVER TO YOU >> YES, THANK YOU THOSE OF US IN THE PRACTICE COMMUNITY JOIN YOU IN SAYING WE FEEL LIKE PUBLIC HEALTH SYSTEM IS A QUIET MIRACLE WE’LL GO TO OUR NEXT QUESTIONER >> YES, HI PRICILLA WALD I TEACH ENGLISH AT DUKE THANK YOU FOR THAT AMAZING TALK AND THE AMAZING WORK YOU ARE DOING I’M REALLY INSPIRED ALSO THAT’S THE BEST SKYPE TALK I’VE EVER HEARD THAT’S NOT AN EASY MEDIUM WHAT I WANT TO ASK ABOUT IS HOW YOUR ORGANIZATION THINKS ABOUT AND DEFINES HEALTH I’M THINKING HERE OF THE WORK OF PAUL FARMER AND THE RETURN TO THINK OF HEALTH AS A STATE OF WELL BEING, A HUMAN RIGHT AND THE NEED TO ADDRESS GLOBAL POVERTY BROADLY AS THE SINGLE VECTOR MOST IMPORTANT VECTOR THAT TURNS AN OUT BREAK INTO A PANDEMIC IS THAT SOMETHING THAT YOUR ORGANIZATION THINKS ABOUT? I REALIZE YOU CAN’T DO EVERYTHING AND YOU ARE DOING AMAZING THINGS >> WHAT RESULTS IN THE HEALTH STATUS OF A POPULATION REALLY IS VERY BROAD SOCIETAL FACTORS FROM WHAT’S CALLED THE SOCIAL DETERMINANCE OF HEALTH, POVERTY, EDUCATION, HOUSING, THIS IS THE SUBSTRAIGHT FOR HEALTH YEARS BACK, I WAS PRINCIPAL FOR A DAY AT A NEW YORK CITY SCHOOL NICE THING THAT WAS DONE

AND I WAS WITH A GROUP OF 8TH GRADERS IN THE INNER CITY THE SINGLE MOST IMPORTANT THING YOU CAN DO TO LIVE A LONG AND HEALTHY LIFE I WAS LOOKING FOR SOMETHING LIKE DON’T GET HIV OR DON’T SMOKE DON’T DO DRUGS AND ONE 8TH GRADE YOUNG WOMAN RAISED HER HAND AND GAVE ME A BETTER ANSWER THAN I HAD IN MY MIND WHICH WAS GRADUATE FROM COLLEGE AND SHE WAS ABSOLUTELY RIGHT THIS IS THE STRONGEST PREDICTOR IS LEVEL OF EDUCATION SO THAT BOTTOM LEVEL IS THE SOCIAL DETERMINANCE OF HEALTH ABOVE THAT ARE THINGS THAT CHANGE THE DEFAULT VALUE CLEAN WATER, CLEAN AIR THINGS THAT MAKE IT SO IF YOU GO ABOUT YOUR BUSINESS, YOU’LL REMAIN HEALTHY YOU DON’T HAVE TO DEAL WITH CIGARETTE SMOKE IN YOUR WORKPLACE OR AS WE DO HERE, SALMONELLA IN THE WATER OR FOOD THE NEXT LEVEL OF OUR LIGHT TOUCH CLINICAL INTERVENTIONS, THINGS LIKE IMMUNIZATION, COLONOSCOPY OR TOBACCO USE OR ALCOHOL USE THEY MAKE A BIG DIFFERENCE AND CAN BE DONE ONCE OR EVERY FEW YEARS AT A LEVEL ABOVE THAT ARE THE CLINICAL INTERVENTIONS THAT REQUIRE LONG-TERM CONSISTENT FUNCTIONING OF THE HEALTHCARE SYSTEM LIKE CONTROL OF BLOOD PRESSURE WHERE GLOBALLY WE’RE AT 14% AND I THOUGHT THE TOP OF THAT PYRAMID OF IMPACT IS COUNSELING, EDUCATION AND ONE ON ONE ACTIVITIES THESE ARE FIVE AREAS WHERE WE CAN EFFECT HEALTH AND WE WANT TO WORK ON ALL FIVE OF THOSE AREAS REALISTICALLY OUR UNIQUE PERSPECTIVE IN PUBLIC HEALTH IS THE ABILITY TO BEAR WITNESS TO TALK ABOUT WHERE THERE ARE HORRIFIC INEQUITIES IN HEALTH MARTIN LUTHER KING JR SAID OF ALL INJUSTICE, INJUSTICE IN HEALTHCARE IS THE MOST SHOCKING IF YOU STEP BACK AND THINK ABOUT IT, IT REALLY IS SOMEONE LIVES OR DIES DEPENDS IN MANY CASES ON WHETHER THEY CAN GET COMPETENT CARE AT THE HEIGHT OF THE EBOLA EPIDEMIC, ONE OF OUR VERY BELOVED DRIVERS IN SIERRA LEON WAS WAITING FOR OUR TEAM HE BEGAN HAVING SEIZURES AND BLEEDING AND HE DIED AND THE ASSUMPTION WAS HE MUST HAVE HAD EBOLA SO HE COULDN’T BE SAFELY RESUSCITATED TURNED OUT HE HAD HYPERTENSION WHICH WAS UNTREATED AND HE HAD A STROKE GLOBALLY, 1.4 PEOPLE WITH HIGH BLOOD PRESSURE AND 1.2 MILLION DON’T HAVE IT UNDER CONTROL AND FROM THAT 1.2 BILLION ARISE 10 — WITHIN THE PUBLIC HEALTH SPACE, WE CAN BEAR WITNESS TO INEQUALITIES AND NEED FOR IMPROVEMENT AND THE SOCIAL DETERMINANCE OF HEALTH WE CAN ALSO IMPLEMENT SPECIFIC PROGRAMS THAT WILL MAKE A DIFFERENCE AND ADDRESS SOME OF THOSE INEQUALITIES THOSE SPECIFIC PROGRAMS INCLUDE THINGS LIKE HYPERTENSION CONTROL THINGS TO PREVENT EPIDEMICS AREAS WHERE WE CAN MAKE A DIFFERENCE THROUGH REDUCING TOBACCO USE OR VACCINATING AGAINST KILLER DISEASES OUR APPROACH THEN IS TO WORK IN THE GENERAL IN BEARING WITNESS, ADVOCATING AND TRYING TO TAKE, WHERE WE CAN, ACTIONS THAT WILL CHANGE THE STRUCTURE OF INEQUALITY WHETHER THAT’S CLEAN WATER OR ACCESS TO FAMILY PLANNING WHICH WILL REDUCE POVERTY IN THE NEXT GENERATION OR OUR SPECIFIC PROGRAMS OF HYPERTENSION TREATMENT WHICH WILL MAKE HUGE DIFFERENCES IN PEOPLE’S LIVES I’LL END WITH A STORY WHEN I RAN A TB PROGRAM IN NEW YORK CITY, WE HAD A TERRIBLE SOCIAL SITUATION WE HAD MASS HOMELESSNESS WE HAD PEOPLE LIVING IN SHELTERS WE HAD VERY POOR INFECTION CONTROL IN HOSPITALS AND MULTI-DRUG RESISTANT TB SPREADING AROUND THE CITY THERE WAS ONE THEME OF THOUGHT THAT SAID THIS IS NOT GOING TO GET BETTER UNTIL WE FIX THE HOUSING CRISIS OR QUICKLY DO INFECTION CONTROL IN HOSPITALS, GENERALLY AND A VARIETY OF OTHER THINGS THERE WAS A SUBTHEME OF THOUGHT THAT SAID EVEN IF WE COULD CONTROL IT, WE PROBABLY SHOULDN’T WITH TB, WE CAN FIX THESE OTHER

