Unseen Enemy (2017) - full transcript

Unseen Enemy is an essential exploration of reasons 21st-century populations are experiencing a rash of diseases that were once only outbreaks, but have now become full-blown epidemics. This increased risk that we face, and the ways society and individuals can work together to reduce that risk, are explained to the public through the case studies of three epidemics: Ebola, influenza and Zika. Moving across the globe, we meet doctors, disease detectives and everyday people who have stepped into the horror of an epidemic and emerged deeply changed. Epidemics bring out the best and worst of human behavior, with effects reaching far beyond the tolls of sickness and death.

Hello, good morning. This is "Breakfast..."

Thanks for joining us,
everyone.

I'm Zoraida Sambolin.
It is 5:00 a.m. here in the east...

Good morning, everyone.
Welcome to "Early Start"...

The Centers for
Disease Control today issued a health warning

following a worldwide outbreak of
a mysterious form of pneumonia.

The highly contagious virus SARS
killed nearly 300 people...

8,500 people around the world
have come down with SARS.

I feel very worried.

I feel anxious
for the health of the masses.

The World Health Organization



has declared
a swine flu pandemic.

...spread
of the H1N1 swine flu.

The outbreak has spread widely and cannot be contained.

I don't think we can contain
the spread of this virus...

Influenza pandemics
must be taken seriously.

A big outbreak

of a deadly Ebola virus
has killed more than...

The Ebola outbreak
that started

in the West African country
of Guinea has now spread.

Our people know nothing.
There is no cure.

They don't have the
resources to actually contain...

Governments around the
world are considering new measures...

I'm calling from the New
York City Health Department...

...your temperature reading
from last night.



The U.
S. Department of Agriculture

confirmed another case
of bird flu.

One and a half million
state turkeys

have been killed
to prevent the spread of...

It is really critical
that they control this...

We have to respond
to the challenge.

Three latest victims

of the new respiratory virus
called MERS

have come from
Middle Eastern countries.

They believe it originated
in bats or camels.

It causes pneumonia
and rapid kidney failure.

As the Zika virus continues

to infect people
across the globe...

The outbreak
started in Brazil,

a suspected link
to severe birth defects.

Zika typically is transmitted
through mosquitoes.

When the weather
starts to warm up,

more of those mosquitoes
could start coming north...

Because I believe there
is such a thing as being too late.

Our home.

You can almost hear
the biological chatter.

Just when technology and science
were supposed to make us safer,

we suddenly seem
more vulnerable to outbreaks.

Whether we like it or not,

our world
is globalizing evermore.

And that's not only true
for markets and for production,

but it's also true
for behaviors, for diseases.

So we're more vulnerable
because of our mobility.

Secondly, we are
far more people,

and we are also living more and
more in very crowded cities.

That's fantastic from the
perspective of a virus,

because in no time,

it can infect hundreds
of thousands of people.

Over the last
three decades, there have been

about 30
newly emerging diseases

that have the potential
to be pandemics.

If we do nothing--

it's not a matter of "if"
there will be a global pandemic.

It's just a matter of when

and which virus
and how bad.

The world changes
around us at increasing speed.

We cause
a lot of that change

migrating to cities,

stripping the Earth
of its resources,

and altering
primeval jungle.

We are seeing
whole, entire ecologies

that which you can see
with your eye

and that which you can only
see with a microscope,

one system after another,
completely reshaped.

Is there a sense...

In every case,

this affords opportunities
for viruses and bacteria

to seek out new homes,
cause new havoc,

including disease
for human beings.

When contagion happens,
life alters in an instant.

We don't feel safe.
We lose trust.

Fear spreads very quickly

when you have an infectious
disease outbreak.

Communication
is so much more pervasive.

People know what's happening
in another part of the world

so much more quickly, so much
more vividly than ever before.

So the contagion of fear
moves faster

than the contagion of the
pathogen, the disease itself,

and the fabric of society
starts to deteriorate.

There's something that destroys the soul of a community...

that happens when an epidemic
is out of control.

It's not just the large number of casualties and the deaths,

which are itself
unthinkable,

but it's what it does to a--

the social fabric
of a community or a nation.

Dr. Soka Moses:

Ah?

Hmm?

Ebola is transmitted
through bodily fluids--

saliva, blood,
urine, feces.

This is an invisible foe.

Ebola first
surfaced in West Africa

in a remote
rural community.

But in our increasingly
connected world,

this Ebola outbreak
didn't stay in the countryside.

The virus quickly found its way to the region's largest cities

and health systems that were
completely unprepared.

Moses:

Moses:

I think we all
underestimated,

absolutely everybody.

I know that one case of Ebola
is an emergency.

Every new case can give rise
to more cases.

So it's really act now
or pay later.

Right now, the World
Health Organization and other doctors

are saying it is out of control
in this area of West Africa.

It's the worst outbreak ever that they've
recorded in this part of the world.

It's unprecedented
for several reasons.

One, first time in West Africa
that we have such an outbreak.

Secondly, this is the first time
that three countries are involved.

And thirdly, it's the first
time that we have outbreaks

in capitals,
in capital cities.

This could explode
into a really mega-crisis.

I think so, and it is
already a mega-crisis...

I really thought, how can this
epidemic be controlled the usual way

when there are so many
outbreaks in different places?

