Glass.txt <time begin="00:00:00.50"/><clear/>[ Silence ] <time begin="00:00:28.35"/><clear/>>> Welcome to the third

Glass.txt <time begin="00:00:00.50"/><clear/>[ Silence ] <time begin="00:00:28.35"/><clear/>>> Welcome to the third lecture in the series Global Diseases Voices from the Vanguard. <time begin="00:00:36.57"/><clear/>Voices from the Vanguard is a joint effort between the Center for Tropical <time begin="00:00:46.57"/><clear/>and Emerging Global Diseases and the Knight Chair in Health and Medical Journalism, <time begin="00:00:53.48"/><clear/>Pat Thomas for the Grady College of Journalism and Mass Communications <time begin="00:00:55.83"/><clear/>with assistance from the office of Provost and I'm very glad <time begin="00:00:57.45"/><clear/>that all of you are here tonight. <time begin="00:00:58.35"/><clear/>Thank you for coming, it is a very lovely spring evening. <time begin="00:01:00.61"/><clear/>As most of you know this lecture series is intended to help create <time begin="00:01:04.75"/><clear/>and strengthen the interest in global health that exists <time begin="00:01:09.74"/><clear/>across the breadth of the UGA campus. <time begin="00:01:13.87"/><clear/>Both speakers thus far in this year's series Eric Gotteson <time begin="00:01:18.22"/><clear/>and Zeda Rosenberg have provided their front line visions of how they think people can make a <time begin="00:01:25.48"/><clear/>difference in global health and <time begin="00:01:28.05"/><clear/>tonight Dr. Roger Glass the director of the NIH's Fogarty International Center <time begin="00:01:34.48"/><clear/>and a world renown expert on rotaviruses is here to share his insights into the realities, <time begin="00:01:46.80"/><clear/>the challenges and the opportunities to improve global health. <time begin="00:01:53.53"/><clear/>Before I ask Dr. Phil Page 1 Glass.txt Williamson the dean of UGA's College of Public Health to introduce Dr. Glass, <time begin="00:02:01.52"/><clear/>I'd like to first remind you of two things, actually three things <time begin="00:02:03.14"/><clear/>and one is this is a blue card event and so seek out the person for that, <time begin="00:02:05.27"/><clear/>second on April 24th we will wind up this years Voices from the Vanguard with one <time begin="00:02:11.68"/><clear/>of the actual voices, someone who speaks on this, Nick Thompson the spokesperson <time begin="00:02:18.01"/><clear/>for the World Health Organization in the area of global infectious diseases will be here, <time begin="00:02:25.83"/><clear/>that's April 24th and I hope you will all plan to be here and just respect him. <time begin="00:02:36.80"/><clear/>And then the last thing is as always there will be a reception next door <time begin="00:02:38.60"/><clear/>and that will be following tonight's lecture. <time begin="00:02:39.65"/><clear/>Now I am pleased to ask Dean Williams to introduce our speaker. <time begin="00:02:41.51"/><clear/>[ Pause ] <time begin="00:02:47.69"/><clear/>>> We are very pleased to have Dr. Roger Glass visit UGA and I would <time begin="00:02:52.36"/><clear/>like to tell you just a little bit about him. <time begin="00:02:56.92"/><clear/>He received his undergraduate degree from Harvard College and his MD degree <time begin="00:03:03.88"/><clear/>from Harvard Medical School and his Masters of Public Health <time begin="00:03:07.17"/><clear/>from Harvard School of Public Health. <time begin="00:03:08.51"/><clear/>He also earned a PhD in microbiology in Sweden. <time begin="00:03:09.81"/><clear/>He has spent the last 30 years working in several positions between the CDC and NIH. Page 2 Glass.txt <time begin="00:03:12.62"/><clear/>Through both the good times and the bad times Dr. Glass has been on the front line <time begin="00:03:16.83"/><clear/>of rotavirus research and provided [inaudible] public health including working with [inaudible] scientists <time begin="00:03:24.20"/><clear/>and epidemiologists and some public health policy majors. <time begin="00:03:27.86"/><clear/>His research is targeted at the neurological studies for the introduction <time begin="00:03:30.93"/><clear/>of rotavirus vaccine and he has maintained field studies throughout the world including studies <time begin="00:03:37.25"/><clear/>in