Original subtitles

[ overlapping news anchors ] Hello, good morning. This is "Breakfast..."

Thanks for joining us, everyone.

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

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

[ overlapping voices in various languages ]

[ overlapping news anchors ] 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.

[ in Chinese ] I feel very worried.

I feel anxious for the health of the masses.

[ overlapping news anchors ] 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.

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

Influenza pandemics must be taken seriously.

[ overlapping news anchors ] 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.

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

Male anchor: Governments around the world are considering new measures...

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

...your temperature reading from last night.

[ overlapping news anchors ] 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...

Woman: It is really critical that they control this...

Man: We have to respond to the challenge.

Female anchor: Three latest victims

of the new respiratory virus called MERS

have come from Middle Eastern countries.

They believe it originated in bats or camels.

Man: It causes pneumonia and rapid kidney failure.

[ overlapping news anchors ] 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.

Man: When the weather starts to warm up,

more of those mosquitoes could start coming north...

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

[ overlapping news chatter ]

[ voices stop ]

- Jeffrey Wright: Our home. - [ whispered voices ]

You can almost hear the biological chatter.

[ overlapping chatter ]

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

we suddenly seem more vulnerable to outbreaks.

[ siren wailing ]

[ crowd clamoring ]

Dr. Peter Piot: 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.

Dr. Larry Brilliant: 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.

Wright: 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.

Laurie Garrett: 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.

Wright: When contagion happens, life alters in an instant.

We don't feel safe. We lose trust.

- [ baby crying ] - [ siren wailing ]

Peter Sands: 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.

Brilliant: 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.

[ distant horn honks ]

[ panting ]

Dr. Soka Moses:

[ panting ]

Ah?

Hmm?

[ man speaking over P.A. ]

Man: Ebola is transmitted through bodily fluids--

saliva, blood, urine, feces.

This is an invisible foe.

Wright: 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:

[ groaning ]

[ woman leading prayer in native language ]

Moses:

[ chatter ]

Piot: 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.

Christiane Amanpour: 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?

[ siren wailing ]

Piot: 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. - Piot: Yes.

Amanpour: Now the Democratic Republic of the Congo...

Piot: 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.

[ speaking French ]

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%.

[ man speaking French ]

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:

[ screeching ]

Garrett: 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.

[ thunder rumbles ]

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.

Wright: 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.

Wright: But they weren't.

Zika jumped from the South Pacific to Brazil in 2013,

two years before it was identified there.

[ indistinct announcement over P.A. ]

Wright: 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.

Male announcer: 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.

[ thunder rumbles ]

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.

[ Veronica Maria dos Santos speaking Portuguese ]

[ crying ]

Wright: 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.

[ Dr. Vanessa Van der Linden speaking Portuguese ]

Garrett: 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.

Wright: 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.

- [ signal bell clanging ] - [ train horn blowing ]

[ music playing on radio ]

Female DJ: ...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.

Gwen Zwanziger: The name Owatonna comes from

an Indian princess that was sick,

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

[ quacking ]

Terry: When we moved here, it just felt like home.

I think we got lucky.

The good Lord just gave us two good kids.

- Woman: Three, two... - Gwen: Do something.

Terry: Sarah was always the princess

and Shannon was the opposite.

She was a tomboy.

She loved skateboarding

and she loved video games.

- Gwen: Shannon, she was a complete surprise. - [ baby crying ]

Sarah was almost 16, and I was 40.

She was a joy.

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

Whoa!

Terry: We were a tight, tight family.

Gwen: Her first time out by herself.

Oh, my gosh.

Terry: I remember when she got her permit,

she was just so tickled.

Gwen: There she goes, by herself.

Terry: So, I was so proud of her.

Gwen: Oh, my gosh! Oh, my gosh!

Somebody's driving.

- Gwen: Catching snowflakes. - [ dog barks ]

Gwen: Hi, girl. Oop.

- [ dog whines ] - [ laughs ] Oh, hi.

Gwen: Shannon was in her senior year of high school.

Terry: 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.

Terry: 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.

[ clicking, chiming ]

[ wind whistling ]

Gwen: 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."