The three countries
in West Africa

that are affected
by the Ebola outbreak

have some of the worst
health indicators in the world.

There are
not enough doctors.

There are not enough nurses.

It is a system that is
understaffed, underfunded,

and where the infrastructure
is very, very old.

Let's go back to 1976
when you were a younger man,

and you actually
codiscovered this virus.

- It was in Zaire.
- Yes.

Now the Democratic
Republic of the Congo...

And they said that there
was a mysterious epidemic.

This was very lethal,
high mortality.

There were nuns
who had died.

A small group
would go to the mission

where the epidemic
had started, apparently.

They asked for volunteers,
and I think I was

about the first one
to raise my hand...

although I had
absolutely zero experience

in doing this.

Our mission was to--
one, to put in place

some basic measures
to contain it

and using quarantine.

That's what we thought.

And two, to find out
how is this transmitted?

Because that's the key
to stop epidemics--

to know exactly
what the risk is.

How is it transmitted?

It's really
a detective work.

So we tested
whole villages,

talked to the population,

and then have a very
primitive questionnaire.

How old, where have they
been, have they traveled?

And what we found was that
there were very few survivors.

Very few,
and that indeed

the what we call
"case fatality rate"

was over 90 %.

Nearly all new viruses
come from animals.

I mean, we are also
an animal.

We are, you know,
human primates.

So, during the outbreak,
we started collecting samples

from all kinds of animals.

I even took blood
from pigs

because a number of pigs
had died

at the beginning
of the epidemic,

so we said,
"You never know."

But we didn't find
any trace of Ebola.

My boss at the time,
Stefaan Pattyn,

had always told me,
"Watch out for the bats."

And it became
a bit of a joke.

But the old man
was right

because
the only reservoir

that we think
where Ebola is hiding

are some kind
of fruit-eating bats.

Dr. George Gao:

If we look around the world,

we can see that
bat populations

are being severely stressed
by climate change.

Some of them
because they live

in the upper tiers
of rainforests

and feed on wild fruit.

But the upper tiers
of the rainforests

are getting the most impact
of this heat increase

and increased
UV radiation.

Add to that that humans are
encroaching into the rainforest,

into bat habitats,
precious caves.

They're very shy creatures.

They do not seek you out,

no matter what vampire movies
you ever saw.

As humans encroach,

we see more and more
bat populations starving

and coming into
human habitation areas

to feed on our
agricultural production.

And in the process,
they're passing their virus on

to other animals
and to humans.

We are imposing changes in the
microbial world willy-nilly,

thoughtlessly,

and we do so at our peril.

We have dramatically increased our contact with animals

in a variety of ways:

through deforestation,

industrialization
of agriculture,

and vastly increased
consumption of animals.

HIV spread out of Africa from
a few monkeys and chimpanzees

to infect millions of people
on every continent.

SARS jumped from a bat

to a civet cat
to a villager in China

to more than 30 countries
in a matter of weeks.

Animal and human health
are completely linked.

In the 21st century,

75 % of all new
infectious diseases

have come from animals.

Sometimes directly,

in other cases,
through intermediaries

like mosquitoes.

If anyone had sat down
and done, you know,

a fantasy hit parade
of emerging diseases

that might
come to the Americas

from Africa
or from Asia,

Zika would never have
even been on the list.

Zika virus originated
in Africa

and had never been
off the African continent

until it started
making its way

across Asia
and South Pacific,

ending up in French
Polynesia and Yap.

Yap is a small place

that most people
have never heard of,

but when Zika hit it,

70 % of the population
got infected.

That was really
quite startling,

if anybody had been
paying attention.

But they weren't.

Zika jumped from the South
Pacific to Brazil in 2013,

two years before it was
identified there.

The timeline corresponds
to an increase in travel

between the South Pacific
and Brazil,

including visitors who attended a
pre-World Cup soccer tournament,

the Confederation Cup.

Go-o-o-o-al!

Someone was carrying
the Zika virus,

and some mosquitoes
bit that individual,

absorbed the virus,

and that's the beginning
of this saga.

And then undoubtedly,
the El Nino weather event

provided the necessary
ingredients--

rainfall and drought--

that fundamentally changed
the conditions on the ground

and allowed for the spread
of this virus.

In 2015, the Zika virus
suddenly spread across Brazil,

primarily through the bite
of one type of mosquito.

The medical establishment only
began to comprehend Zika's danger

as the number of babies born with
the birth defect microcephaly

started to dramatically
increase.

Since the alarm went sounding
around the world from Brazil,

we have seen
almost every day

another revelation
about this virus.

What we now know is that
this is a very dangerous virus.

We grossly
underestimated it.

It is malaria in that it is
transmitted by mosquitoes

and can cause
enormous outbreaks.

It is HIV in that
it is sexually transmitted.

And it's worse
than all of the above

as we've come
to understand

what this virus
actually lives on.

Where does the virus go
in a pregnant woman?

It goes into this tiny
forming creature, the fetus,

and it feeds on it
and re-infects

back into the mother's
bloodstream over and over again.

And what is it feeding on
in that fetus?

Baby brain cells.

And so, every single part
of the brain

of that developing child
is damaged.

The Zika virus
affects its victims

in a completely different way
from the Ebola virus.

What they share in common
is how fast they can move,

randomly attacking some
while sparing others.