countries such as India, Bangladesh, Brazil, Mexico, <time begin="00:03:41.36"/><clear/>Russia, Vietnam, and China just to name a few. <time begin="00:03:45.06"/><clear/>A complete listing of his awards and memberships would be too extensive to do here tonight. <time begin="00:03:52.03"/><clear/>But just to give you a few of them, <time begin="00:03:54.78"/><clear/>he is a member of the Institute of Medicine and National Academy, <time begin="00:03:56.58"/><clear/>a member of the American Academy of Microbiology and he received the outstanding service medal <time begin="00:03:59.07"/><clear/>from the US Public Health Service. <time begin="00:04:01.18"/><clear/>He has authored and coauthored over 400 publications and he is fluent in lectures in five languages. <time begin="00:04:07.72"/><clear/>Last June, Dr. Glass began his current duties as Director for the Fogarty International Center <time begin="00:04:13.08"/><clear/>and Associate Director for International research at NIH. <time begin="00:04:18.93"/><clear/>As many of you know the Fogarty International Center, <time begin="00:04:23.85"/><clear/>is the international component of the NIH and address global health challenges. <time begin="00:04:27.88"/><clear/>Tonight Dr. Glass will be Page 3 Glass.txt discussing global health and the 21st Century: Lessons from Rotavirus. <time begin="00:04:29.95"/><clear/>Please join me in welcoming Dr. Glass. <time begin="00:04:31.51"/><clear/>[ Applause ] <time begin="00:04:37.27"/><clear/>>> Thank you. <time begin="00:04:39.43"/><clear/>Thank you very much dean. I'm delighted to be here today particularly because when I came <time begin="00:04:44.19"/><clear/>in the door I saw the writing in chalk on the door step that said, "For Everything in Love." <time begin="00:04:50.52"/><clear/>Is that why you came? <time begin="00:04:53.04"/><clear/>How many of you have actually heard of rotavirus? <time begin="00:04:55.86"/><clear/>Raise your hands, oh my gosh I'm amazed. <time begin="00:04:59.23"/><clear/>You know when I went back to the CDC in 1986 to talk about, <time begin="00:05:03.27"/><clear/>to having worked in Bangladesh and NIH. <time begin="00:05:06.27"/><clear/>I went to the director of the CDC and I asked him about rotavirus and he was welcoming me back <time begin="00:05:11.59"/><clear/>and I spent an hour telling him all about rotavirus the disease and its prevention <time begin="00:05:15.71"/><clear/>with my work in Bangladesh and afterwards he wrote me a note welcoming me back and he wrote <time begin="00:05:21.75"/><clear/>to me as the chief of the retrovirus laboratory. <time begin="00:05:25.53"/><clear/>He didn't know the difference between a retrovirus and a rotavirus <time begin="00:05:28.38"/><clear/>and when they both start with R and I realized that I had an upward battle to attack. <time begin="00:05:33.95"/><clear/>So I am going to talk to you a little bit about my love of rotavirus if you will. <time begin="00:05:39.91"/><clear/>The lessons that I've learned from rotavirus and global health and how that's led me <time begin="00:05:44.36"/><clear/>to my current job, but before Page 4 Glass.txt I begin, I'm amazed that you've all come to hear <time begin="00:05:50.73"/><clear/>about diarrheal diseases before dinner so we'll move on. <time begin="00:05:55.49"/><clear/>My undergraduate major was in the history of medicine and history of science and I was very interested <time begin="00:06:01.24"/><clear/>in the epidemiology of Cholera because cholera is at the basis of epidemiology and global health. <time begin="00:06:08.46"/><clear/>You know the quarantine system and the public health service hospitals in the US were all based <time begin="00:06:13.52"/><clear/>around cholera and epidemiology really came from John Snow identifying the broad street pump here <time begin="00:06:20.22"/><clear/>in London in 1854 plotting out these little cases of Cholera and showing that epidemiology could link these <time begin="00:06:26.92"/><clear/>to the pump and that by removing the pump handle you could actually stop the disease <time begin="00:06:31.98"/><clear/>and stop an epidemic. <time begin="00:06:33.68"/><clear/>So I figured that epidemiology was really simple and I should go