[ sniffles ] 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...

[ sighs ]

I pounded on the wall and woke Terry up.

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

[ clears throat ]

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.

[ touch tones beeping, line rings ]

Operator: 911, what's going on there?

Terry: My daughter, she's 17 years old.

- Gwen: She's not breathing! - Terry: She's not breathing!

- Dispatcher: She's not breathing? - Terry: She's not breathing.

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

Just stay on the line with me, okay?

- Gwen: Come on, breathe for Mama! - Terry: Breathe, Shannon.

- [ sirens wailing ] - Oh, Lord.

- [ dog barking ] - Come on in.

She's right in there. Go ahead.

Gwen: 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.

[ beeping ]

[ machines beeping rapidly ]

[ flatlining tone ]

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.

[ chirping ]

Dr. Barbara Rath: 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.

[ man speaking German on radio ]

Rath: The question of how and why one particular person

may die from influenza is the million-dollar question

that we absolutely need to tackle.

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

a disease which causes worldwide epidemics every year.

Mother: She had a little raspiness in her chest.

Mother #2: The flu test came back positive.

Mother #3: I actually remember saying, "Okay, it's just the flu,"

like it was no big deal.

Wright: It spreads across the globe,

hospitalizing three to five million.

Mother #4: And within 24 hours, she was intubated.

[ man speaking French ]

Wright: Killing at least 200,000 every year.

Mother #5: We went in as they were coding her.

- [ machines beeping ] - Mother #6: My baby girl, Scarlet Anne...

- [ flatline tone ] - ...pronounced dead.

Rath: 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.

Wright: 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.

Mark Smolinski: 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.

Wright: 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.

[ crowd chanting ]

Wright: Flu poses a strong pandemic threat

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

Yeah. Yep.

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

that we know is highly pathogenic.

Paul Horwood:

Wright: Currently, this deadly new bird flu

doesn't spread easily between people,

but it is spreading rapidly among wild birds and poultry.

[ horns honking ]

Experts are afraid this could be

a pandemic threat.

[ ducks quacking ]

Dr. Arnaud Taranola: 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.

[ crowd chattering ]

Taranola: 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.

Wright: 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.

Smolinski: 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.

Sands: 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.

[ overlapping news anchors ] 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.

Sands: 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.

Garrett: 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.

Wright: 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.

Brilliant: 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.

[ horns honking ]

Brilliant: 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. - [ train whistle blows ]

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.

[ train whistle blows ]

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.

[ whistle blowing ]

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.

[ people singing in Hindi ]

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.

[ music playing ]

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.

[ birds chirping ]

[ roosters crowing ]

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."

[ chuckles ]

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.

[ airplane buzzing ]

[ indistinct chatter ]

[ crying ]

Chicken pox.

[ seagulls screeching ]

[ subway chimes ]

Dr. Heidi Larson: 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.

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

Larson: 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.

Sands: 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.

[ overlapping news anchors ] President Ellen Johnson Sirleaf

likened the outbreak to a war.

Cases and deaths continue to surge.

Riots are breaking out.

Wright: As Ebola continued to spread across West Africa,

the governments implemented massive quarantines.

- [ crowd shouting ] - Wright: Distrust exploded.

[ overlapping news anchors ] 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. - [ gunshots ]

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.

[ overlapping news anchors ] Two Americans who had been infected...

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

[ speaking Spanish ]

- 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.

- Woman: That's him? - Woman #2: Mm-hmm.

- Woman #3: That's him. - Woman: Oh, my God.

- He's from West Africa, right? - Woman #2: No, he's from the States, from here.

- Woman: Oh, he's from the States? - Woman #2: He's an American.

- Woman: Oh, my God. - Woman #3: I got here-- oh, my God...

Wright: In a repeating pattern, the world only really started

to pay attention to the Ebola epidemic

when foreign workers began to fall sick.

Male anchor: The international responses continue to ramp up.

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

and medical supplies into West Africa faster.

David Cameron: Over a billion euros across Europe will be galvanized.

[ François Hollande speaking French ]

[ overlapping news anchors ] China is sending healthcare professionals.

[ speaking Chinese ]

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.