THINGS I DIDN’T AGREE WITH THAT PERSPECTIVE I WANTED, OF COURSE, HOMELESSNESS TO BE SOLVED BUT HERE WE ARE 25 YEARS LATER AND WE STILL HAVE A BIG HOMELESSNESS PROBLEM WE DON’T HAVE A BIG TB PROBLEM NOT JUST AN INDIVIDUAL ISSUE ONE OF THE BIG CHALLENGES AT THAT TIME WAS THAT THERE WAS A SMALL NUMBER OF PATIENTS 1-2% WHO WOULDN’T TAKE THEIR MEDICATIONS NO MATTER HOW SENSITIVE THEY WERE OFFERED AND THEY WERE VISIBLE TO THE CLINICIANS THEY CAME BACK TO THE HOSPITALS ONE OF THEM 32 TIMES INFECTIOUS AND THE HOSPITAL SAID WHAT CAN THE HEALTH DEPARTMENT DO IF THEY CAN’T EVEN DEAL WITH THESE INDIVIDUALS? WE ESTABLISHED A SECURE UNIT TO CARE FOR PEOPLE WITH TB UNTIL THEY WERE CURED BOSTON HAD BEEN DOING THIS FOR YEARS WE WENT UP TO BOSTON TO SEE THEIR PROGRAM AND LEARN FROM THEM I SAID THESE PEOPLE HAVE SO MANY PROBLEMS ARE YOU DOING ANY GOOD? AND I’LL NEVER FORGET WHAT THE NURSE SAID TO ME SHE SAID THEY COME HERE, THEY’VE GOT TB MANY OF THEM ARE HIV POSITIVE THEY ARE HOMELESS, MENTALLY ILL AND DRUG ADDICTED THEY LEAVE HERE, THEY ARE STILL DRUG ADDICTED, MENTALLY ILL WE MAY OR MAY NOT HAVE FOUND THEM HOUSING BUT THEY DON’T HAVE TB IT’S NOT A SMALL THING IT’S A BIG THING FOR THEM IN THEIR LIVES WE’VE DONE THEM A LOT OF GOOD AND I THINK MORE BROADLY THAT’S AN IMPORTANT PERSPECTIVE IN PUBLIC HEALTH THANKS >> THANK YOU WE HAVE TALKED ABOUT DISPARITIES IN DEALING WITH EPIDEMICS AND REACHING THOSE WHO ARE OUTSIDE THE SYSTEM OR NOT PARTICIPATING IN ALL OF THE EFFORTS TO CONTAIN AN OUT BREAK THANK YOU FOR BRINGING THAT HOME AGAIN DR. COSTER >> THANK YOU, LEAH INDIA’S ASSOCIATION OF SCIENCE CENTERS IS RENOUND FOR ATTENTION TO PUBLIC HEALTH ISSUES MUCH MORE THAN THE REST OF THE WORLD IN MY KNOWLEDGE AND THIS GOING VIRAL SIMPOSIUM IS ACCOMPANIED BY AN EXHIBITION THAT OPENS NEXT MONTH AND ALSO A POP-UP EXHIBIT AND WE’RE BRINGING IT TO A PUBLIC FRONT TOMORROW AT THE NORTH CAROLINA MUSEUM AND NATURAL SCIENCES SINCE YOU HAVE SUCH GLOBAL KNOWLEDGE TO RECOMMEND , IF I MAY, TO THE MORE EURO NORTH AMERICAN MUSEUM AND SCIENCE CENTER FIELD WHAT WE SHOULD BE DOING MORE OF IT’S NOT A SUBJECT THAT COMES UP VERY OFTEN AND IT IS LACKING IN THAT REGARD WE LIKE TO SAY IN THIS COUNTRY THAT MORE PEOPLE VISIT MUSEUMS THAN GO TO PROFESSIONAL SPORTS EACH YEAR BUT WE’RE NOT DOING A VERY GOOD JOB IN TERMS OF BEING RELEVANT TO THE ISSUES THAT ARE THIS FUNDAMENTAL SO IF YOU WERE A KEYNOTE AT THE AMERICAN ASSOCIATION OF MUSEUM’S MEETING, WHAT WOULD YOU SAY? >> FIRST, IT’S A GREAT EXHIBIT, BY ALL MEANS, GET WHATEVER PART OF IT YOU CAN SECOND, THE CENTERS FOR DISEASE CONTROL AND PREVENTION HAS A MUSEUM IT’S AFFILIATED WITH THE SMITHSONIAN THEY CAN BE ROTATING PROBABLY NEED SOME HELP WITH FUNDING CONGRESS DOESN’T WANT TO FUND MUSEUMS VERY IMPORTANT, VERY POWERFUL VERY INTERESTING I WOULD SAY EVEN SURPRISINGLY INTERESTING I SHOULDN’T PROBABLY TELL THIS STORY BUT I WAS WALKING PAST THE MUSEUM ONE DAY USHERING MAYOR BLOOMBERG INTO CDC AND WE WALKED PAST THE MUSEUM AND I SAID IT’S ACTUALLY MUCH MORE INTERESTING THAN YOU THINK AND HE SAID IT WOULD HAVE TO BE >> THANK YOU >> IT IS QUITE INTERESTING THERE’S PHOTOGRAPHIC EXHIBITS THAT ARE POWERFUL AND TELL STORIES AND ULTIMATELY WHAT WE WANT TO DO WHETHER IT’S ABOUT HEALTH OR GLOBAL ISSUES IS TELL STORIES THERE WAS AN EXHIBIT THEREOF WHERE CHILDREN SLEEP AROUND THE WORLD PHOTOGRAPHIC AS WELL AS DEMONSTRATIONS AND IT’S VERY, VERY POWERFUL AND IF YOU SPEAK TO THE FOLKS THERE, PLUS, YOU CAN LOOK INWARDLY AT YOUR LOCAL COMMUNITY AT THE MUSEUM OF NATURAL HISTORY WE’VE DONE QUITE A FEW VERY POWERFUL PROGRAMS LECTURE SERIES AS WELL AS EXHIBITS AND YOU HAVE A REALLY GOOD PUBLIC HEALTH PROGRAM YOU CAN THINK ABOUT WHAT YOU CAN DO TOGETHER MUSEUMS HAVE BEEN TERRIFIC AT

DOING OUTREACH TO SCHOOLS IMPORTANT THINGS YOU CAN DO THOSE ARE A FEW IDEAS >> THANK YOU WE DO WORK CLOSELY WITH OUR MUSEUM OF NATURAL SCIENCES HERE IN NORTH CAROLINA WE’RE GOING TO TAKE ONE MORE QUESTION THE DEAN OF OUR SCHOOL OF PUBLIC HEALTH WRAP US UP >> THANK YOU SO MUCH AND THANK YOU FOR YOUR GLOBAL LEADERSHIP I WAS PROUD TO BE ABLE TO HEAR YOU A FEW WEEKS AGO WHEN YOU SPOKE TO THE ASSOCIATION OF SCHOOLS AND PROGRAMS AND YOU DID A GREAT JOB AND DID A GREAT JOB THIS MORNING I’M REALLY STRUCK AND I AGREE WITH YOUR COMMENTS ABOUT SPEED, SIMPLICITY AND SCALE AND I WONDERED IF YOU WOULD JUST COMMENT THERE ARE A NUMBER OF STUDENTS HERE AND FACULTY WHAT ARE THE KINDS OF SKILLS THAT MAYBE WE AREN’T TEACHING SO WELL IN SCHOOLS OF PUBLIC HEALTH RIGHT NOW THAT WOULD HELP TO ACHIEVE SPEED, SIMPLICITY AND SCALE >> THANK YOU AND THANK YOU, DEAN, FOR ALL THE GREAT WORK YOU DO GREAT TO HEAR YOUR VOICE AGAIN AND INTERACT WITH YOU I’D START WITH SIMPLICITY THERE’S THAT OLD SAYING I DIDN’T HAVE TIME TO WRITE YOU A SHORT LETTER SO I WROTE YOU A LONG LETTER ONE OF THE THINGS WE’RE DOING IN HYPERTENSION TREATMENT IS SIMPLIFIED NOT DUMBING DOWN BUT SIMPLIFIED IF YOU LOOK AT KAISER, THE TOP HEALTHCARE SYSTEM IN THE U.S., THEIR RESULTS ARE BETTER THAN ANY OTHER PLACE IN THE U.S START WITH ONE PILL, DOUBLE IT TO TWO PILLS THERE’S NO WAY TO GET SPEED AND SCALE WITHOUT SIMPLICITY SO YOU HAVE TO START WITH THAT AND THAT MEANS THAT THE STUDENTS THAT WE TRAIN SHOULD BE ABLE TO INTEGRATE INFORMATION AS I SAID AT THAT CONFERENCE, I’VE OFTEN THOUGHT IF I WERE DESIGNING A FINAL EXAM, IT WOULD BE YOU HAVE FOUR HOURS ON THE INTERNET, HERE’S A PROBLEM, GIVE ME A ONE PAGER ABOUT WHAT TO DO ABOUT IT I THOUGHT OF THAT BECAUSE IT ACTUALLY HAPPENED I WAS IN NEW YORK CITY AND SUDDENLY AS COMMISSIONER, I FORGET WHY, BUT THERE WAS AN OPPORTUNITY TO ESTABLISH A PROGRAM IN OUR SCHOOLS TO EXPAND DENTAL SEALANTS WE HAD FOUR HOURS TO DEVELOP A ONE PAGER THAT WOULD GO TO THE BUDGET OFFICE AND THE MAYOR AND WOULD BE DECIDED ON AND VERY GOOD SPECIAL ASSISTANT WHO KNEW ABSOLUTELY NOTHING ABOUT DENTAL SEALANTS BY THE END OF HOUR FOUR HAD PRODUCED A TERRIFIC ONE PAGER THAT RESULTED IN A BIG DENTAL SEALANT PROGRAM IN THE CITY THAT KIND OF CLARITY AND SIMPLICITY CAN LEAD TO SCALE ON THE SPEED ISSUE, I THINK IT’S IMPORTANT TO BE RELENTLESS ESPECIALLY IN THE PUBLIC SECTOR AND ACADEMIC SECTOR TO RECOGNIZE THAT EVERYDAY, EVERY WEEK, EVERY MONTH THAT GOES BY AND WE’RE NOT IMPLEMENTING PROGRAMS, PEOPLE ARE DYING BILL FAGEY SAYS THAT PUBLIC HEALTH IS BEST WHEN WE SEE AND WE HELP OTHERS SEE THE FACES AND THE LIVES BEHIND THE NUMBERS AND FOR THAT, I THINK ALL OF YOU IN THE AUDIENCE ARE SO IMPORTANT TO HELP US SEE THE NUMBERS OF PEOPLE WHO ARE BECOMING ILL, DISABLED, DYING OR AT RISK FOR DYING BECAUSE WE’RE NOT ACTING TODAY TO REDUCE THE RISKS THANK YOU, ALL, VERY MUCH FOR WHAT YOU DO AND BEST WISHES FOR THE REST OF THE CONFERENCE >> THANK YOU SO MUCH [ APPLAUSE ] >> THANK YOU FOR YOUR MARVELOUS PRESENTATION AND FOR PUTTING US AT THE END OF YOUR DAY WHICH I’M SURE IS NOT ACTUALLY THE END OF YOUR DAY YOU ARE GOING TO KEEP WORKING SO THANK YOU SO MUCH WE’RE GRATEFUL FOR ALL OF YOUR LEADERSHIP GLOBALLY. BYE NOW, IT IS MY PLEASURE TO WELCOME DR. JANE THRAKIAL HERE ON OUR CAMPUS AT UNC AND SHE ALSO DIRECTS AN INITIATIVE CALLED HEALTH AND HUMANITIES SO THANK YOU >> HELLO, EVERYBODY I AM JANE HERE FROM UNC’S COLLEGE OF ARTS AND SCIENCES I AM A PROFESSOR OF ENGLISH AND I DO RUN ALONG WITH JORDAN JACK THE HEALTH HUMANITIES LAB HERE AT UNC CHAPEL HILL I’LL BE MODERATING THIS SESSION