off and study cholera <time begin="00:06:38.72"/><clear/>and see why we still had a problem of cholera in the world today and also from the early studies <time begin="00:06:47.48"/><clear/>of cholera there was a first vaccine for enteric disease, a cholera vaccine here developed <time begin="00:06:53.54"/><clear/>in 1893, never very effective but it was still the basis of immunology of an enteric disease <time begin="00:07:01.54"/><clear/>of a potentially vaccine preventable disease and finally it was because of this pump <time begin="00:07:07.76"/><clear/>that I thought that if I went to a cholera endemic area like Bangladesh, <time begin="00:07:11.74"/><clear/>like Ganges Delta I might actually be able <time begin="00:07:14.61"/><clear/>to take the handle off the pump if you will and stop cholera. Page 5 Glass.txt <time begin="00:07:19.52"/><clear/>So after I was at CDC for a couple of years I went off to Bangladesh with my wife <time begin="00:07:24.80"/><clear/>to see what we could do to stop cholera in the world. <time begin="00:07:27.12"/><clear/>This was a naive mission of a young person, so it's not so bad to be naive <time begin="00:07:32.55"/><clear/>and young and here's what we saw. <time begin="00:07:35.32"/><clear/>It's basically the same pump and the same children getting the same water and getting cholera <time begin="00:07:40.74"/><clear/>so I figured that this would be an easy match. <time begin="00:07:44.87"/><clear/>A patient with cholera has severe dehydrating diarrhea, they can lose 10 percent <time begin="00:07:50.45"/><clear/>of their weight in liquids in 12 to 24 hours. <time begin="00:07:54.66"/><clear/>So if you're a 60 kg person and you lose 6 liters you're on deaths doorstep <time begin="00:08:01.13"/><clear/>and this is what happens with the disease. <time begin="00:08:03.45"/><clear/>It's now completely treatable by rehydration with intravenous fluids and water <time begin="00:08:08.01"/><clear/>and salt solutions but in 1960 this was not so, it was a highly fatal disease. <time begin="00:08:13.94"/><clear/>So here's a young girl and you can see that she is so depleted that she's shocky, <time begin="00:08:18.77"/><clear/>her eyes are sunkin, she has tinting of her skin <time begin="00:08:21.38"/><clear/>under the doctor's hand and she's at death's doorstep. <time begin="00:08:25.21"/><clear/>With oral rehydration she can get up and walk away, so it's with this that I got <time begin="00:08:30.32"/><clear/>into diarrheal diseases and tried to look at how important were diarrheal diseases in the world today. <time begin="00:08:37.04"/><clear/>Now when you listen to CDC Page 6 Glass.txt and our spokesmen around the country, <time begin="00:08:42.12"/><clear/>every year we have had a different epidemic, Smallpox, Ebola, West Nile fever, <time begin="00:08:47.34"/><clear/>and the like, anthrax. But in fact these are not the real killers in the world. <time begin="00:08:53.33"/><clear/>The real killers are the diarrheal diseases, Malaria, Tuberculosis, <time begin="00:08:58.19"/><clear/>acute respiratory diseases, things that are much less sexy but much more important. <time begin="00:09:04.28"/><clear/>So here I began to look at where diarrhea fit into the, into the leading causes of mortality <time begin="00:09:11.54"/><clear/>and after ARI in children, diarrhea is the next major cause of disease in the world and of these <time begin="00:09:19.10"/><clear/>about 20 to 45 percent of these diarrheal deaths are from rotavirus, much more them cholera. <time begin="00:09:25.89"/><clear/>So I scratch my head and I think a lesson for you all is where's your next job going to take you <time begin="00:09:30.58"/><clear/>and how are you going to earn money and I decided that if I was going to work <time begin="00:09:33.84"/><clear/>on cholera it would be hard to find a lot of cholera cases when I came back <time begin="00:09:37.77"/><clear/>to the United States, I better work on something that was global and that which is global is rotavirus. <time begin="00:09:44.06"/><clear/>So this background really led me to go to NIH and then to begin to work on rotaviruses. <time begin="00:09:50.52"/><clear/>Well and the one feature of rotavirus which is very important is <time