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Session I of a Council On Foreign Relations Symposium on Pandemic Influenza:Science, Economics and Foreign Policy Panelists: Arnold Monto, Professor,Epidemiology, University of MichiganPeter Palese, Professor and Chair, Microbiology and Professor of Medicine,Infectious Diseases, Mount Sinai School of MedicineLone Simonsen, Research Professor and Research Director, Department ofGlobal Health, George Washington UniversityPresider: Jon Cohen, Correspondent, Science MagazineIntroductory Speaker: Laurie A. Garrett, Senior Fellow For Global Health, Councilon Foreign RelationsOctober 16, 2009Council on Foreign RelationsReference Website:http://www.cfr.org/publication/20442/session_i_of_a_council_on_foreign_relations_symposium_on_pandemic_influenza.htmlLAURIE GARRETT: Good morning, and good morning to all of you on the Internet. Myname is Laurie Garrett, and you are here in the Council on Foreign Relations inNew York on a grim, wet, chilly day. Thanks to all of you who managed to forgethrough the nasty weather. And I expect that we'll have stragglers coming in as aresult of the weather problems.I am the senior fellow for Global Health here at the Council on Foreign Relations,and I welcome everybody who is both here and in cyberspace with us.In a few moments my colleague, Jon Cohen, will tell those of you out in the cyberworld how you can actively participate all day today via Twitter. Jon is theoutstanding, infamous, notorious, famous science correspondent for ScienceMagazine, which is our co-sponsor today. It's a first for the Council on ForeignRelations. We embrace it wholeheartedly and hope it will be the beginning of manymore to come, for this symposium entitled "Pandemic Influenza: Science, Economics,and Foreign Policy."On August 24th, the President's Council of Advisers on Science and Technology,some of whom are with us today, so-called PCAST, issued a remarkable analysis ofwhat's in store with the H1N1 virus, the so-called swine flu, and the likelypandemic impact this fall on the United States of America.The PCAST offered a scenario -- not a prediction, let me say -- a scenario thatsuggested the virus would indeed return, having already been here in the spring,for a second wave, and that we would see it appear sometime in September and bepeaking right about today in the United States, and that sometime, by the end ofthe year, roughly half of the American population would have had H1N1 influenza.The PCAST warned that this H1N1, despite being a not terribly dangerous virus inand of itself on a scale of influenza dangers, would overwhelm many of ourhospitals and pose a great burden to our intensive-care-unit capacities across thecountry.After circulating in the southern hemisphere for the last three or four months,H1N1 did indeed return as forecast, or shall we say scenario'd, by PCAST and hasnow been back in most of the United States for at least two weeks. It is indeedsurging very rapidly around the country.On Tuesday, Dr. Ann Schuchat from the Centers for Disease Control opened a press
 
briefing with these remarks: "Unfortunately, we're seeing more illnesses, morehospitalizations and more deaths from it. Flu is widespread in 37 states. That'sup from 27 states just last week. Unfortunately, 19 more pediatric deaths frominfluenza got reported to us this past week. We're now up to 76 children havingdied from the 2009 H1N1 virus." She means in the United States.To put that in context, in the past three years the total pediatric influenzadeaths ranged from 46 to 88. We've had 76 children dying from the 2009 H1N1 virus,and it's only the beginning of October.There's a great deal of uncertainty about this flu pandemic. One thing is certain:It is a worldwide event, and it is occurring in the dawn of our age ofglobalization.With us today is a stellar group of scientists -- some of them PCAST members, as Isaid -- analysts, journalists, and, as usual at the Council on Foreign Relations,a highly diverse and intelligent audience.Before we jump into the subject at hand, a few quick bits of housekeeping and aset-up for what we're going to experience today. We have three panels with twoshort breaks. And because this is live on the Web, we're going to ask that theaudience that's physically here in New York please clear out quickly during breaksand come back quickly during breaks so that we stick to our time scheduleabsolutely.In addition, a couple of other things. Because we are live on the Internet,absolutely no wireless devices can be on in this room. It's not just we don't wantthem to ring; we don't want them to interfere. So PDAs, cell phones, laptops,whatever they are, please turn