Some epidemics grab
our attention,

while others, in spite of the
larger number of victims,

remain more hidden.

...oldies all the
time on your hometown station,

and of course adding in
some holiday music.

Oh, it's so close.

On a local note,
I'm gonna pass along to you

that those in need of a flu
shot may still get them.

Walk-ins are welcome at the
Steele County Public Health,

weekdays between
8:00 and 4:00.

Owatonna, Minnesota--
it's a beautiful town.

To me, it's like "Mayberry R.
F.D.," Opie Taylor's town.

The name
Owatonna comes from

an Indian princess
that was sick,

and the chief brought her here
because of the healing waters.

When we moved here,
it just felt like home.

I think we got lucky.

The good Lord just gave us
two good kids.

- Three, two...
- Do something.

Sarah was
always the princess

and Shannon
was the opposite.

She was a tomboy.

She loved skateboarding

and she loved
video games.

Shannon, she was a complete surprise.

Sarah was almost 16,
and I was 40.

She was a joy.

Right from the get-go,
she was a joy for everybody.

Whoa!

We were
a tight, tight family.

Her first time
out by herself.

Oh, my gosh.

I remember when
she got her permit,

she was just so tickled.

There she goes, by herself.

So, I was so proud of her.

Oh, my gosh! Oh, my gosh!

Somebody's driving.

Catching snowflakes.

Hi, girl. Oop.

Oh, hi.

Shannon was in her
senior year of high school.

She came home
Wednesday night,

said, "I think I got
the flu at school."

That was Wednesday,

and Thursday,
she just seemed to be,

you know, baseline
for being sick,

but she wasn't
getting better.

And that's when Terry and I agreed
that we've got to take her.

When I took her that
Sunday to go to the hospital,

we waited two hours.

It was that packed.

That's when I knew

there was a big epidemic
of flu going on.

And she's sitting next to me,
and she's got her head on me,

and I took a selfie,
sent it to her mom,

saying,
"We're still waiting."

The doctor said it was just the flu,
that it had to run its course.

They gave her some cough
medicine just for comfort,

and Terry went and got it while
I got her back up in her bed.

It's about
5:00 in the morning.

I was sitting
in the living room

and I heard her
moving around upstairs.

I thought, "Wow," you know,
"she's getting out of bed."

I got up, and I
went to the coffee maker,

and I saw in my peripheral
that she got up

and she went
into the bathroom.

She tapped
on the shower curtain,

and I said, "You want
to take a shower?"

And she nodded yes,
and I said, "Okay."

I was filling the water up.
I only got it about so full.

She laid back,
but her knees kept buckling.

You know, she kept pushing
on the end of the tub

to keep herself
from sliding under, and...

and then I saw her eyes.

And...

I pounded on the wall
and woke Terry up.

Said, "She's not breathing,"
and I come running down, and...

I still remember her
on the floor,

her mom giving her CPR.

I never had to do that
before.

And it's nothing like
they teach you in class.

All I could do
was dial 911.

911, what's going on there?

My daughter,
she's 17 years old.

- She's not breathing!
- She's not breathing!

- She's not breathing?
- She's not breathing.

Okay, I'm sending
the paramedic to help you now.

Just stay on the line
with me, okay?

- Come on, breathe for Mama!
- Breathe, Shannon.

Oh, Lord.

Come on in.

She's right in there.
Go ahead.

I don't remember any
kind of time passing.

I just remember
a pair of blue pants

that kneeled down
on the other side of her,

and he told me they'd take
over, and I stepped away.

Even when the--
when they said,

"We're flying her
to Rochester,"

you know, I waved
at the helicopter,

you know, thinking
everything's fine.

I had no clue.

You know,
when they told us...

that she didn't make it,
and I said, "I want to see her,"

and they said,
"You'd never recognize her

from what we've had
to do to her."

Because the flu actually
killed all of her organs

long before
she actually died.

I still think she ought
to be coming home.

The biggest
pain in the world as a parent

is losing their child.

This is the most
unnatural thing

to happen
to a human being.

And you stand next to it
and you think, my goodness,

I am there to prevent this
from happening,

and sometimes I cannot,

and...

sometimes I don't know
why I cannot.

The question of how and
why one particular person

may die from influenza
is the million-dollar question

that we absolutely
need to tackle.

It is surprising how much
we still need to learn about flu,

a disease which causes worldwide
epidemics every year.

She had a little
raspiness in her chest.

Mother

Mother

like it was no big deal.

It spreads
across the globe,

hospitalizing
three to five million.

Mother

Killing at least
200,000 every year.

Mother

Mother

...pronounced dead.

The majority of
adult influenza patients

have something
that we call a risk factor.

They have
very weak immune system,

or they have diabetes
or obesity.

Pregnant women
have a risk,

for both themselves
as well as the child.

Okay, we know
these factors.

But this is a virus that can
mess up your body to a degree

that even the most healthy,
young and happy, playful person

is taken away from this planet
within a couple days.

Every year, we struggle
to fight seasonal flu.

But what experts
are really afraid of

is a new strain of flu,

one that the human population hasn't been exposed to before,

one that almost no one will
have any immunity against.

When we think
about the threat of a disease

spreading around the world
as a pandemic threat,

obviously airborne infections
are at the very top.

Things like SARS and flu
are something

that we know
is difficult to control

because of the way
it spreads through aerosols.