begin="00:09:56.89"/><clear/>that it's a democratic disease, and what do I mean by democratic? <time begin="00:10:01.23"/><clear/>It affects blacks and whites, rich and poor, everyone gets rotavirus. Page 7 Glass.txt <time begin="00:10:07.15"/><clear/>In fact every one of you in the audience has had rotavirus in your first few years of life <time begin="00:10:12.39"/><clear/>and probably have been infected multiple times since, although without any symptoms. <time begin="00:10:16.80"/><clear/>But that first infection can cause a severe dehydrating diarrhea that can be lethal <time begin="00:10:22.40"/><clear/>in a small percentage of cases, well here's rotavirus, it's the most common cause <time begin="00:10:28.91"/><clear/>of severe diarrhea in children, it's a democratic virus and of course <time begin="00:10:33.21"/><clear/>in this republican administration, I was advised that I should call it an equal opportunity virus, <time begin="00:10:39.69"/><clear/>not a democratic virus so I have to change this slide <time begin="00:10:44.08"/><clear/>or leave it till the next administration perhaps. <time begin="00:10:46.90"/><clear/>First infections are asymptomatic, there's good evidence of natural immunity, <time begin="00:10:51.79"/><clear/>there're limited strains in circulation and of course my son got rotavirus the day I started the <time begin="00:10:57.14"/><clear/>rotavirus lab at the CDC and why would my son get rotavirus, you know we have a clean house, <time begin="00:11:03.67"/><clear/>we wash our hands, there's clean water, there's good food. <time begin="00:11:08.18"/><clear/>Why does my son get rotavirus? <time begin="00:11:10.41"/><clear/>It's not clearly from clean water, poor sanitation or anything like that, <time begin="00:11:15.08"/><clear/>we really don't know enough about transmission of this virus but we do know <time begin="00:11:19.02"/><clear/>that because we can't stop it in our country with clean water and clean food, Page 8 Glass.txt <time begin="00:11:23.50"/><clear/>that vaccines represent a way to prevent this disease. <time begin="00:11:27.73"/><clear/>So here's a child in Mexico with, a cute, unhappy child who had for 12 hours, <time begin="00:11:37.21"/><clear/>severe vomiting episodes, 8 episodes of vomiting, couldn't hold a thing down. <time begin="00:11:42.02"/><clear/>Followed by diarrheal episodes, about 20 in the 12 hour period <time begin="00:11:47.26"/><clear/>and here the child is getting IV's to prevent shock and to be rehydrated. <time begin="00:11:53.16"/><clear/>It's a very severe disease in the small number of children and here when this child, <time begin="00:11:59.43"/><clear/>this is an autopsy from a child who died and the intestine is all broken up and what you see <time begin="00:12:05.93"/><clear/>in the intestinal cells, all of these little dots here are the viruses, <time begin="00:12:10.07"/><clear/>they completely invaded and taken over the cell of this child's intestine causing death. <time begin="00:12:16.45"/><clear/>So it can be a very severe and fatal disease. <time begin="00:12:20.09"/><clear/>Well where does rotavirus kill? <time begin="00:12:22.92"/><clear/>And here is the distribution of diarrheal deaths from rotavirus and you can see that there are <time begin="00:12:28.89"/><clear/>about a 100 thousand in India alone. <time begin="00:12:31.72"/><clear/>Most of the deaths are in South Asia about 150 thousand in Sub Saharan Africa, <time begin="00:12:37.15"/><clear/>about 20 thousand in Latin America. <time begin="00:12:39.55"/><clear/>So if we had a vaccine and we have vaccines now. <time begin="00:12:43.37"/><clear/>These vaccines will be most helpful to prevent death in Sub Saharan Africak, Asia, South Asia. Page 9 Glass.txt <time begin="00:12:50.23"/><clear/>But in the US and Europe and Australia, Japan, they would really not stop diarrheal deaths, <time begin="00:12:56.34"/><clear/>we don't have them, but they would stop hospitalizations, clinic visits, <time begin="00:13:00.90"/><clear/>doctor visits and the cost incurred. <time begin="00:13:05.18"/><clear/>Well here's the disease burden and as I look around now at the importance <time begin="00:13:11.95"/><clear/>of diarrheal diseases in general, this is really