[ overlapping voices ] 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.

Brilliant: 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.

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

- has tested positive for the Ebola virus. - [ siren wailing ]

[ overlapping news anchors ] 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.

Garrett: 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.

Woman: In addition, we have renewed

our determination to remain vigilant...

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

Woman: And we will rid our beloved country

of this dreadful, unwanted guest-- Ebola.

Piot: ...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.

[ beeps ]

Wright: 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.

[ members arguing ]

[ banging on table ]

Wright: It was chaotic,

and coordination was often difficult.

But makeshift ETUs were finally replaced

with purpose-built field hospitals.

Moses:

[ chatter ]

[ thunder rumbles ]

Moses:

He just dropped and died.

He just dropped and died.

Yeah.

[ sniffles ]

[ horn honking ]

[ beeps ]

[ machinery powers on ]

Decontee Davis:

- [ car horns honking ] - [ chatter ]

- Davis: A cat... - Kids: A cat...

- Davis: ...a rat... - Kids: ...a rat...

- Davis: ...on a mat. - Kids: ...on a mat.

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

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

[ chatter ]

Moses:

How are you?

[ machine whirring ]

Wright: 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.

Wright: 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.

Wright: 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:

Wright: 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.

[ lock beeps ]

Computerized voice: 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.

[ Dilma Rousseff speaking Portuguese ]

[ overlapping news anchors ] 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.

[ woman speaking Spanish ]

[ speaking Spanish ]

Wright: Scientists are still trying to understand

the full range of neurological effects

the Zika virus causes in both babies and adults.

Male anchor: Florida officials have finally found the Zika virus

in mosquitoes in the Miami area.

David Jolly: 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.

Wright: Zika is spreading rapidly around the world.

At least 49 countries or territories

in the Western Hemisphere have local Zika transmission.

Garrett: 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.

[ dog barking ]

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."

[ imitates shotgun cocking ] "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.

[ crowd chanting ] Don't shoot, hands up!

- [ crowd shouting ] - Garrett: If there's one hallmark

of my lifetime on this planet,

it is the erosion of trust in government.

[ crowd chanting ]

And public health

is paying a price at every level

for that erosion of trust.

Gwen: 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.

Wright: 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.

Gwen: 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.

[ crying ] 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.

Rath: 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...

Rath: Vaccine hesitancy is something

that we observe to be on the rise,

which is quite alarming.

[ squeals, laughs ]

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.

[ indistinct announcement on P.A. ]

[ crowd shouting ]

Brilliant: 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...

Brilliant: 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.

[ clucking ]

Wright: 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.

[ screeching ]

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.

Woman: Pandemic flu will soon reach this country.

Man: If you become sick while traveling, contact...

Garrett: So, once the epidemic has really begun to spread,

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

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

Man #2: It's going to come to your community...

Garrett: 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...

- [ siren wailing ] - ...the police...

- [ helicopter whirring ] - ...the fire department.

Then people start blasting their conspiracy theories out

about where this disease came from,

who caused it, why is it here.

[ cell phone chimes ]

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...

- [ siren wailing ] - [ explosions ]

...is something close to social collapse.

Sands: 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.

Wright: 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.

[ horn honking ]

To prevent pandemics, we need to do

a much better job of controlling outbreaks.

- Morning! - Morning.

Moses:

[ humming tune ]

♪ ...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.

- Woman: ♪ When you see the power of God... ♪ - [ group clapping ]

♪ 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. - Group: Amen.

I want to present this certificate to you.

- Meyma. Meyma? - [ laughter ]

Meyma, please talk to me.

This is for you.

Take it from me now, baby.

- It's for you. - Yeah!

[ applause ]

Moses:

- [ babies crying ] - [ chatter ]

[ Dos Santos speaking Portuguese ]

[ laughs ]

[ crying ]

[ speaking Portuguese ]

Wright: 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!

- [ laughter ] - 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.

- [ birds screeching ] - [ car horns honking ]

The time has gone that we lived on islands

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

- [ babies crying ] - ...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.

Wright: 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.

Wright: 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.

Brilliant: 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.

[ music playing ]