Most people become
infectious with the flu

before they even
have symptoms.

Anybody can travel
clearly across the world

with an infectious disease
incubating in them

without them even knowing
that they're sick yet.

In 2009, a
new flu emerged--

H1N1, also known
as swine flu.

We now know it first appeared in the U.
S. In the pig industry,

initially infecting people
at state and county fairs.

In a little over a year,

swine flu infected
around 1.3 billion people.

It was the most common
shared experience on Earth.

Flu poses a
strong pandemic threat

because it has the ability to be both
very contagious and very deadly.

Yeah. Yep.

What we're most worried
about right now is this bird flu

that we know
is highly pathogenic.

Paul Horwood:

Currently, this
deadly new bird flu

doesn't spread easily
between people,

but it is spreading rapidly
among wild birds and poultry.

Experts are afraid
this could be

a pandemic threat.

It's a live poultry
market, so the birds are alive.

And when they're sold,
they are sold alive

because people value the fact
that it's very fresh meat.

So you buy your
chicken or your duck live.

And then it is killed...

and cleaned and emptied,
of course, eviscerated.

The viscera go into
some of these buckets here,

and then the birds
are put in hot water

and then put
in these drums

where these
little plastic tubings

help get rid
of the feathers.

And then when the birds
have been defeathered,

eviscerated, and cleaned,
then they're cut up

and they're given back
to the person who bought it.

The issue here is that
the water is the same

to clean all the ducks
and chickens.

The other issue is that these
people are wading in--

in viscera, feathers,

and the water that served
to clean them.

So, there's really
a lot, a lot of virus here.

In 2011,
when the Pasteur Institute

started monitoring
the wash water,

18 % of the water samples
were positive for H5N1.

Four years later,
66 % of samples were positive.

We know that bird
flu is very, very deadly,

and we know swine flu
spreads very quickly.

What we worry about
is if those two reassort,

and then we could have a new
strain that literally could spread

as quickly
as the swine flu did

but have the mortality rate
of bird flu.

That's the big fear,

that we have now
literally created

the petri dish
that we all worried about

and both of those viruses are
sitting in there at the same time.

Pandemics are one of
the biggest risks we face.

This is an issue
of human lives.

It should be thought of
in the same way

that we think
of terrorism,

protection against
natural disasters,

against national defense.

This is a human
security issue,

and it is also
an economic security issue.

The outbreak
of SARS could trigger a global downturn.

Fear of the SARS virus
has caused

serious financial damage
to businesses,

cities,
even entire countries.

During the height of SARS,
nobody was going to restaurants,

people didn't want
to go shopping.

At one point, at the peak
of the SARS crisis,

air travel into Hong Kong
was down by 80 %

and retail sales
were down by 50 %.

Businesses began to run
out of money.

Estimates of the impact
of SARS

have been an economic impact
of around 40 billion or so.

If a global pandemic
took place,

you're looking
at an economic impact

measured in the trillions
of dollars,

not tens or hundreds
of billions.

It has such a big impact
on business and life.

You hope the world has
the capacity to see an outbreak,

mobilize forces,
and contain it, right?

Unfortunately,
we rarely do that.

Especially
if the outbreak occurs

in a poor country.

Well, here we are
in Liberia.

That's Sierra Leone.

And this is
the border crossing.

Do you see security?
Do you see any military?

Do you see anything
that would stop someone

from coming across
this border?

And then,
it not only spreads

beyond the borders
of the original country

as occurred with Ebola
and West Africa,

but it crosses seas,

it crosses continents,

and that constitutes
a pandemic.

Endemic is your
worst-case scenario.

So you failed to control
the outbreak,

you failed to control
the epidemic,

and you failed to control
the pandemic,

and now that microbe
is a permanent feature

in the biological landscape
that humans are living in.

The worst example
of that is HIV.

We started off
with tiny outbreaks

in a handful of places,

and the world responded
completely incorrectly.

It became pandemic
and now endemic.

So we have 37 million people
living infected with HIV,

and there is no country
on the planet

without this virus.

Before the
devastation of AIDS,

there was smallpox.

Smallpox killed
500 million people

in the 20th century alone,

more than all the wars
in that century combined.

Whenever an infectious disease truly catches hold,

it forces health workers
to make impossible choices

about the public's freedom
and rights.

I was the youngest
person in the smallpox team.

And I was certainly
the only person

in the history
of the United Nations

recruited from
the Neem Karoli Baba Ashram.

We had eradicated
smallpox in Madhya Pradesh.

It's this big state
in the middle of India.

And we were about to do
our victory dance,

and then suddenly
across the border,

we started getting
new outbreaks.

And they all came
from one place,

a place called Tatanagar.

First place we went to was the railway station.

And it was a scene
from the worst nightmare

you ever had
in your life.

There were dozens of people
stretched out near the tracks,

in the waiting room,
on the cement,

dead from smallpox.

It smelled from the death.

The Tatanagar
was the home

of the Tata
Iron and Steel Company.

So I just went
to the company's house.

It was almost midnight
when I got there.

I said, "I need Jeeps,
I need managers,

I need doctors,
I need vaccine."

The next day,
I had 100 Jeeps.

We set up
training programs.

We used maps
to develop a strategy,

and we took
the 100 Jeeps,

and we built
our little army.