key <time begin="00:13:16.88"/><clear/>Every child here, gets rotavirus. About 114 million episodes a year of rotavirus diarrhea. <time begin="00:13:23.53"/><clear/>About one in five children will have to go to a doctor or clinic to get rehydrated <time begin="00:13:28.18"/><clear/>because the disease is that severe. <time begin="00:13:30.88"/><clear/>About one in fifty or so will need treatment as inpatients because the disease is severe enough <time begin="00:13:36.92"/><clear/>to require intravenous and about 1 in 200 to 1 in 300 will die <time begin="00:13:41.70"/><clear/>of their disease in their developing world. <time begin="00:13:44.37"/><clear/>So this is clearly an important cause of death, about five percent of all deaths in children <time begin="00:13:49.84"/><clear/>under five will be from rotavirus, so it's because of this huge disease burden <time begin="00:13:56.44"/><clear/>that I really saw this as a priority. <time begin="00:13:59.28"/><clear/>Well when I went back to CDC we had no data on rotavirus in the United States, <time begin="00:14:05.44"/><clear/>and you know in the government if you can't document how important your disease is compared <time begin="00:14:09.68"/><clear/>to someone else's disease, you know, you're Page 10 Glass.txt cooked, you just can't make it. <time begin="00:14:15.20"/><clear/>So we had to go out with few resources and few people and figure out what the burden <time begin="00:14:20.36"/><clear/>of rotavirus was in the US, so here's what we did. <time begin="00:14:24.43"/><clear/>We looked at hospitalizations for children under five years of age, here you see it here by month <time begin="00:14:31.31"/><clear/>for a 20 year period from about 1979 to, 79 to 1998, 1997 and you can see each year there are <time begin="00:14:41.14"/><clear/>about 200 thousand children hospitalized for diarrheal diseases, <time begin="00:14:45.22"/><clear/>that's about 10 to 12 percent of all hospitalizations of children in the US, <time begin="00:14:50.11"/><clear/>a huge number. And of those there's this winter seasonal pattern each year in children <time begin="00:14:56.50"/><clear/>under 5 and that's seasonality is most apparent in children from 6 months, <time begin="00:15:01.56"/><clear/>7 months, to 2 years of age and there's a little bit at two2br/> <time begin="00:15:05.25"/><clear/>to 3 years and then it goes away. <time begin="00:15:07.18"/><clear/>So a big seasonal peak in winter, and we've now learned that, <time begin="00:15:11.27"/><clear/>that seasonal peak of winter diarrhea is rotavirus. <time begin="00:15:15.68"/><clear/>Well if we were to have a vaccine, and we have a vaccine this year 2006 for the first time, <time begin="00:15:21.72"/><clear/>what would we expect to happen in a few years. Well if we're right and you can watch this <time begin="00:15:27.75"/><clear/>in the next few years, we would expect this curve to flatten out, <time begin="00:15:32.80"/><clear/>those big winter seasonal peaks of Page 11 Glass.txt diarrhea hospitalizations to go away <time begin="00:15:37.96"/><clear/>and we would have a nice flat line where a third lesser, <time begin="00:15:41.25"/><clear/>40 percent fewer cases, hospitalization for diarrhea. <time begin="00:15:45.46"/><clear/>Furthermore in the first year of this program we hope that these, this light blue curve of children <time begin="00:15:51.89"/><clear/>under 1 year will go away by the end of this year or sometime next year, <time begin="00:15:57.26"/><clear/>so this is one of the ways we are going to monitor the impact <time begin="00:16:00.52"/><clear/>of a national immunization program. <time begin="00:16:03.16"/><clear/>So our disease burden in the US has very few deaths but lots of hospitalizations <time begin="00:16:10.13"/><clear/>at an incredible cost about, over a billion dollars a year. And it's with this type of data <time begin="00:16:17.50"/><clear/>that we were able to convince American pediatricians and the advisory committee <time begin="00:16:22.10"/><clear/>on immunization policy in the US to take rotavirus vaccines for, <time begin="00:16:27.07"/><clear/>as a program for a globe, for US immunization, universal immunization of all children, <time begin="00:16:33.13"/><clear/>so