ON ISSUES FROM MINORITY POPULATIONS FROM EARLY 20TH CENTURY TO THE PRESENT WHEN PRESENTATIONS CONCLUDE AT 10:10, WE WILL BEGIN A MODERATED DISCUSSION AND TAKE QUESTIONS FROM THE AUDIENCE BECAUSE OUR AGENDA IS SO FULL, MY COMMENTS ABOUT OUR SPEAKERS BIOGRAPHIES WILL BE BRIEF BUT MORE INFORMATION IS AVAILABLE ABOUT SPEAKERS ON THE ONLINE PROGRAM WORLD WAR I INTERSECTED WITH THE 1918 INFLUENZA PANDEMIC IN IMPORTANT WAYS FOR EXAMPLE, THE FACT THAT SOLDIERS WERE PACKED INTO MILITARY UNITS NEVER BUILT FOR THE NUMBER OF MEN WHO THEY HOUSED AND WERE SENT TO EUROPE IN BOATS THAT WERE TERRIBLY OVERCROWDED THIS CREATED BREEDING GROUNDS FOR THE VIRUS TO SPREAD QUICKLY AMONG THE POPULATION OF YOUNG MEN THESE YOUNG MEN UNFORTUNATELY PROVED ESPECIALLY SUSCEPTIBLE TO THIS PARTICULAR STRAIN OF INFLUENZA EVER SINCE DR. RIMER AND A GROUP OF OTHERS CREATED OR IMAGINED THIS INFLUENZA PANDEMIC CONFERENCE OR THIS CONFERENCE ABOUT GOING VIRAL, I’VE BEEN NOTICING AT THE EDGES OF TELEVISION SHOWS, NOVELS AND OTHER POPULAR NARRATIVES IN OUR CULTURE MENTION THE FLU PANDEMIC BUT IT’S INTERESTING IT’S VERY RARE THAT WE HAVE FULL NOVELISTIC REPRESENTATION OF THE PANDEMIC ALMOST AS IF THE GARGANJUIN SCALE WAS UNIMAGINABLE SO TO ME AS AN ENGLISH PROFESSOR AND A STUDENT OF HISTORY, THAT, TO ME, IS FASCINATING SO TODAY TO SPEAK ABOUT SOME OF THESE RELATED OR QUESTIONS THAT FALL OUT FROM THIS IMPORTANT PANDEMIC, WE HAVE DR. LENT SMITH WHO WILL DISCUSS THIS PERIOD IN U.S. HISTORY AND IN THE SOUTH, PARTICULARLY, IN WHICH JIM CROW LAWS DOMINATED DR. LENT SMITH IS ASSOCIATE PROFESSOR OF HISTORY AT DUKE UNIVERSITY AND SHE WROTE ABOUT THIS IN BOOK FREEDOM OF STRUGGLES, AFRICAN AMERICANS AND WORLD WAR I HER BOOK EXAMINES HOW AFRICAN AMERICANS WORKED THROUGH IDEAS OF MANHOOD, CITIZENSHIP TO PURSUE THEIR FREEDOM DREAMS HER LATEST WORK IS FOCUSED ON BLACK LIVES AND STATE VIOLENCE IN THE TWILIGHT OF THE CIVIL RIGHTS YEARS SECOND, WE WILL HAVE DR. KROUSE QUINN WHO WILL TALK ABOUT THE HEALTHCARE SYSTEM AMONG MINORITY POPULATIONS DR. QUINN IS PROFESSOR AND CHAIR OF THE DEPARTMENT OF FAMILY SCIENCE AT THE UNIVERSITY OF MARYLAND’S SCHOOL OF PUBLIC HEALTH AND DIRECTOR OF CENTER FOR HEALTH EQUITY SHE STUDIES VACCINATION NARRATIVES AND BEHAVIORS USING SOCIAL MEDIA AND SHE STUDIES CULTURAL BELIEVES RELATED TO VACCINE AND RACIAL DISPARITIES AS WELL AS VACCINE ACCEPTANCE IN EMERGENCY SITUATIONS RACIAL DISPARITIES IN VACCINE UPTAKE AGAIN, MORE INFORMATION ABOUT THESE AMAZING SPEAKERS IS AVAILABLE ON THE ONLINE PROGRAM WE’LL HAVE TIME FOR QUESTIONS FOLLOWING THESE TWO SPEAKERS AT A.M. PLEASE JOIN ME IN WELCOMING DR. LENT SMITH [ APPLAUSE ] >> GOOD MORNING, EVERYBODY IF I WERE CORNIER, I WOULD POINT OUT WE WOULD CALL DR. QUINN MEDICINE WOMAN AND YES, I AM THAT CORNY I AM GOING TO TAKE US BACK TO 1918 TO THE WORLD WAR I YEARS FOR A LITTLE BIT I IMAGINE YOU WERE THERE WITH MY HISTORIAN COLLEAGUES A BIT YESTERDAY I WANT US TO THINK, YOU KNOW, I DON’T KNOW MUCH ABOUT HEALTH, ACTUALLY MY OWN IS MIDDLING BUT I WANT US TO THINK ABOUT THE WORLD, THE LIVE THAT PEOPLE WERE LIVING WITH THE WORLD THAT THE FLU SORT OF IMPEDED ON AND WHAT THAT LOOKED LIKE AND I WANT FOR US TO KEEP IN MIND A LITTLE BIT — WHAT DO I WANT TO DO?

THAT INTERVENTIONS, MEDICINE AND INTERVENTION ONLY WORKED IN SO MUCH AS SOME PEOPLE WERE CONSIDERED WORTHY OR DESERVING OF CARE AND THAT OTHERS — AND THAT PEOPLE TRUSTED THAT THE CARE GIVERS OR THE PEOPLE TRYING TO MAKE INTERVENTIONS HAD THEIR WELL BEING IN MIND SO THAT WOULD LIMIT IN THE 19-TEENS HOW FOLKS COULD ADDRESS THE FLU PANDEMIC AND I SUSPECT WERE WE TO HAVE OTHER PANDEMICS IN OUR CURRENT MOMENT, IT WOULD AFFECT IT NOW I’M GOING TO OPEN WITH A SPECTACLE, A PARADE ON JULY 28TH, 1917, NEARLY 10,000 AFRICAN AMERICANS PARADED UP NEW YORK’S 5TH AVENUE CHILDREN FIRST, THEN WOMEN, THEN MEN ALL IN THEIR SUNDAY BEST WOMEN AND CHILDREN WORE ALL WHITE AS IF THEY WERE ATTENDING A BAPTIST MEN WORE DARK SUITS AS IF THEY WERE ON THEIR WAY TO A FUNERAL THEY KEPT DISCIPLINE SILENCE BUT CARRIED PLACARDS THAT PROCLAIMED IN SO MANY WORDS THAT BLACK LIVES MATTER THIS PROTEST CAME IN RESPONSE TO PAGRAM IN EAST ST. LOUIS RACE RIOTS WERE MOBS GOING INTO BLACK NEIGHBORHOODS RAISING HOMES AND BUSINESS AND MURDERING PEOPLE OFTEN BY THE DOZENS OR THE SCORES IT CAME IN RESPONSE TO A PAGRAM IN EAST ST. LOUIS TO SPECTACLE LYNCHINGS IN MEMPHIS AND WACO IN THE SPRING AND SUMMER BEFORE SPECTACLE LYNCHINGS MEANING THEY WERE DONE PUBLICALLY ADVERTISED BEFOREHAND IN FRONT OF CROWDS OF HUNDREDS AND PEOPLE TOOK BODY PARTS AS SOUVENIRS AWAY FROM THEM IN THE AFTERMATH ONE PLACARD CHALLENGED THEIR FELLOW AMERICANS NEWLY ENTERED INTO A GLOBAL CONFLICT THAT PRESIDENT WILSON HAD LABELED A WAR FOR DEMOCRACY TO MAKE AMERICA SAFE FOR DEMOCRACY AS WELL OTHER PLACARDS MADE LINKS BETWEEN MILITARY SERVICE AND THE RIGHTS OF CITIZENSHIPS SO VIOLENTLY DENIED THEM AND THEY FORM AN ACCOUNT, IF WE READ THEM ONE AFTER THE OTHER, OF BLACK MILITARY SERVICE UP THROUGH U.S. ENTRY INTO THE FIRST WORLD WAR WE HAVE FOUGHT FOR THE LIBERTY OF WHITE AMERICANS IN SIX WARS OUR REWARD IS EAST ST. LOUIS ANOTHER READ THE FIRST BLOOD FOR AMERICAN INDEPENDENCE WAS SHED BY AN NEGRO ANOTHER READ NEGROS FOUGHT FOR AMERICAN INDEPENDENCE UNDER GEORGE WASH WE FOUGHT WITH PERRY AT LAKE ERIE 12,000 OF US FOUGHT WITH JACKSON IN NEW ORLEANS WE HELPED PLANT THE AMERICAN FLAG IN EVERY DOMINION FROM BUNKER TO CARIZOL, WE HAVE DONE OUR BIT ANOTHER PLACARD REITERATED THE TENSION IN ALL THESE MOMENTS OF AFRICAN AMERICANS MILITARY SERVICE PATRIOTISM AND LOYALTY PRESUPPOSE PROTECTION AND LIBERTY YET AS THE NAACP STAFFERS WHO ORGANIZE THE PARADE AND 10,000 AFRICAN AMERICANS WHO MARCHED WELL KNEW, GOVERNMENT PROTECTION AND THE PRIVILEGES OF FREEDOM, LIFE, LIBERTY, THE PURSUIT OF HAPPINESS REMAINED ELUSIVE GOALS I WANT TO JUMP AHEAD TO THE 1918-1919 TO THE NAACP RECORDS IT’S IMPORTANT TO KEEP IN MIND THE BLACK PRESS IN THIS PERIOD WAS VIBRANT AND A NECESSARY ALTERNATIVE TO WHAT SOME MIGHT CALL THE FAKE NEWS BEING CIRCULATED ABOUT AFRICAN AMERICANS IN WHITE NEWSPAPERS SNIPPET ONE THE RECENT INFLUENZA EPIC HAS BEEN NO — AND MANY PEOPLE WERE STRICKEN DOWN ADVERTISEMENT IN THE BACK OF CRISIS, THE NAACP’S MONTHLY MAGAZINE OBSERVED IN DECEMBER 1918 ACCORDING TO THE AD, THE STANDARD BASE LIFE INSURANCE COMPANY HAD ISSUED PAYMENTS RANGING FROM $500 TO $2500 FOR FLU-RELATED DEATHS ANOTHER SNIPPET IN PITTSBURGH, THE MEN’S DIVISION OF THE INDUSTRIAL BRAN OF THE LOCAL URBAN LEAGUE HELPED TO FOUND AN EMERGENCY HOSPITAL IN A FACTORY TO ADDRESS THE FLU PANDEMIC THE HOSPITAL EMPLOYED 14 AFRICAN AMERICAN NURSES BY 1919 ONCE THE EMERGENCY PASSED, FACTORY OWNERS OPTED TO HIRE ON TWO AFRICAN AMERICAN NURSES ON A PERMANENT BASIS STEPPING BACK TO NOVEMBER 1918, LET ME CITE A BULLETIN WHICH NUMEROUS NAACP BRANCHES HAMPERED