We were doing great.

We found 2,000 cases
of smallpox.

We were stopping the disease
in Tatanagar,

but still, as we're
vaccinating everybody,

the trains were carrying
people away.

It was still exporting
smallpox.

We closed the railway station. We closed the buses.

We quarantined the city
of 600,000 people.

Nobody could leave the city
unless they were vaccinated.

We eliminated smallpox in that
entire area around Tatanagar

in less than six months.

But it kept coming back.

We traced it to a tribal group called the Ho tribe.

So, I went and visited the
members of that tribe,

and I said, "Well, you've
gotta take smallpox vaccine.

You gotta stop
this transmission."

And he said,
"I won't take it.

I do whatever
God's will is, and...

if I'm to get smallpox,
I'll get it."

After a while, more cases kept
coming out from the Ho community,

and we all agreed
that we were going to have to

forcibly vaccinate
these Ho tribesmen.

In the middle of the night,
we went out into the villages,

into the jungle,
and we surrounded them

and pulled them
out of their houses,

and we vaccinated them.

And then after we had
broken into their house,

pulled them out of bed,
forcibly vaccinated them,

this dignified tribal elder
looked at me,

and reached over
to the vine.

And there was one fruit,
a cucumber, a kind of gourd.

And he pulled it off,
and he cut it,

and he put it on a leaf,
and he offered it to us to eat.

He said, "I don't like
what you did.

I think you're wrong.

But that's over now.

Now I see that you are
a guest in my house.

The only thing I have to offer
is this cucumber."

And so,
you ask yourself...

"Were we right?"

We did
a lot of things that,

in their
individual isolation,

if I put the harshest light
of truth on it right now,

I would be begging to find
an alternative way to do it.

And I ask myself,

"Did I exaggerate
the importance of what I did?

Did I place myself above
some kind of moral compass?

Did I--

did I quit too early
trying to find a way

to accomplish
the same thing?"

But...

But that's sort of between,
right now, me and God

and me and my conscience.

Smallpox has been
eradicated.

And I'm thrilled
about that.

Chicken pox.

The idea of night
raids or forcible vaccination today

is just unthinkable.

There's a few big things
that are very different--

internal politics,
global politics, extremism,

the whole issue
of human rights.

You have to be transparent
because the wrong information

can actually contribute
to the spread of a disease.

I'm particularly interested
in looking at rumors.

The way that rumors
replicate and spread

are very similar
to how viruses spread.

They need a host.

They need to be supported
to stay alive and thrive.

- Oh, there we go.
- There we are. Okay, hi.

Rumors have been
around since man existed,

but I think right now,
what's changed with technology,

and particularly
social media and the Internet,

is the global spread
and the speed.

I mean,
look at Twitter.

You needed 140 characters
or something,

and that's all you need
to spread some of the rumors

and perceptions
that we're certainly tracking.

And one of the things we found
is that rumors thrive

in times of uncertainty,
they thrive in times

where people need an answer,
are eager for an answer.

The old model
of how you respond

to an infectious disease
outbreak

is you issue some sort of, you
know, firm warning to the public

and tell them what they
should and shouldn't do.

That doesn't work anymore

because people
are responding

to rumors on Twitter
or Facebook,

and they want to engage
and they want to challenge

and they want to have their own
opinions about what's going on.

I'll be back.

Okay, I have a pen.
I have my books.

The agenda.
Okay, go for it.

When an epidemic occurs,
there is a clinical management,

but there's also
the reactions of society,

and managing that
can be as important

as actually dealing
with the epidemic itself.

Okay, good afternoon,
everybody.

This is the third meeting
of our task force on Ebola.

And, John, would you
like to give an update?

Because where we are
with the epidemic,

I'm very worried,
to be honest.

President Ellen Johnson Sirleaf

likened the outbreak
to a war.

Cases and deaths
continue to surge.

Riots are breaking out.

As Ebola continued to
spread across West Africa,

the governments implemented
massive quarantines.

Distrust exploded.

Security forces blocked roads

with scrap wood
and barbed wire.

An angry mob forced open
an isolation ward.

Hundreds clashed
with the police,

who fired live rounds and tear gas.

Liberia has tried,
we've used our own resources,

but obviously
we have limitations,

and we hope that the
international community see this

as an international
catastrophe.

Two
Americans who had been infected...

...will be sent home
for care in Atlanta.

- William Pooley...
- ...became infected whilst working as a nurse

in eastern Sierra Leone...

A news photographer for NBC
just diagnosed with Ebola.

Much like the other
Americans before him,

he will be flown back to the
United States for treatment.

- That's him?
- Woman

Woman

- He's from West Africa, right?
- Woman

- Oh, he's from the States?
- Woman

- Oh, my God.
- Woman

In a repeating pattern,
the world only really started

to pay attention
to the Ebola epidemic

when foreign workers
began to fall sick.

The international
responses continue to ramp up.

We're going to create an
air bridge to get health workers

and medical supplies
into West Africa faster.

Over a billion euros
across Europe will be galvanized.

China
is sending healthcare professionals.

There are 84 flights a week
leaving these affected countries.

For the first time, the Ebola
virus is in the United States.

Thomas Duncan contracted Ebola in
Liberia before flying to Dallas, Texas.

He lied on his exit form
so he could leave Liberia.