if any of you have small brothers or sisters or nieces or nephews who are just born <time begin="00:16:37.80"/><clear/>or under 1 they should be getting a rotavirus vaccine this year. <time begin="00:16:42.85"/><clear/>Well let's go on to the virology and how we get to this, the vaccines. <time begin="00:16:47.24"/><clear/>Here's a picture of a rotavirus, a schematic of a rotavirus here and it's a virus that's made <time begin="00:16:53.15"/><clear/>up of a shell, a protein shell, an outer coat like a basketball and inside are 11 segments <time begin="00:17:01.95"/><clear/>of double stranded RNA, Page 12 Glass.txt nucleic acid and each of these can be separated on a gel <time begin="00:17:08.13"/><clear/>and each one codes for a separate protein, a different protein. <time begin="00:17:12.34"/><clear/>Well what does your body see when it sees this virus, <time begin="00:17:15.00"/><clear/>what does your gut see when it sees this virus? <time begin="00:17:17.53"/><clear/>It sees what's on the outer coat just like what I see when I look at you <time begin="00:17:21.97"/><clear/>is I see your outer clothing, I see your clothes, I don't see anything underneath, okay. <time begin="00:17:26.63"/><clear/>What your body sees to get an immune response is a reaction to your clothes, <time begin="00:17:30.83"/><clear/>an antibody to your clothes if you will. And in this virus those clothes are on the outside, <time begin="00:17:36.29"/><clear/>this bright yellow, the VP7, it's a neutralization intergen and these little spikes <time begin="00:17:41.28"/><clear/>that allow the virus to attach to your intestine and go to work. <time begin="00:17:45.99"/><clear/>Well this is important because it's against this outer coat that your body makes antibodies <time begin="00:17:51.15"/><clear/>and if we want to develop a vaccine we have to entice your body to make antibodies <time begin="00:17:58.41"/><clear/>to these two proteins. And if we can do that then when your body sees the virus <time begin="00:18:05.16"/><clear/>from the natural setting it will neutralize that, <time begin="00:18:09.05"/><clear/>it'll kill it and you won't get the disease. <time begin="00:18:11.67"/><clear/>So that's the idea of a live oral vaccine. <time begin="00:18:15.36"/><clear/>So the vaccines that we'll talk about are live viruses that have been attentuated, <time begin="00:18:20.77"/><clear/>they're not pathogenic, they're given orally Page 13 Glass.txt and they give you a good immune response. <time begin="00:18:26.22"/><clear/>Well the other thing that's important to know is that rotavirus comes in different flavors <time begin="00:18:31.98"/><clear/>that we call serotypes and these serotypes are defined by the clothing that the virus wears, again <time begin="00:18:38.23"/><clear/>that VP7, the G protein and the P protein and they're basically four different types of flavors <time begin="00:18:44.59"/><clear/>of rotavirus, one, two, three, and four, they're very creative names, okay, <time begin="00:18:50.39"/><clear/>and if we have a vaccine against these four strains we think we'll have a vaccine <time begin="00:18:55.44"/><clear/>against most rotaviruses. <time begin="00:18:57.37"/><clear/>Just like Polio vaccine, includes three serotypes of rotavirus, three flavors. <time begin="00:19:02.88"/><clear/>But also rotaviruses can evolve and new strains can always come into the, <time begin="00:19:08.34"/><clear/>into the virus from rotaviruses from pigs, rabbits, cows, monkeys, dogs, and cats and the like. <time begin="00:19:15.37"/><clear/>So even if we have a vaccine there's the possibility of new viruses evolving, <time begin="00:19:21.26"/><clear/>and in fact in places like Argentina, all the cows are immunized against rotavirus <time begin="00:19:28.06"/><clear/>to prevent neonatal calf diarrhea virus, a disease that kills <time begin="00:19:32.23"/><clear/>about 10 percent of calves that are infected. <time begin="00:19:34.85"/><clear/>So there are already vaccines for cows, now we're working on vaccines for people. <time begin="00:19:39.73"/><clear/>Well we're going to go on and talk about vaccines, and when I was at NIH <time begin="00:19:45.54"/><clear/>in the early 80's my mentor Dr. Kapikian was working