AS THE FOLKS WROTE BY THE OUT BREAK OF THE SPANISH FLU IN CHARLESTON, WEST VIRGINIA, THEY SET ASIDE LIBERTY LOAN DRIVE FOR FOCUSING ON THE SICK THEY HAD BEEN QUOTE, DEPRIVED OF HOLDING ANY MEETING FOR THREE WEEKS THE MONTGOMERY BRANCH 2 BLAMED THE FLU AND THE ACCOMPANYING QUARANTINE FOR KEEPING THEIR NUMBERS DOWN INVESTIGATING A SERIES OF LYNCHINGS THAT SAME NOVEMBER, WALTER WHITE FOUND A WITNESS LAID UP IN BED SICK WITH SPANISH INFLUENZA BOTH WHITE AND THE MAN’S DOCTORS TRIED TO CONVINCE THE WITNESS TO GO ON RECORD WITH WHAT HE KNEW ABOUT THESE LYNCHINGS, A SPADE OF THEM HORRIFIC INCLUDING A LYNCHING OF A BLACK WOMAN WHO WAS PREGNANT AND THE SUBSEQUENT ATTACK ON HER BABY TO TESTIFY ON WHAT HE KNEW WHITE PROMISED TO RELOCATE HIM AND HIS FIVE CHILDREN UP NORTH TO FIND HIM A JOB AND SUPPORT HIM UNTIL AFTER HE TESTIFIED THE MAN TURNED THE NAACP DOWN CITING HIS CHILDREN’S VULNERABILITY, THE FACT HIS AUNTS, COUSINS AND OTHER EXTENDED KIN WOULD BE LEFT BEHIND AND SUBJECT TO RETRIBUTION IF HE FLED AND HE OWNED THREE PIECES OF PROPERTY IN THE SURROUNDING COUNTIES HE WOULD SELL THEM IF HE COULD SELL THEM AT A GREAT LOSS EXILE THEN WOULD MEAN LOSING HIS LIVELIHOOD AND PUTTING FAMILY IN THE CROSS HAIRS OF LOCAL WHITE FOLKS LYNCHED AT LEAST 10 PEOPLE SINCE MAY LYING ABED, TENDED BY TWO DOCTORS, THAT MAN UNDERSTOOD THAT HE LITERALLY COULD NOT AFFORD TO BE BRAVE SO WHAT DO THESE SNIPPETS TELL US? ON THE BROADEST SCALE, THEY TELL US THE FLU INTERRUPTED LIVES BEING LIVED AND ALL OF THEIR AMBITION, TRAGEDY AND HORROR AS THE LIFE INSURANCE AD REMINDED READERS, THE FLU WAS NO RESPECTOR OF PERSONS THESE GIVE US GLIMPSES TOO OF THE LIVES THEY WERE LEADING IN THE REPORT FROM THE URBAN LEAGUE, WE HEAR A SUGGESTION OF THE GREAT MIGRATION OF AFRICAN AMERICANS TO URBAN CENTERS PARTICULARLY IN THE INDUSTRIAL NORTH DATING FROM 1910 OR SO THE MIGRATION OF AFRICAN AMERICANS OUT OF THE BLACK BELT ACCELERATED WITH WARTIME MOBILIZATION SO BETWEEN 1916 AND WE CAN KIND OF LOOK THROUGH THROUGH THE 20s ABOUT 1 MILLION AFRICAN AMERICANS LEFT THE SOUTH AT A RATE OF ABOUT 500 PER DAY THESE NUMBERS WOULD ACCELERATE EVEN MORE THE SECOND WORLD WAR HAD A MORE HIGHER AMOUNT OF MIGRATION THE REPORT FROM THE NAACP BRANCHS SHOWS AN ORGANIZATION WITH MOMENTUM FOUNDED IN 1909 AFTER A RIOT IN SPRINGFIELD ILLINOIS, THE NAACP HAD GROWN STEADILY BUT BLOOMED DURING THE WORLD WAR I I CAN’T RECALLS FROM 9,000 MEMBERS IN 1917 TO 90,000 IN 1919 WITH 300 LOCAL BRANCHES, THE ORGANIZATION WAS VERY MUCH WHAT ITS MEMBERS OFTEN WORKING CLASS, QUITE OFTEN ACTIVIST WOMEN MADE OF IT AND THEN THERE’S THE BROOKS COUNTY LYNCHINGS IN GEORGIA THEY WERE PARTICULARLY HORRIFIC BUT THEY WERE NOT ISOLATED BY THE MOST CONSERVATIVE ESTIMATES, 208 AFRICAN AMERICANS WERE LYNCHED IN THE FIRST TERM FROM 1913 TO 1917 AND ANOTHER 172 IN THE WORLD WAR I YEARS FROM 1917 TO 1919 IN SOME, FOLKS JUST DISAPPEARED OTHERS WERE PUBLIC SPECTACLES THE GEORGIA LYNCHINGS HAD BOTH SUCH VIOLENCE REMINDS US THAT JIM CROW WHAT THEY REFERRED TO AS WHITE SUPREMACY WAS A SYSTEM OF POLITICAL ECONOMY STRUCTURED AND DEFENDED THROUGH WHITE RACIAL TERROR MORE THAN AN SLOGAN AND LESS THAN A FACT, WHITE SUPREMACY WAS A SOCIAL ARGUMENT AND A POLITICAL PROGRAM CONSISTED OF IDEAS AND PRACTICES PROMISES AND THREATS, ORATORY AND MURDER IN OTHER WORDS, IT WAS A CAMPAIGN WAGED BY WHITE ELITES AND IMPORTANT TOO, IT WAS A WAGE TO KEEP EVERYDAY WHITE FOLKS IN LINE THAT IS TO CONVINCE THEM THEIR RACIAL INTERESTS, THEIR IDENTITY TRUMPED ANY OTHER WAY THEY MIGHT IMAGINE THEIR INTERESTS, COMMUNITIES AND EVEN THEMSELVES, CLASS, FOR EXAMPLE ECONOMIC INTERESTS OR A BROADLY

CONCEIVED RELIGIOUS COMMUNITY IT’S IMPORTANT TO REMEMBER THAT WHITE SUPREMACY WAS NOT STATIC KEPT FORMING AND REFORMING IN RESPONSE TO POLITICAL AND SOCIAL CIRCUMSTANCES ESPECIALLY IN RESPONSE TO CHALLENGES WAGED BY AFRICAN AMERICANS IN THE SOUTH AND THEIR ALLIES SO WORLD WAR I WAS ONE OF THESE MOMENTS OF DISRUPTION AND REMAKING PRO WAR PROGRESSIVE THE BUSY SOCIAL REFORM THE PUBLIC HEALTH FOREBEARERS JOHN DUEY THOUGHT OF WORLD WAR 1 AS A PLASTIC JUNCTURE WHICH THE WORLD MIGHT BE MADE ANEW MOST AFRICAN AMERICANS WERE A BIT LESS FLORID THEY TOO HOPED THE WAR MIGHT AT LEAST CLIP JIM CROW’S WINGS SO IN MY REMAINING FEW MINUTES, I WANT TO SKETCH FOR YOU WHAT THIS MOMENT LOOKED LIKE THE WAR WOULD BRING AFRICAN AMERICANS A HOST OF NEW EXPERIENCES ABOUT 386,000 AFRICAN AMERICANS SERVED IN THE WARTIME MILITARY AND MILLIONS MORE REGISTERED FOR THE DRAFT 200,000 OF THEM TRAVELED OVERSEAS WITH THE AMERICAN EXPEDITIONARY FORCES MOST OF THEM AS LABOR TROOPS LARGELY BECAUSE THE ARMY DID NOT BELIEVE IN EITHER THE CAPACITY FOR AFRICAN AMERICANS TO FIGHT FOR THE WISDOM OF ARMING BLACK MEN AND TELLING THEM FIGHTING FOR DEMOCRACY WAS A NOBLE CAUSE SOME PEOPLE BELIEVED BOTH AT THE SAME TIME IT BECAME AN OCCASION TO THINK ABOUT THE RELATIONSHIP TO THE NATION, TO THE WORLD, TO THEIR FELLOW AMERICANS TO OTHER COMMUNITIES OF COLOR ALSO GAVE THEM A RALLYING CRY FOR ASKING FOR OR DEMANDING FREEDOM AT HOME DID NOT OFFER A DISTINCT BREAK FROM THE DYNAMICS OF WHITE SUPREMACY RATHER, SERVE ABROAD — SERVICE ABROAD OFFERED EXEMPTION INTO THEIR MILITARY SPACE AFRICAN AMERICANS FIGHTING ABROAD FOUND THEMSELVES RANGLING WITH THEIR FELLOW WHITE AMERICANS MORE STEADILY AND MORE OFTEN THAN THEY FOUGHT ANY FOREIGN ENEMY SOLDIERS WROTE HOME ABOUT FELLOW SOLDIERS ARRESTED OR SHOT FOR TALKING TO FRENCH WOMEN THEY WROTE OF RACE RIOTS OVERSEAS THEY WROTE OF LYNCHINGS IN FRENCH TOWNS THEY SENT BACK ACCOUNTS OF BLACK OFFICERS THERE WERE ONLY A HANDFUL THEY WERE OFTEN DEMOTED FOR NO REASON OTHER THAN WHITE OFFICIALS DIDN’T BELIEVE THEM CAPABLE OF BEING OFFICERS OFFERED THEM A PLACE TO BE AND EXPERIENCE BEING SOMETHING OTHER THAN — IT HAD ITS OWN EMPIRE AND COLONIAL SUBJECTS TO MANAGE WHAT THE FRENCH DID WAS TO TREAT AFRICAN AMERICANS AS AMERICANS FIRST AND BLACK SECOND BASICALLY, AFRICAN AMERICANS WERE NOT FRENCH PEOPLE’S PROBLEM SO THEY DIDN’T TRY TO MANAGE THEM WHICH GAVE BLACK SOLDIERS AND FOLKS MOVING AROUND A SPACE AND A PLACE TO EXPLORE OTHER WAYS OF BEING INTELLECTUAL AND ACTIVIST CAPTURED SOME OF THE RAGE AND RESOLVE OF AFRICAN AMERICAN VETERANS OF THE SOLDIERS THAT RAN IN THE CRISIS OF MAY OF 1919 THE EDITORIAL IS ANGRY BUT PURPOSEFULLY SO IN IT, THE VIN DICTUM FATE THAT HAD AFRICAN AMERICANS FIGHTING FOR A DOMINANT MINORITY THAT WANTED TO DEBASE BLACK FOLKS AS HE WRITES, SERVANTS, WHORES, DOGS AND MONKEYS HE SUPPLIES LITANY OF ILL DOING IT LYNCHES, IT DISFRANCHISES, STEALS FROM US, INSULTS US BUT IN THE END, SHIFTS TO A CALL TO ARMS BY THE END — HE WRITES BY THE GOD OF HEAVEN, WE ARE COWARDS AND JACK ASSES WE DO NOT MARSHAL EVERY OUNCE TO FIGHT A STERNER, LONGER MORE UNBENDING BATTLE AGAINST THE FORCES OF HELL IN OUR OWN LAND WE RETURN, WE RETURN FROM FIGHTING, WE RETURN FIGHTING MAKE WAY FOR DEMOCRACY. WE SAVED IT IN FRANCE AND WE SHALL SAVE IT IN THE UNITED STATES OR