Why not
just shut down the flights

- and secure the borders?
- A travel ban may make sense.

We should not be allowing
these folks in, period.

As of today, one
case came from Liberia.

One.

Now, there'll be more,
but right now, one.

And in response to that they
say, "Let's close the borders.

Nobody from Africa
will be allowed in."

They don't even know where West
or East or South Africa is.

"Nobody from Africa
should be allowed in.

And close our airports."

I mean, that's a combination
of ignorance and arrogance

that could create
ruination

for our economic system,
our financial system.

Please be advised that a health
care worker who lives in your area

has tested positive for the Ebola virus.

Today, testing confirmed

that a patient here in New York
City had tested positive for Ebola.

Craig Spencer treated
Ebola patients in Guinea.

12 hours before
he detected his fever,

he was in an Uber car,
he was on the L train,

he was on the A train,
he was on the 1 train,

he went to two bowling alleys, and he ate at a restaurant

as no quarantine
was required.

Late this afternoon,
the governors of New York

and New Jersey
decided to change that.

After returning from treating
Ebola patients in Sierra Leone,

Kaci Hickox
was forcibly quarantined,

even though she tested
negative for Ebola twice.

We have the legal
authority to do it.

Um, we're doing it.

It was pretty clear
that the United States epidemic

was overwhelmingly
an epidemic of fear.

We got a practice run
on how Americans will respond,

and, boy, we got an F.

In addition,
we have renewed

our determination
to remain vigilant...

We're spending a lot of
time with the community...

And we will rid
our beloved country

of this dreadful,
unwanted guest-- Ebola.

...community leaders
with our colleagues

to assess how to better
handle this Ebola epidemic.

My big question, and I guess it is
the concern of everybody here, is--

is this a wake-up call
for you,

also the international
community,

to start looking
at other potential viruses

that may come to harm us, as
vulnerable as we are, in the future

so that we start putting
things in place now for us to--

to prevent us getting
in those types of situations?

Well, to be honest,
in these 38 years,

we have
collectively failed.

And every time when there's a big
epidemic, we say, "Oh, never again.

And we're going to--
you know, to set,

put in place mechanisms
to do this and that,"

and it doesn't happen.

And so we have
to now really fight

that this will happen
this time

and that there are
better systems in place.

In the fall of 2014,
significant aid and manpower

finally started arriving
in the region.

In Liberia,
there were contingents

from Médecins
Sans Frontières,

China, Cuba, Germany, Sweden,
and the United States.

It was chaotic,

and coordination
was often difficult.

But makeshift ETUs
were finally replaced

with purpose-built
field hospitals.

Moses:

Moses:

He just dropped and died.

He just dropped
and died.

Yeah.

Decontee Davis:

- A cat...
- A cat...

- ...a rat...
- ...a rat...

- ...on a mat.
- ...on a mat.

- A fat cat...
- A fat cat...

- ...sat on the mat...
- ...sat on the mat...

Moses:

How are you?

The 21st century can
be characterized by a race

between the dangers
of modernization

and the advances.

Our only chance
of winning the race

is to use 21st century tools
to fight epidemics,

ideally even to prevent them
with vaccines.

Yes, he is.
Come right on in.

Garcia-Sastre:

- They sent the slides.
- Oh, yeah, okay.

Currently, we create a
new flu vaccine every year,

adjusting it to match
the circulating strains of flu.

It takes months
to make that vaccine.

Yeah, it looks quite nice.

What scientists
are trying to develop

is a universal
flu vaccine,

one that could work against
all strains of flu,

seasonal and pandemic.

Garcia-Sastre:

Gao:

Better
diagnostics are critical

to preventing outbreaks
from becoming epidemics.

We frequently
misdiagnose influenza.

And initially
in the field,

we misidentified
both Ebola and Zika.

Confusing them
with other diseases,

we lost valuable time
to contain them.

Thank you.

You have been
identified.

This is the area
where we have a lot

of the diagnostic machinery
that we're working on.

So, the general idea is your
sample's gonna get placed in here,

and it will run
across the chip.

You close it up,

and then the cartridge
can sit right here.

Right now, the run time is somewhere
in the order of half an hour.

So what you can see on the screen
here-- this is the intact virus.

Maybe it's Ebola, maybe it's
influenza, maybe it's Zika.

You could imagine it being
useful in your doctor's office.

You can imagine it
being useful in an airport.

Or you can imagine somebody wanting
to bring it to a triage site

if there is some disaster
or some outbreak.

Today the President
of Brazil gave public health officials

the right to enter
any home or business

to try to eradicate
mosquito breeding grounds.

Cases of the Zika virus
have been reported

in dozens of countries across
Southern and Central America.

Already, Puerto Rico is in
the crosshairs of the virus.

Scientists are
still trying to understand

the full range
of neurological effects

the Zika virus causes
in both babies and adults.

Florida officials
have finally found the Zika virus

in mosquitoes
in the Miami area.

People are scared.

Cases of Zika rose
from 4,000

to, by some estimates,
over 16,000.

Can you imagine, colleagues, the
fear and anxiety in this chamber

if these hundred mosquitoes were
outside this jar, not inside this jar?

A lot of folks talk about
protecting Americans from threats.

Well, Zika is a serious threat
to Americans.

Zika is spreading
rapidly around the world.

At least 49 countries
or territories

in the Western Hemisphere
have local Zika transmission.