on his first rotavirus vaccine. Page 14 Glass.txt <time begin="00:19:52.73"/><clear/>He took a strain of rotavirus from a monkey, <time begin="00:19:57.39"/><clear/>he re-assorted it so that it would have the outer coat from different serotypes <time begin="00:20:03.88"/><clear/>of human rotaviruses, one, two and four, and he made up a re-assortment vaccine <time begin="00:20:08.64"/><clear/>of four different strains that was called a rhesus tetravalent vaccine <time begin="00:20:12.68"/><clear/>and that was the first vaccine licensed in the US. <time begin="00:20:16.50"/><clear/>It took 20 years, about almost 20 years to develop this vaccine from isolation of the strains <time begin="00:20:22.58"/><clear/>to understanding the principles of vaccine development. <time begin="00:20:25.59"/><clear/>As soon as it was licensed, August of 1998, it went right into approved by FDA, <time begin="00:20:33.16"/><clear/>the Food and Drug Administration. <time begin="00:20:35.91"/><clear/>It was heralded as the first vaccine to stop those half a million deaths from diarrhea <time begin="00:20:41.58"/><clear/>around the world and the about 5 percent of children <time begin="00:20:45.02"/><clear/>in the U.S. hospitalized for rotavirus. <time begin="00:20:47.34"/><clear/>It was a big thing. <time begin="00:20:49.81"/><clear/>It went right, immediately into the routine schedule for childhood immunizations at 2, <time begin="00:20:55.24"/><clear/>4 and 6 months of age so that every child would get this and we were really ecstatic. <time begin="00:21:01.39"/><clear/>Dr. Kapikian and Ruth Bishop, who discovered the vaccine, and myself, we were overjoyed <time begin="00:21:07.83"/><clear/>and we received the Pasteur Award of the Children's Vaccine Initiative. <time begin="00:21:12.26"/><clear/>And we really thought we had won the world Page 15 Glass.txt with a great vaccine and with the ability <time begin="00:21:17.80"/><clear/>to have a new tool to stop a half a million deaths a year. <time begin="00:21:22.35"/><clear/>It was an exhilarating moment. <time begin="00:21:24.63"/><clear/>Well, you know, you can't be exhilarated for too long and in 1999 <time begin="00:21:28.74"/><clear/>when this happened, I had a full head of hair. <time begin="00:21:31.53"/><clear/>I want you to know, I was really, you know, almost an afro, it was huge, <time begin="00:21:36.75"/><clear/>I lost it all in the next two years, and this is why I lost it, <time begin="00:21:42.55"/><clear/>after 9 months of immunizing the U.S. public, 600,000 children immunized, <time begin="00:21:48.51"/><clear/>a million and a half doses distributed, a great success in this program, <time begin="00:21:53.59"/><clear/>we identified fifteen cases of a rare, adverse event called inteceception <time begin="00:21:59.95"/><clear/>in a few children in the two weeks after they had received this vaccine. <time begin="00:22:04.68"/><clear/>Half a million kids, 600,000 kids, 15 adverse events, <time begin="00:22:09.49"/><clear/>and everybody raised the red flag and said, what's going on here? <time begin="00:22:14.18"/><clear/>Well, inteceception here caused, main cause of intestinal obstruction in small children. <time begin="00:22:20.40"/><clear/>Their bowel gets blocked at the ileocecal junction. <time begin="00:22:23.51"/><clear/>It telescopes on itself, becomes obstructed and can be a lethal complication. <time begin="00:22:29.67"/><clear/>You don't want this to happen in the U.S., let alone in a developing country. Page 16 Glass.txt <time begin="00:22:33.72"/><clear/>So we did an investigation to find out if this was linked to the vaccine, <time begin="00:22:38.03"/><clear/>if so what we could do about it, and whether we could get around this problem. <time begin="00:22:42.27"/><clear/>And in the investigation, there was a cluster of cases of inteceception right <time begin="00:22:46.96"/><clear/>after the two weeks after the first dose of the vaccine, a smaller, but insignificant cluster <time begin="00:22:53.10"/><clear/>after the second, and we really knew the association was real, <time begin="00:22:57.65"/><clear/>but we didn't know the level of risk, whether this was one in 2,000 here, <time begin="00:23:02.47"/><clear/>as it was first