KNOW THE REASON WHY THE EDITORIAL HAD FIERY BUT GREAT PRIDE AND HOPE WHEN I FIRST WRITING MY BOOK, I FOCUSED ON THAT HOPE ONE READS BOOKS DIFFERENTLY AND FROM MY CURRENT VANTAGE POINT AS I WONDER ABOUT THE CARE WE TAKE OR DON’T WITH OUR CURRENT CROP, MANY OF WHOM HAIL FROM MARGINALIZED AND VILED COMMUNITIES AND AS I WATCH AS PEOPLE REJECT THE CURRENT ASSERTION THAT BLACK LIVES MATTER, IN PART BECAUSE THEY SEEM TO MISS THAT ASSERTION IS A REJOINDER TO THE CLAIM MADE IN WORD AND DEED THAT THOSE LIVES DON’T MATTER, I BETTER UNDERSTAND THE HURT AND VAROCITY NOW, AS A READ ACCOUNTS OF SOMEONE LIKE FORMER LIEUTENANT LOGAN’S WRITING ABOUT HIS SHELL SHOCK WHERE HE WRITES THAT HE FOUGHT TWO WARS AT ONCE AND HE DOESN’T KNOW WHICH ONE DID MORE DAMAGE TO HIM OR ACCOUNT OF WATCHING MILITARY POLICEMAN NEARLY KILLED BLACK SOLDIERS BECAUSE THEY WERE BORED OR MEMORIES OF BEING RUN OUT OF TEXAS BY THE WAR BECAUSE HE REFUSED TO STOP WEARING EITHER HIS MILITARY UNIFORM OR HIS CHAUFFEUR’S UNIFORM I GRASP THE RAGE THAT UNDERLIE THE EDITORIAL EITHER TEMPERING OR CONSUMING THEM MOBILIZING THEM OR EATING THEM ALIVE BUT RAGE CAN’T FLAME INDEFINITELY IT BURNS THROUGH TURNING TO DESPAIR IN DIFFERENCE OR RESOLVE BLACK VETERANS KNEW THIS AS DID THE SEGREGATIONISTS EACH TOLD STORIES WHITE VETERANS WHO WROTE TO THEIR SENATORS WARNING THEM TO GUARD AGAINST AFRICAN AMERICAN SOLDIERS WHO WROTE TO THE GOVERNMENT AND SAID YA’LL BETTER WATCH OUT FOR WE IS COMING IT’S IN THE MILITARY INTELLIGENCE FILES WHEN YOU WRITE THINGS LIKE THAT, YOU END UP GETTING SURVEILLED ALL OF THESE THINGS YOU SEE FEEDING THE POST WAR ENERGY ON BOTH SIDES THE VICIOUSNESS OF THE RED SUMMER WHICH WAS A REACTION TO THE ACHIEVEMENT OF THE WORLD WAR I YEARS ALL OF THEM WANT TO SAY SOMETHING TO US NOW I’M STRUCK BY THE NUMBER OF SOLDIERS WHO SHOW UP BOTH APPEALING TO THE FEDERAL GOVERNMENT IN THE RUN UP TO WORLD WAR II AND WARNING THEM THAT THIS TIME AROUND THEY ARE NOT GOING TO SERVE LOYALLY FIRST AND HOPE FOR REWARD WE WILL BARGAIN WITH YOU NOW, GET CONCRETE RIGHTS AND WE WILL SHOW UP TO FIGHT PEOPLE LIKE CHARLES HAMILTON HOUSTON WHO WAS A JUDGE ADVOCATE GENERAL DURING WORLD WAR I CAME OUT SAYING HE WOULD NEVER BE THAT POWERLESS TO DEFEND PEOPLE AGAIN WENT TO HARVARD LAW SCHOOL AND BECOMES THE LAWYER WHO TRAINS LAWYERS AT HOWARD LAW SCHOOL INCLUDING SARAH GOOD MARSHAL HE’S THE MIDWIFE OF THE STRATEGY TO BRING DOWN SEGREGATION THROUGH LITIGATION AND HOUSTON IS INTERESTING TO ME THEY ARE PEOPLE WHO FELT AS VETERANS THEY WERE ENTITLED BOTH TO THEIR RAGE AND TO THEIR RIGHTS HE PURSUED CIVIL RIGHTS THROUGH THE STATE UNDERSTANDING STATE POWER BUT THROUGH A STATE WHOSE GOOD FAITH AND HE DID NOT TRUST AND WHOSE GOODWILL HE NEVER ACTUALLY HOPED FOR IT’S AN UNRELENTING PRAGMATISM FASCINATING TO ME EVEN INSPIRING AND ONE THAT I THINK PROVIDES WAY THROUGH THINKING ABOUT HOW TO ADVOCATE FOR AND PURSUE POSITIVE INTERVENTIONS AND CHANGE EVEN WHEN SO MANY THINGS FROM THE FEDERAL GOVERNMENT AS DIRECTED TOWARDS COMMUNITIES OF COLOR FEEL LIKE BETRAYAL THANK YOU [ APPLAUSE ] >> THANK YOU SO MUCH

NOW WE HAVE DR. QUINN >> GOOD MORNING THANK YOU SO MUCH FOR HAVING ME THIS IS VERY EXCITING TO BE HERE DR. LYNN SMITH WAS PROVIDED A FOUNDATION FOR WHAT I’M ABOUT TO SAY IN TALKING ABOUT MORE CONTEMPORARY TIMES I’M GOING TO TALK ABOUT BUILDING TRUSTS IN THE FLU VACCINE SOME OF THE CHALLENGES AND OPPORTUNITIES WITH AFRICAN AMERICANS MUCH OF MY WORK IS FOCUSED ON AFRICAN AMERICANS HOWEVER, SOME OF THE ISSUES THAT ARISE WITH OTHER POPULATIONS AND I’LL SPEAK TO THAT BRIEFLY SO SHE REALLY DESCRIBED LIFE IN A JIM CROW SOUTH CAMP WHEELER, OCTOBER 26, 1918 THINKING SOLDIER GUARDS PACING THE STATION PLATFORM WEARING FLU MASKS WHERE RECEPTION COMMITTEE FOR THE KKK 1300 NEGRO SELECTED MEN WERE GIVEN THE FRIGHT OF THEIR LIVES WHEN THEY ARRIVED HERE KU KLUXES HE YELLED AS HE STAIRED INTO THE GAUZE MASK FACE OF A CENTURY 1500 NEGROS MADE A SCRAMBLE FOR COVER TOOK THE MILITARY AUTHORITY SOME TIME TO CONVINCE THE NEGROS THE MASS WERE INTENDED TO PROTECT THEIR LIVES WE CAN UNDERSTAND WHY A SENSE THEY WERE THERE TO PROTECT THEIR LIVES WAS PROBABLY NOT WITHIN THE REALM OF THE EXPERIENCES OF THE MEN GETTING OFF THAT TRAIN CONTEXT MATTERS AND CONTEXT MATTERS TODAY AS WELL AS IT DID IN 1918 SO I HAVE TO ACKNOWLEDGE MY RESEARCH TEAM AT THE UNIVERSITY OF MARYLAND, UNIVERSITY OF GEORGIA AND UNIVERSITY OF PITTSBURGH AND WHAT I’M GOING TO DO TODAY IS NOT TALK ABOUT ODDS RATIOS AND SHOW YOU GRAPHS AND FIGURES BUT TO TALK ABOUT SOME OF THE THEMES WE’VE LEARNED IN OUR JOURNEY AND TRYING TO UNDERSTAND WHY THERE ARE CONSISTENT YEAR AFTER YEAR DISPARITIES AND AFRICAN AMERICANS RECEIVING THE FLU VACCINE EVEN WHEN THE RATE OF DISPARITIES AND CHRONIC DISEASES THAT PLACE MANY AT INCREASED RISK OF COMPLICATIONS MAKES THIS A SERIOUS MATTER SO I’M GOING TO SPEAK FROM THE DATA OF THREE DATA SETS ONE CONDUCTED AT THE BEGINNING OF THE H1N1 PANDEMIC ONE CONDUCTED PARTWAY THROUGH IT AS IT TURNS OUT, CLOSER TO THE END IN 2010 AND THEN ONE CONDUCTED IN 2015 THE FIRST TWO 2009-2010 WERE WHITES, AFRICAN AMERICANS AND ENGLISH AND SPANISH SPEAKING LATINOS THE THIRD ONE, EXCUSE ME, THE THIRD ONE IN 2015 WAS ONLY WHITES AND AFRICAN AMERICANS WE REALLY WANTED TO FOCUS ON THOSE ISSUES EVENLY SPLIT, A LITTLE OVER 100 EACH WE DID ALSO EXTENSIVE QUALITATIVE RESEARCH WITH 110 WHITES AND AFRICAN AMERICANS IN MARYLAND AND IN GEORGIA THAT INCLUDED EXPLORE TORI INTERVIEWS, NINE FOCUS GROUPS AND EXTENDED IN-DEPTH INTERVIEWS SO I’M GOING TO TALK ABOUT WHAT WE DID AND WHAT WE HEARD SO 2009, CARRIE TOLD US YESTERDAY HIGH LEVELS OF UNCERTAINTY, HIGH MEDIA INTEREST THERE WAS CERTAINLY SEASONAL FLU VACCINE PRODUCTION WAS UNDERWAY BY THE TIME WE KNEW WE HAD A PANDEMIC IT WAS UNCERTAIN WHEN OR IF WE WOULD HAVE AN H1N1 VACCINE THERE WAS A DISCUSSION OF HAVING AN EMERGENCY USE AUTHORIZATION WHICH MEANS THE FDA AND PUBLIC HEALTH EMERGENCY CAN APPROVE THE USE OF A VACCINE OR A DRUG THAT’S REALLY IN THE EXPERIMENTAL STAGES SO THIS WAS THE CONTEXT IN WHICH WE DECIDED TO INVESTIGATE TRUST AND OTHER ATTITUDES WE MEASURED TRUST AND INFORMATION SOURCES LOCAL AND STATE AND FEDERAL PUBLIC HEALTH AGENCIES LOCAL, STATE AND FEDERAL ELECTED OFFICIALS PRESIDENT OBAMA AND THE SECRETARIES OF HEALTH AND HUMAN SERVICES WE LOOKED AT TRUST AND OTHER SOURCES, DIFFERENT TYPES OF NEWS ORGANIZATIONS, HEALTHCARE