We're already seeing
mosquitoes transmitting Zika

in the United States.

It's really just a question
of how many states,

how widespread,
and how many people

will acquire infection
as a result.

We are not prepared
for Zika.

Every outbreak, we go to the
Capitol Hill folks and beg.

And every outbreak,
it becomes very political.

In the United States,

there are a patchwork of laws
that guide health.

There's no consistency
in the level of funding

or urgency or training
or expertise.

Am I allowed as a public health
official to go on your front lawn,

your private property,
and spray insecticide?

In some cities, yes.
In some cities, no.

Am I allowed to force you,
compel you,

to drain a swampy-like
condition in your backyard

because it's breeding
mosquitoes?

Again, there's
no consistent law.

Public health
is a two-way trust.

I have to trust that government's
going to do the job,

but government
can't do the job

of public health
unless the public is engaged.

If government says,
"Mosquitoes are here

and they're carrying
a really dangerous disease,

we need to come
on your property.

We need to have
access to ways

to eradicate
those mosquitoes."

And you say, "I believe
in the Second Amendment."

"Nobody's coming on my property,"

then there's no trust
and there's no public health.

And similarly,
if there's an epidemic

that involves a vaccine,

government doesn't line
your children up.

You line your children up.

And if you're not
willing to do so,

then you're not part
of the trust

that is the basis
of public health.

Don't shoot, hands up!

If there's one hallmark

of my lifetime
on this planet,

it is the erosion of trust
in government.

And public health

is paying a price
at every level

for that erosion
of trust.

Each year, Terry
gets the vaccine.

I don't get it.

And we gave Shannon
the choice,

and she chose not to.

I'm trying to understand
the flu vaccine

because I want to know if we had
have gotten Shannon vaccinated,

if it might have saved
her life.

There's so much information
on the Internet.

I can go
to 30 different websites

and get
30 different answers.

You don't know
who to trust.

There is something
about the flu vaccine

that conjures confusion.

While not currently
a perfect tool

and varying in effectiveness
from year to year,

over the last decade,
the flu vaccine reduces

the risk of getting the flu
by at least 50 %.

It also reduces
hospitalizations and deaths.

A little over a year ago,
a mom that lost a little girl

put together a Facebook page,
and she titled it "Flu Moms."

And when she hears
of another mom

or somebody finds us,
they join.

Here's a mom.

She had a booth at a fair,

and all of our children
were pictured.

There's Shannon.

And...

when children came
to the booth

to get their faces
painted...

then the parents
standing there waiting

would get
the information.

They'd be told about
these children who have died

and the importance
of vaccination,

that kind of thing.

We have a new mom.

Julia.

"Not wonderful to be part
of a flu mom group,

but it's great that we all
are here for one another."

Shoot.

We'll learn her story
pretty soon.

There's a huge amount of parents
that are just utterly confused.

And that's a big
communication challenge

when it comes
to the vaccine.

So, the question is
does she have anything now?

Yes, you know...

Vaccine hesitancy
is something

that we observe
to be on the rise,

which is quite alarming.

Influenza is actually possibly
preventable with a vaccine.

That's great.
But nobody uses it.

That's not great.

One of the most common
misconceptions about the flu vaccine

is that people say, "You know
what, I'm in my best years.

I'm healthy.
I've never been sick."

But there's another aspect
to vaccines, obviously,

and that's not just me,
it's also the people around me

because of the potential of me
giving something to somebody

that may be
serious to them,

even if it may not be
serious to me at this moment.

And I may very well sit
in the subway next to somebody

who has a very weak
immune system.

And they may not even know it, and I may not know it,

but I may very well
give somebody the flu.

So, there's the question
of the common good

versus
the individual good.

If we want any effectiveness
of a vaccine,

we need to get
vaccinated.

The great
influenza of 1917, '18,

that virus
is said to have

gone around the world
four times

without an airplane.

That's 100 years ago now.

At the end
of the great influenza,

50 million or 100 million
had died.

That's against a global
population at the time

less than two-sevenths
of what it is today.

Multiply 50 or 100 million
by three,

you're talking about
a number of deaths

that's totally catastrophic,

a hit to our economy
that's unimaginable.

In 2006, I brought
the top epidemiologists

from all over the world
together.

The vaccine needs...

And the vast majority felt

that in the next
20 years, 30 years,

there will be a pandemic,

and it will have
the potential

to bring humanity
to its knees.

New strains of influenza

are already infecting birds
in over 75 countries.

And the way we are interacting with the animal world

is putting us at risk.

We encroach on wetlands,
so wild birds

mix more frequently
with domestic poultry;

our food trade
is completely globalized;

and factory farms are growing
in scope and size.

With all influenzas,
there is some critical moment

when a virus circulating
in one species,

of, say, birds,

manages to mutate
in a form

that allows it
to get into, say, pigs,

and then from there
to spread easily

between people.

We've seen this
over and over.

It's going on all the time,
right at this moment.

Here's what
a truly horrible,

worst-case scenario pandemic
would look like.

First, there would
be a jump

from some animal species
to humans.

The first humans would be

the people close
to those animals.

And then their families
and the kids in the schools.

And it would not be

regionally confined
for long at all.

Days, that's it.

And let's assume
that it kills

5 % of the people
it infects.