them off.We welcome that webcast audience. And as I said, Jon is going to tell you how youcan twitter. And because this is the first big event co-sponsored with ScienceMagazine, we really want to thank and welcome all the folks from AAAS and Sciencefor their participation and the tremendous help we got in organizing today'sevent.We also want to thank Council member Richard Brown from Philadelphia, whogenerously provided some personal support for today's event. All of theproceedings will be available to you after today on our website, CFR.org, and onthe Science website.So, finally, I just want to hand things over to Jon Cohen for the first panel withthese words. I have had a long and storied career myself in journalism. If I hadone competitor who rode me harder than any other journalist in the business, gaveme more trouble, scooped me more times, it was Jon Cohen.Jon.JON COHEN: Thank you, Laurie. That was very kind. (Laughter.) And the feeling ismutual.I did breathe a sigh of relief when Laurie first came to the Council. And Lauriereally put a lot of effort into making this happen, and I thank her and theCouncil, because it really takes a great deal of coordination to make somethinglike this happen.As a journalist, I rely on the smartest people to be my teachers, and fortunatelythree of them are here with me on the panel. I've learned a lot from each of them
 
as I've tried to keep up with covering the spread of the novel H1N1.On my far left is Dr. Arnold Monto, who is an epidemiologist from the Universityof Michigan and has been covering -- studying flu probably since I was born andknows a tremendous amount about the virus. Peter Palese, who's from Mount SinaiSchool of Medicine, is one of the foremost basic researchers of influenza and hasdone really fascinating work looking at how different viruses transmit and whythey transmit when they do under the conditions. Lone Simonsen, who's with theGeorge Washington University, is also an epidemiologist and has done really eye-popping historical analyses of past pandemics.So we're going to have a conversation for about 40 minutes. Then we'll open it upto the audience. We are not here to agree with each other. This is not to developa consensus document. If they disagree with each other, that's just fine.If you do want to ask questions on the Web, you can tweet your questions. And thetweet hashtag or pound sign is cfrq@a.So I think one of the questions that most people are curious about is why is thisflu different, and why should anyone care about it? And so I open it up to thepanel. Is this one any different? Has it been hyped?ARNOLD MONTO: I think they're all different. That's a standard influenzastatement, that if you've seen one outbreak, you've seen one outbreak, or ifyou've seen one pandemic, you've seen one pandemic. And this is clearly differentand a little challenging in terms of how to handle it, because it is so different.Our two past pandemics in the 20th century, '57 and '68, had characteristics whichwe associated with seasonal influenza, most of the mortality in people with riskconditions -- older individuals, very young. And this one is behaving a bitdifferently -- high attack rate, but selecting out for problems a small percentageof children and 20- to 50-year-olds.And that really is a challenge in terms of how you handle this by vaccination,because we can't come up with our usual recommendations; older individuals shouldget vaccinated. In fact, we've said just the opposite.So this has presented a challenge, and I think it's also created a challenge interms of mortality, trying to give scenarios about mortality, because withoutventilation, without ECMO and the rest in emergency rooms, we may -- we could beseeing a much higher mortality than we are.So it's been a challenge trying to deal with this. And part of this, which I'msure Peter can talk about, is the fact that this is not a totally new virus. Andthis explains some of the phenomena that we're seeing.COHEN: Dr. Palese, you've questioned whether this is a real pandemic. How do yousee it?PETER PALESE: Okay, let me sort of say -- (inaudible) -- there is a saying themore things change, the more they stay the same. One can look at this as a verydifferent virus. And clearly Dr. Monto pointed out what some of the differencesare with this new 2009 virus.On the other hand, I feel it is sort of like the fourth regular seasonal influenzavirus. And let me explain a little bit. With regular influenza, we have threedifferent strains. We have two what we call influenza A viruses, and they belongto the H1N1 -- and many have seen this for a long time -- H1 meaning hemagglutinin
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