PROVIDERS, FAMILIES, FRIENDS, AND TRUST IN GOVERNMENT ACTION DURING THE PANDEMIC NOT TRUST IN GOVERNMENT BUT SPECIFIC TO HOW THE GOVERNMENT WOULD REACT IN THE PANDEMIC HOW OPEN WAS THE GOVERNMENT HOW HONEST, HOW CARING, HOW COMMITTED TO WHAT EXTENT THE PEOPLE BELIEVE THE GOVERNMENT WOULD ACT IN THEIR BEST INTEREST AT THE SECOND SURVEY IN 2010, WE ALSO SOUGHT TO UNDER HOW THEY FELT ABOUT THE COMMUNICATION AND SO WE WERE INTERESTED IN HOW CLEAR THEY SAW THE INFORMATION BEING HOW CONSISTENT TO WHAT EXTENT THEY WERE OKAY AS INFORMATION CHANGED AS GOVERNMENT LEARNED MORE AND HOW OPEN DID THEY FEEL THE GOVERNMENT HAD BEEN FINALLY, PRESIDENT OBAMA TALKED OPENLY ABOUT GETTING HIS DAUGHTERS VACCINATED DID THIS CHANGE CONFIDENCE AND TRUST IN THE VACCINE? SO WHAT DID WE FIND? TYPICALLY WHEN YOU DO SOCIAL SURVEYS, YOU FIND AFRICAN AMERICANS, LATINOS OFTEN HAVE LOWER TRUST IN GOVERNMENT IN PART BECAUSE OF ALL THE THINGS WE JUST HEARD WHAT WE FOUND IN JUNE OF 2009, SEVERAL MONTHS AFTER THE INAUGURATION OF PRESIDENT OBAMA THAT ACTUALLY WHITES HAD THE LOWEST LEVELS OF TRUST IN GOVERNMENT ACTIONS AND AFRICAN AMERICANS AND LATINOS HAD HIGHER TRUST CONTEXT MATTERS PUBLIC HEALTH OFFICIALS THIS WILL BE GOOD NEWS FOR MANY OF YOU WHO ARE PRACTITIONERS FOR DR. DEVLIN PUBLIC HEALTH OFFICIALS WERE MORE TRUSTED THAN ELECTED OFFICIALS SO BAD NEWS FOR THE ELECTED OFFICIALS PERSONAL HEALTHCARE PROVIDERS WERE HIGHLY TRUSTED BY BOTH — BY ALL THREE GROUPS IN THE SURVEYS BUT AFRICAN AMERICANS STILL TRUSTED THEM LESS THAN WHITES AND FINALLY, PEOPLE WHO REPORTED THEY CLOSELY FOLLOWED THE NEWS, THEY WERE PAYING ATTENTION AND HAD HIGH LEVEL OF KNOWLEDGE ACTUALLY HAD HIGHER LEVELS OF TRUST SO, AGAIN, THAT THEME AROUND COMMUNICATION, UNDERSTANDING AND INFORMATION BUT WE ALSO HEARD THAT TRUST ALONE DID NOT PREDICT VACCINE UPTAKE FOR AFRICAN AMERICANS AND LATINOS WHEN WE DID — THAT WAS AT THE FIRST SURVEY WHEN WE DID THE SECOND SURVEY, WE DID FIND SOME PROMISING THINGS THAT THE QUALITY OF COMMUNICATION MADE A DIFFERENCE THE EXTENT TO WHICH PEOPLE WERE FOLLOWING THE NEWS, THE EXTENT TO WHICH THEY SAW THE QUALITY OF COMMUNICATIONS BEING HIGH AND THE PRESIDENT OBAMA’S WILLINGNESS TO TALK ABOUT HIS DAUGHTERS ACTUALLY MADE A DIFFERENCE IN TRUSTING GOVERNMENT ACTION AND TRUSTING GOVERNMENT SPOKES PERSONS AND THAT’S IMPORTANT SO WE’LL COME BACK TO ALL THESE IN A MOMENT THE OTHER THING IS QUALITY OF COMMUNICATION MADE A DIFFERENCE WE ASKED PEOPLE WHO HADN’T YET GOTTEN VACCINATED DID THEY INTEND? THE QUALITY OF COMMUNICATION WAS A VARIABLE THAT MADE A DIFFERENCE MOVING THEM FROM NO TO EITHER I DON’T KNOW OR YES BUT GIVEN WHAT WE HEARD HERE, WE KNEW WE DIDN’T FULLY UNDERSTAND THIS TRUST IS ACTUALLY OFTEN THE BUCKET WHEN WE CAN’T EXPLAIN ALL THE VARIANCE, WE SAY IT MUST BE TRUST WHAT WE RECOGNIZED IS A COUPLE OF THINGS NUMBER ONE THAT WE NEEDED TO UNDER TRUST IN THE VACCINE, NOT JUST TRUST IN GOVERNMENT ACTIONS AND WE LEARNED IN LISTENING TO PEOPLE DURING OUR QUALITATIVE RESEARCH THAT WHITES NO MATTER WHAT THEIR AGE AND AFRICAN AMERICANS HAD TWO FOUNDATIONAL KINDS OF PERSPECTIVES FOR WHITES, THEY SAID THE POLIO VACCINE WAS SUCH A SUCCESS, IT JUST MADE ME TRUST I DON’T QUESTION VACCINES AFRICAN AMERICANS, THE FIRST FOCUS GROUP NOT SURPRISING, I WAS NOT SHOCKED AT THIS FIRST PERSON SAYS HOW CAN YOU EVEN TALK ABOUT VACCINES WITHOUT TALKING ABOUT THE SYPHILIS STUDY? SO WE HEARD THOSE THINGS SORT OF FROM BOTH AFRICAN AMERICANS WERE MORE LIKELY TO TALK ABOUT CONSPIRACIES AROUND THE FLU VACCINE EVEN UNITED AND TALKING ABOUT PHARMACEUTICAL COMPANIES HAVE A PROFIT MOTIVE WHEN WHITES QUESTION THE COMPETENCE — WHEN WHITES QUESTION GOVERNMENT AROUND VACCINES, THEY QUESTION COMPETENCE WHEN AFRICAN AMERICANS QUESTION,

THEY QUESTION MOTIVES WOULD GOVERNMENT ACT IN OUR BEST INTEREST AND FINALLY, THEY ALSO HAD DIFFERENT PERSPECTIVES ON PERCEIVED RISK OF THE VACCINE ITSELF SO WHITES TEND TO THINK IF SIDE AFFECTS ARE GOING TO BE MY ARM MIGHT BE SORE AFRICAN AMERICANS SAW THEM AS FAR MORE SERIOUS YOU COULD DIE IT’S A LIVE VIRUS, IT CAN KILL YOU SO WE USED ALL OF THAT TO CREATE A NUMBER OF RELIABLE MEASURES WE MEASURED GENERALIZED TRUST WE ASK ABOUT TRUST IN THE FLU VACCINE AND WE HEARD NOBODY UNDERSTOOD THIS PROCESS WE GO THROUGH EVERY YEAR OF CREATING A FLU VACCINE WE CREATE A GRAPHIC AND LITERALLY SHOWED IT TO THEM AND THEN ASKED ABOUT TRUST IN ALL THE PARTIES PRESENT THERE LET ME BACK UP BEFORE I GO TO FINDINGS THE OTHER THING IS WE WERE INFLUENCED BY PUBLIC HEALTH CRITICAL RACE PRACTICES AND HEARING WHITE PRIVILEGE AND THE PERSPECTIVE OF AFRICAN AMERICANS IN THE QUALITATIVE RESEARCH SO, AGAIN, WE CREATED A SET OF VARIABLES RACIAL FAIRNESS IS TREATMENT AND HEALTHCARE BY THE GOVERNMENT FAIR TO ONE’S RACE HOW CONSCIOUS ARE YOU OF YOUR RACE IN A HEALTHCARE SETTING HAVE YOU EXPERIENCED DISCRIMINATION? AND WHAT IMPACT DOES THAT HAVE ON YOUR ABILITY TO GET HEALTHCARE? AND WE ASKED THIS OF BOTH WE ASKED FROM THE PERSPECTIVE OF ONE’S RACE WE THOUGHT WE WERE HEARING WHITE PRIVILEGE AND WE WERE CERTAINLY HEARING WHAT IT FEELS LIKE TO LIVE AS AN AFRICAN AMERICAN IN THE UNITED STATES AFRICAN AMERICANS HAD LOWER TRUST IN ALL ORGANIZATIONS BUT THE SAME RANK ORDER AS WHITES SO DOCTORS, ONE’S A PERSONAL DOCTOR CDC GOOD NEWS FOR THE CDC FOLKS FDA WERE TRUSTED PHARMACEUTICAL COMPANIES WERE WHERE EVERYONE AGREED THEY DID NOT TRUST THE DRUG COMPANIES BUT WE ALSO FOUND AND THIS IS THE GOOD NEWS THAT WHEN YOU MEASURE TRUST IN THE VACCINE ITSELF AND IN THE PRODUCTION PROCESS THAT IT ACTUALLY DID PREDICT INCREASED VACCINE UPTAKE SO WE’LL COME BACK TO ALL THIS A LITTLE BIT LATER THERE WERE A COUPLE OTHER THINGS THAT ARE TIED TO THIS HIGHER PERCEIVED RISK LOWER PERCEIVED RISK OF SIDE AFFECTS HIGHER KNOWLEDGE OF THE FLU OLDER AGE AND HIGHER INCOME ARE ASSOCIATED WITH TRUST SO THOSE ARE IMPORTANT THINGS TO THINK ABOUT HIGHER RACIAL CONSCIOUSNESS THE MORE YOU ARE CONSCIOUS OF YOUR RACE IN A HEALTHCARE SETTING AND EXPERIENCE WITH DISCRIMINATION NOT SURPRISINGLY WAS ASSOCIATED WITH HIGHER PERCEIVED RISK FROM VACCINE SIDE EFFECTS, LOWER TRUST AND LOWER UPTAKE SO THIS WAS REALLY POWERFUL FOR AFRICAN AMERICANS NOT SIGNIFICANT FOR WHITES FOR BOTH GROUPS, HIGHER PERCEIVED FAIRNESS WAS ASSOCIATED WITH HIGHER TRUST IN THE PROCESS, THE VACCINE AND GREATER UPTAKE THAT WAS FOR BOTH GROUPS SO WHAT DO WE DO ABOUT THIS? HOW DO WE ADDRESS AN INCREASED TRUST AND UPTAKE OF THE VACCINE? SO IN THE FOCUS GROUPS, WHILE WE CERTAINLY HEARD A LOT WITH TUSKGEEGEE THIS IS TWO DIFFERENT AFRICAN AMERICAN PARTICIPANTS THE MISTRUST NEEDS TO BE DONE AWAY WITH SOME OF THAT STUFF IS OLD AND OUT DATED THE SAME THING WITH THIS VACCINE MIND SET SOME OF THAT STUFF IS JUST OLD THE GOVERNMENT HAS BECOME MORE TRUST WORTHY I WAS WILLING TO GIVE THE FLU VACCINE A SHOT BY THE WAY, THIS IS 2013, MAYBE EARLY 2014 I TRUST THEM AND I’M GOING TO TELL YOU WHY THERE ARE TOO MANY PEOPLE THAT WORK IN GOVERNMENT THAT HAVE OUR BEST INTEREST SO DON’T THINK GOVERNMENT IS TRYING TO HURT US IF THEY SAY GO GET YOUR FLU SHOT I DON’T BELIEVE THEY ARE I THINK WE HAVE OPPORTUNITIES AND WAYS FORWARD NOT WITHOUT CHALLENGES PUBLIC HEALTH AGENCIES I THINK DO A GOOD JOB AT TALKING ABOUT GET THE VACCINE THEY DO A GOOD JOB AT TALKING ABOUT RISK OF THE DISEASE BY IN LARGE HOWEVER, THERE’S STILL A LOT OF MIS-INFORMATION, MISUNDERSTANDING OF THE VACCINE AND FLU ITSELF SAW THAT AS ASSOCIATED WITH TRUST SOME OF THE COMMUNICATION NEEDS