Well, 5 % would be hundreds
of millions of human beings.

Pandemic flu will
soon reach this country.

If you become sick
while traveling, contact...

So, once the epidemic
has really begun to spread,

you can't even begin to
imagine the scale of this.

You want to be as far away
from the city as possible.

Man

You have huge
numbers of people

that are not
coming to work,

and that includes jobs
we consider essential

for public safety,

like the guys that turn
water systems on and off...

...the police...

...the fire department.

Then people start blasting
their conspiracy theories out

about where this disease
came from,

who caused it,
why is it here.

You would see
a whole wave of shortages

of goods and services
all over the world.

The stockouts
of every single kind of drug,

the overcrowding
of the hospitals,

the overcrowding
of the mortuaries,

the sheer numbers
of both sick and dying.

What a really severe influenza
pandemic would look like...

...is something close
to social collapse.

We're not effectively prepared as a world for a pandemic.

We don't have effective enough
coordination and response.

But the biggest thing

is that the on-the-ground
preparation and preparedness

is full of holes.

There's a pattern here
of responding to an outbreak

rather than investing in
preparedness.

Preparedness
is so much cheaper,

so much more
cost-effective

than responding
after the event has happened.

Major nations
around the world

currently spend 10 to 25
times less on bio-security

than they do
on homeland security,

in spite of the likelihood
of an epidemic

causing even
greater loss of life.

We are overdue
for an influenza pandemic.

On average, they happen
every 20 to 40 years.

A lesser influenza pandemic,
one equivalent to 1968,

would likely now kill
up to two million people.

An influenza pandemic
like 1918

could kill
200 million people--

more than the entire
population of Germany,

Great Britain,
and Spain combined.

To prevent pandemics,
we need to do

a much better job
of controlling outbreaks.

- Morning!
- Morning.

Moses:

♪ ...on my shoulder

♪ I'll be your guide

♪ Always be your guide

♪ Won't you hear
my people cry? ♪

Chickie-chickie-chickie!

Yeah.
It gives me joy.

♪ When you see the power of God... ♪

♪ It is my ability

♪ It has to be
the Lord working ♪

♪ It is my ability

- ♪ Tomorrow
- ♪ Tomorrow I escape

♪ Will try to find my way
out of this again. ♪

- Amen.
- Amen.

I want to present
this certificate to you.

Meyma. Meyma?

Meyma,
please talk to me.

This is for you.

Take it from me
now, baby.

- It's for you.
- Yeah!

Moses:

When an
outbreak catches hold,

it affects every part
of our lives--

business and government,
trust and freedom,

equity and security.

The fight against epidemics
can only be won

if each of us
does our part.

It turns out we are all
the front line.

I think it goes
on your left side.

- What if I don't want to wear it?
- Oh, no!

Picture of you?

- A selfie.
- Oh, my God.

They created
a procedure

so that when people look
at-- open your iPhone...

It was in this hall
52 years ago

that my life
was forever changed.

I felt I had been drafted
into a different kind army

to fight for human rights.

In 1980, smallpox was declared
eradicated from the world,

and so far,
it's the only human disease

ever eliminated
by a public health campaign.

If smallpox could be eradicated,
we thought, what about HIV/AIDS?

Can we stop SARS and MERS,
H5N1 at their source,

and never become
a pandemic?

I don't dispute it's hard
and complicated,

but we have the tools.

We know what to do.

It's merely the application
of public will.

Go out
and change the world.

- How are you?
- I'm fine.

Ohh!

Good morning,
Professor Piot.

Oh, Soka.
How are you?

- Fine.
- Good to see you.

What keeps me awake
at night now

is that we will deliver
on our promises

to the people
of West Africa.

Shall we have a seat?

That we will support
these countries,

to build the systems
to make sure that

when there's another case of
Ebola, which will happen,

that it doesn't give rise
to a big epidemic.

The time has gone
that we lived on islands

or that we were protected, and
there's no way to stop that...

...because fighting AIDS

or fighting the flu
and SARS in Asia

benefits people in Europe
and in North America.

So we need to act
beyond the boundaries

of our own countries.

The networks that connect
us accelerate everything--

the spread of ideas,
conflict,

people, and microbes.

There is no running away.

There is no wall
high enough.

What's absolutely missing,

just not there,
is trust.

And so, coming up
with preparedness

that looks like
it could stand up

to the microbes
when the attack comes

is really about each country
carrying their own weight.

Yes, we always need
to be watching.

Vigilance is permanent.

The hallmark
of the 21st century

is that our world is
simultaneously more connected

and more fraught.

Epidemics are a test
of who we are.

We can use our connections
for good,

to make the world safer
and healthier,

or those connections will
turn on us in an instant.

We cannot just continue
to be responding

to every outbreak
as it occurs.

If we do not invest
in better preparedness,

we are setting ourselves up for
future epidemics and pandemics

that will cost
enormous amounts

in terms of both lives
and money.

I constantly run
into people who are fatalists

and they say, "Well,
pandemics are inevitable,

so don't work on them."

Pandemics are not
inevitable.

Outbreaks are inevitable.

Pandemics are optional.

It's our option
if we will be lazy.

It's our option whether
we will deny the risk.

It's our option whether we will
refuse to face the consequences.

We have a chance
to stop something

that otherwise
could be horrific.

But it's going to take
all of us.