TO BEGIN TO ADDRESS THAT ISSUE THE PERCEIVED RISK OF SIDE AFFECTS WE DON’T OFTEN TALK ABOUT THOSE THINGS AND I THINK THE CLEAR MESSAGE ABOUT QUALITY OF COMMUNICATION IS WE NEED TO BE OPEN AND TALK DIRECTLY ABOUT THESE IF WE DON’T, SOCIAL MEDIA WILL AND OTHERS WILL SO THAT’S AN IMPORTANT COMMUNICATION MESSAGE FINALLY, WE DID HEAR A LOT ABOUT BARRIERS AND HIGHER PERCEIVED BARRIERS WERE ASSOCIATED WITH LOWER TRUST AND SO THOSE BARRIERS WERE PERCEIVED AS COST FOR SURE THEY WERE ALSO THINGS LIKE IS THAT VACCINE I GET IN MY BLACK NEIGHBORHOOD THE SAME AS THE VACCINE YOU GET IN YOUR RICH NEIGHBORHOOD? WHY DO WE HAVE SHORTAGES BUT YOU DON’T HAVE SHORTAGES? SO THE PERCEPTION IS AS IMPORTANT AS IF IT WERE THE REALITY A COUPLE OTHER THINGS WE LEARN WHEN WE LOOKED AT VACCINE BEHAVIOR ACROSS FIVE YEARS AS WE DID, CLEARLY WHAT WE SAW IS WE NEED MORE ATTENTION TO YOUNGER AFRICAN AMERICANS LOWER INCOME AFRICAN AMERICANS WE DID A PAPER THAT LITERALLY JUST LOOKED AT OUR AFRICAN AMERICAN PARTICIPANTS BY THEIR VACCINE BEHAVIOR SO I THINK WE HAVE OPPORTUNITIES WE HAVE UNIVERSAL FLU VACCINE RECOMMENDATION WE HAVE OPPORTUNITIES TO REACH OUT TO YOUNGER PEOPLE TO LOWER INCOME PEOPLE THE QUALITY OF COMMUNICATION IS ESSENTIAL HERE AND IN A PANDEMIC, WE OFTEN SAY THE KEY PRINCIPLES COMMUNICATE EARLIER, COMMUNICATE OFTEN, BE OPEN ADDRESS UNCERTAINTY, WARN YOUR POPULATION, YOUR PUBLIC THAT THERE WILL BE UNCERTAINTY DR. FRIEDMAN DID THAT WELL SAY THAT YOU UNDERSTAND THIS WILL BE HARD AND CDC LEARNED THAT LESSON PRETTY WELL THE CAUTION IN TODAY’S MEDIA IS TO NOT TO GET ENGAGED IN MIS-INFORMATION THAT’S A LONGER CONVERSATION WE ALSO FOUND THAT LANGUAGE MATTERS AND SO WHEN EUA FACT SHEETS TALK ABOUT EXPERIMENTAL DRUGS, CLINICAL TRIALS, THAT IS A TRIGGER FOR AFRICAN AMERICANS AND THAT DECREASES LIKELIHOOD SO LANGUAGE MATTERS WE CANNOT DO THIS UNLESS HEALTHCARE SYSTEMS CHANGE THIS IS NOT JUST ON THE BACKS OF THE POPULATION IN AFRICAN AMERICAN COMMUNITIES BUT ADDRESSING WHAT WE KNOW IS STILL A PROBLEMATIC RACIAL BIAS IN HEALTHCARE IS CRITICAL AND I’M HEARTENED BY SOME OF THE EFFORTS TO DO IMPLICIT ASSOCIATION TESTS AND OTHER EFFORTS TO INCREASE THE ABILITY OF PROVIDERS TO ADDRESS AND BUILD TRUSTING RELATIONSHIPS WE ALSO KNOW THAT PROVIDERS IN GENERAL AND AFRICAN AMERICAN PROVIDERS DO NOT TAKE THE FLU VACCINE THAT’S A CRITICAL ISSUE IF I’M ASKING YOU DO YOU TAKE IT AND YOU SAY TO ME I DON’T TAKE IT, THAT IS GOING TO BE A CLUE TO ME SO HAVING — INCREASING THAT VACCINE UPTAKE IS CRITICAL BUT THE OTHER THING AS WE KNOW FROM THE LITERATURE THAT AFRICAN AMERICANS, WHEN THEY GO DURING THE FLU SEASON TO SEE A PROVIDER ARE LESS LIKELY TO GET A RECOMMENDATION AND AN OFFER AT THE SAME VISIT YET WE KNOW IF YOU GET A RECOMMENDATION AND AN OFFER, DR LYNN SMITH, I STRONGLY RECOMMEND YOU GET THIS VACCINE BY THE WAY, I GOT MINE LAST WEEK AND I CAN HAVE MY NURSE GIVE IT TO YOU TODAY YOU KNOW WHAT? VACCINE UPTAKE GOES UP FINALLY, WITHIN COMMUNITIES AND PUBLIC HEALTH AGENCIES WORK WELL OR MANY OF THEM WORK WELL WITH COMMUNITY ORGANIZATIONS AND I THINK IT’S ESSENTIAL THAT WE ADDRESS THESE CONCERNS IN THIS ON-GOING DIALOGUE WE BEGIN TO CHANGE WHAT WE HEARD IN OUR QUALITATIVE DATA PEOPLE DON’T TALK A LOT ABOUT GETTING THE FLU VACCINE BUT IF THEY BELIEVE PEOPLE CLOSE TO THEM, THEIR FAMILY AND FRIENDS AND THEIR DOCTOR WANT THEM TO GET IT, THEIR TRUST IN THE VACCINE AND THEIR VACCINE UPTAKE GOES UP SO CHANGING THAT SOCIAL NORM IS CRITICAL

SO CONTEXT MATTERS AND TODAY IN AN ERA WHEN PEOPLE BELIEVE THE BLACK LIVES MOVEMENT IS CRITICAL JUST TO GET RESPECT AND FEEL SAFE IN COMMUNITIES, THEN I THINK TODAY IT’S GOING TO TAKE NOT JUST AFRICAN AMERICAN COMMUNITIES, HEALTHCARE PROVIDERS, HEALTHCARE SYSTEMS AND PUBLIC HEALTH AGENCIES ALL WORKING TOGETHER TO CHANGE THIS AND HERE’S THE BOTTOM LINE OR WHAT WE CALL THE GIST WE KNOW FROM OUR WORK THAT IF YOU TAKE A SEASONAL FLU VACCINE EVERY YEAR, WHEN THERE’S A PANDEMIC, YOU ARE MORE LIKELY TO GET THE VACCINE SO THIS IS WORK THAT HAS TO BE DONE TODAY, NOT WHEN ANOTHER PANDEMIC ARRIVES SO I MUST ACKNOWLEDGE NIH, NATIONAL INSTITUTE OF MINORITIES, CDC AND THE FOOD AND DRUG ADMINISTRATION FOR THEIR SUPPORT THANK YOU [ APPLAUSE ] >> THANK YOU FOR THESE WONDERFUL PAPERS DO WE HAVE TIME FOR SOME QUESTIONS? 10 MINUTES EXCELLENT SO WE DO HAVE MICROPHONES, I BELIEVE SO PLEASE APPROACH THE MICROPHONE IF YOU HAVE A QUESTION I KNOW OUR PANELISTS ARE EAGER TO HEAR FROM THE AUDIENCE CAN WE START WITH YOU PLEASE AND THEN TO THIS ONE >> THAT WAS A WONDERFUL TALK THANK YOU SO MUCH WE HEARD YESTERDAY FROM DR HOWARD MARQUEL ABOUT HOW POWERFUL IDEOLOGIES LED TO A BIG PARADE IN PHILADELPHIA DURING THE WAR WITH FLU INFECTED SOLDIERS INCREASING SPREAD OF FLU AND YOUR NARRATIVE ABOUT AFRICAN AMERICAN SOLDIERS IN THE SOUTH PROMPTS A QUESTION ABOUT WHAT THE IMPACTS WERE OF THE DOMINANT CULTURE’S NARRATIVE AROUND PATRIOTISM FOR AFRICAN AMERICANS WHERE I CAN IMAGINE THERE’S A CONFLICTED SENSE ABILITY >> QUICK QUESTION FOR YOU COULD QUESTIONERS INTRODUCE THEMSELVES? >> SURE ELIZABETH FRENCH FROM THE GILLINGS SCHOOL >> THANKS NICE TO MEET YOU THANKS FOR YOUR QUESTION YOU SEE PEOPLE SORT OF MOBILIZING THE LANGUAGE OF PATRIOTISM IN A NUMBER OF WAYS THE MILITARY INTELLIGENCE FILES ARE FASCINATING AND FUN FUN, HISTORIAN FUN YOU HEAR THINGS THAT YOU WOULDN’T NECESSARILY OR SEE THINGS YOU WOULDN’T NECESSARILY GET THIS IS THE OTHER THING ABOUT WORLD WAR I PART OF THE VOLUNTEERISM WAS ALL ABOUT NEIGHBORING SUVAILING EACH OTHER IN BARBERSHOPS OR PRIVATE CONVERSATIONS, YOU GET SOME OF THIS THE GERMANS HAVE DONE NOTHING TO ME AND IF THEY HAVE, I FORGIVE THEM THIS IS NOT MY FIGHT PUBLICALLY IN THE BLACK PRESS IN SERMONS AND ALL OF THESE PLACES, YOU GET A VERY PATRIOTIC PRO WAR RODERICK FROM SELF STYLED AFRICAN AMERICAN LEADERS AND IN A WAY THAT PLAYS ALMOST UGLY THE NEGRO IS THE ONE AMERICAN WHO KNOWS NO HYPHEN OTHER THAN OTHER ETHNIC GROUPS BUT THERE’S A SENSE THAT THIS IS OUR COUNTRY MORE THAN IT IS ALMOST ANYONE’S WE BUILT IT, WE DID IT, WE HAVE SOME KIND OF INVESTMENT IN THE FIGHT SO PEOPLE GO IN SPEAKING THAT LANGUAGE PART OF WHAT HAPPENS IS THE DEEP DISILLUSIONING HOW INVESTED THEIR FELLOW AMERICANS ARE IN REMINDING THEM THAT THEY ARE OUTSIDERS THAT THEY DON’T BELONG SOME PEOPLE CLAIM HARDER DOUBLE DOWN ON PATRIOTISM AND OTHER PEOPLE SEE PEOPLE OF COLOR FIGHTING FOR OTHER COUNTRIES AND BEGIN TO START THINKING ABOUT OTHER FORMS OF CONNECTION AND COMMUNITY THAT MIGHT DEFINE THEM MOST PEOPLE COMBINE THOSE THINGS AND TO A SELF CONTRADICTORY MASS OF EMOTION AND RESPONSE >> HI MATTHEW PEEK I MANAGE THE WORLD WAR I PAPERS THERE FOR THE STATE ONE OF THE QUESTIONS I HAD

RELATED TO THE WAY THE INFORMATION AND ACCESS TO CARE WAS TRANSMITTED TO AFRICAN AMERICAN POPULATIONS IN THE STATE USED MAILING LIST TO SEND INFORMATION OUT BUT AFRICAN AMERICANS IN RURAL COMMUNITIES DIDN’T HAVE MUCH EDUCATION AS WE KNOW FROM DRAFT REGISTRATION AND READING TRAINING IN GREENSBORROUGH AND RED CROSS NURSE CHAPTERS WERE MARGINALIZED FROM THE WHITE CHAPTER I WAS WONDERING WHAT YOU FOUND RELATED TO THE TRANSMISSION OF INFORMATION HOW THAT AFFECTED CARE IF YOU CAME ACROSS ANYTHING LIKE THAT >> I DON’T KNOW I DIDN’T COME ACROSS ANYTHING BUT MY GUESS WOULD BE PREACHERS WHO COULD READ AND COLORED WOMEN’S CLUBS WHO WERE ALREADY DOING COMMUNITY AND HEALTH RELATED WORK WOULD BE THE NODES WHERE THOSE THINGS WERE CIRCULATING DO YOU KNOW? >> I THINK THERE’S MORE COMPLEXITY TO THE STORY THAN WE RECOGNIZE I’M GOING TO FORGET HER NAME FOR A MOMENT SICK AND TIRED OF BEING SICK AND TIRED IT’S REALLY A HISTORY OF THE BLACK WOMEN’S LAY HEALTH MOVEMENT THAT WAS EFFORT BY WOMEN THEMSELVES TO ADDRESS THE HEALTH ISSUES OF THEIR COMMUNITIES BUT STARTING IN 1915, THERE WAS ALSO AN EFFORT CALLED THE NATIONAL NEGRO HEALTH WEEK WHICH BECAME NATIONAL NEGRO HEALTH MOVEMENT THAT WAS BEGUN BY BOOKER T WASHINGTON AND IT WAS REALLY — IT’S A FASCINATING AND VIRTUALLY UNKNOWN PART OF HISTORY IN WHICH EVERY WEEK THERE WAS A NATIONAL THEME AND THE WEEK WAS STRUCTURED BEGAN IN THE CHURCH WITH A PREACHER WHO HAD A THEME AND I CAN’T REMEMBER NOW HOW EACH DAY WENT BUT THERE WAS A SCHOOL DAY, THERE WAS A CLEAN-UP DAY TO ADDRESS ISSUES OF SANITATION IN COMMUNITIES I CAN’T REMEMBER ALL THE DAYS NOW I HAVEN’T LOOKED AT MY OWN I HAVE AN ARTICLE AND HAVEN’T LOOKED AT IT IN YEARS BUT IT GREW TO A NATIONAL MOVEMENT AND IT REALLY WAS WITHIN THE BROADER BLACK COMMUNITY INTEGRATED NOT JUST PUBLIC HEALTH PEOPLE AND HEALTHCARE PROVIDERS BUT IT BROUGHT IN CHURCH, IT BROUGHT IN THE NEGRO INSURANCE COMPANIES WAS WHEN THE BIG FUNDERS IT WAS A LARGE CORPORATION AND SO IT BROUGHT TOGETHER MANY PEOPLE TO ADDRESS AND REACH PEOPLE WHERE THEY LIVED BY PEOPLE THEY TRUSTED TO TALK TO THEM ABOUT HEALTH AND TO WORK WITH THEM >> THE FIRST TIME I GOT A FLU VACCINE BECAUSE I HAD DONE THIS THING WHERE I WAS LIKE I WAS THE IMMUNE SYSTEM OF A HORSE THE FIRST TIME I GOT A FLU VACCINE WAS WHEN MY OB SAID YOU SHOULD GET A FLU VACCINE WHY DON’T I CALL YOU ONE AND I WAS LIKE OH, FINE 11 YEARS LATER >> HI I’M SERANA THANK YOU FOR YOUR RESEARCH AND I’M SO INSPIRED BY DR SMITH I REALLY APPRECIATE YOU GETTING THE VOICES OUT OF THE PEOPLE EXPERIENCING THE DIFFICULT TIMES THAT WERE HAPPENING I JUST BLANKED I WANTED TO SAY THAT THIS IS GOING TO BE EXTREMELY CHALLENGING TO GET THE TRUST OF PEOPLE OF COLOR CONSIDERING THE TOP GOVERNMENT OFFICIALS ARE SAYING THINGS THAT KIND OF DIMINISH THE TRUST AND THEN ALSO I HEARD ON NPR ONE OF THE UNC PUBLIC HEALTH PEOPLE TALKING ABOUT HOW AFRICAN AMERICANS HAD A 1.5% INCREASED RATE OF DEATH DURING THE 1918 FLU PARTLY BECAUSE THERE ARE A LOT OF AFRICAN AMERICANS IN THE SHARE CROPPERS AND TENANTS WORKING IN THE FIELDS IN NORTH CAROLINA AND THE HOUSING ADDITIONS WERE POOR AND CROWDING, ET CETERA SO I WONDERED IF YOU COULD SPEAK ON THAT AT ALL AND THANK YOU SO MUCH FOR BOTH OF YOUR EFFORTS >> QUICK INTER INJECTION WE HAVE A MINUTE LEFT SO WE MAY NOT GET TO OUR LAST QUESTION

BUT PERHAPS YOU COULD COME UP AFTERWARD AND SPEAK WITH THE SPEAKERS INDIVIDUALLY >> I THINK TWO THINGS NUMBER ONE IS — AND WE HEARD IN YESTERDAY’S HISTORY SESSION WHICH WAS FABULOUS THE SOCIAL DETERMINANCE OF HEALTH ARE CRITICAL HERE WHEN I FOCUS ON THINGS LIKE TRUST AND PERCEPTION AND COMMUNICATION AND PROVIDERS, THAT IS NOT TO MINIMIZE THE FACT THAT WE HAVE TO ADDRESS THE SOCIAL DETERMINANCE WE’RE NOT GOING TO SOLVE RACISM TOMORROW WE HAVE A LONG WAYS TO GO SO WE HAVE TO ADDRESS WHAT WE CAN BUT WE KNOW THOSE DETERMINANTS OF HEALTH MAKE A DIFFERENCE AND I HAVE TO SAY THIS BECAUSE I FOCUS ON THE DISPARITIES IN THAT VACCINE UPTAKE THE DISPARITIES IN CHRONIC HEALTH CONDITIONS ARE SO SERIOUS IN AFRICAN AMERICAN, NATIVE AMERICAN AND MANY OF OUR MINORITY COMMUNITIES THAT THEY ARE FOR GREATER RISK AND OFTEN WITH LESS ACCESS AND SOCIAL DETERMINANTS THAT UNDER MINE THEIR HEALTH THAT SAID, THE AMERICAN POPULATION AS A WHOLE GETS — IF YOU LOOK AT WHITES, WHITES GET VACCINATED ABOUT 40-45% EACH YEAR WE DON’T DO WELL WITH ANYONE ON THE FLU VACCINE AND WHILE IN A SEASONAL FLU, MAYBE IT’S A MILD ONE, MAYBE IT’S NOT A CRISIS IN A PANDEMIC, THAT’S POTENTIALLY A HUGE ISSUE WE HAVE TO DEAL WITH IT NOW WE CAN’T LOSE TRACK OF THE BIGGER CONTEXT >> I’M AFRAID WE HAVE TO CALL OUR PANEL ON THAT NOTE PLEASE JOIN ME IN THANKING OUR PANELISTS [ APPLAUSE ] >> PART OF WHAT’S DELIGHTFUL ABOUT A CONFERENCE LIKE THIS IS WE CAN CONTINUE THE CONVERSATIONS MORE INFORMALLY AFTER THE PANELS AND I CERTAINLY ENCOURAGE YOU TO SPEAK WITH OUR PANELISTS WE HAVE A 10-MINUTE BREAK GET YOUR COFFEE AND COME BACK FOR MORE