thought, or one in 28,000 as it was later thought. <time begin="00:23:06.57"/><clear/>A very important difference. <time begin="00:23:08.94"/><clear/>Why is it important? <time begin="00:23:10.68"/><clear/>Well, in developing countries where one and two hundred children will die of rotavirus, <time begin="00:23:15.60"/><clear/>to have an adverse event of one in 30,000 would mean that if you save 150 children's lives <time begin="00:23:22.52"/><clear/>for every case of inteceception that might occur. <time begin="00:23:25.33"/><clear/>So it's, it might be that in a developing world this would still be a very useful vaccine. <time begin="00:23:33.00"/><clear/>Well, my real target was the developing world that I lived in, Bangladesh, <time begin="00:23:36.64"/><clear/>and this is where I was interested in protecting children primarily. <time begin="00:23:43.43"/><clear/>So we called the ministers of many developing countries together <time begin="00:23:46.70"/><clear/>to say we've got this rotavirus Page 17 Glass.txt vaccine, fabulous vaccine for protecting kids <time begin="00:23:51.85"/><clear/>against diarrheal diseases, rotavirus virus, but it has this rare, adverse event. <time begin="00:23:57.14"/><clear/>Would you still use it? <time begin="00:23:58.69"/><clear/>Would you still see the benefit of this for your population? <time begin="00:24:02.81"/><clear/>What would you say? <time begin="00:24:05.11"/><clear/>You'd save a couple hundred children for every adverse event? <time begin="00:24:08.93"/><clear/>Clearly in the U.S. where the disease is not fatal, the adverse event that might lead <time begin="00:24:14.07"/><clear/>to surgery or obstruction is pretty bad, but in a country where one in 200 kids dies <time begin="00:24:19.62"/><clear/>of the disease, where there'd be thousands of hospitalizations. <time begin="00:24:23.73"/><clear/>Well the ministers thought there and scratched their head and finally one of them, from India, <time begin="00:24:27.95"/><clear/>came back to me and said Roger, great vaccine, we would love to use it tomorrow, but, <time begin="00:24:34.35"/><clear/>but the first time we identify a case of inteceception in one of our children <time begin="00:24:39.83"/><clear/>who was vaccinated, the newspapers will be all over me <time begin="00:24:43.66"/><clear/>and they'll ask the question how could I permit this vaccine to be used when it was withdrawn <time begin="00:24:49.78"/><clear/>from use in the United States for this very complication. <time begin="00:24:53.65"/><clear/>If it had been tested here and licensed it would be one thing, <time begin="00:24:56.16"/><clear/>but it hadn't been used, so I better step back. <time begin="00:25:01.55"/><clear/>And so we lost the first vaccine almost 10 years ago and in that 10 years <time begin="00:25:07.51"/><clear/>about four million children Page 18 Glass.txt have died of this diseases who might have been saved by a vaccine. <time begin="00:25:14.35"/><clear/>Well, what we learned in the process was that inteceception spares children <time begin="00:25:19.91"/><clear/>in the first 3 months of life and then part of our problem was <time begin="00:25:23.47"/><clear/>that we vaccinated children up to six months. <time begin="00:25:26.62"/><clear/>From three to six months the rate of inteceception for whatever reason <time begin="00:25:31.30"/><clear/>in natural goes up about 10 fold. <time begin="00:25:34.70"/><clear/>Half the children we vaccinated were over 4 months of age, <time begin="00:25:39.16"/><clear/>they were in catch up phase, half were under. <time begin="00:25:41.61"/><clear/>And most of the intececeptions, 80 percent, were in these older children. <time begin="00:25:45.78"/><clear/>So we told the other manufacturers that if they ever wanted to use a live oral vaccine, <time begin="00:25:50.77"/><clear/>they should probably restrict its use to those children under 3 months of age, <time begin="00:25:55.33"/><clear/>for reasons that were not completely obvious. <time begin="00:25:58.55"/><clear/>So here was our balance, our scale, should we use the vaccine or not? <time begin="00:26:04.92"/><clear/>One death in 250 children, lots of deaths and admissions <time begin="00:26:08.85"/><clear/>or intececeptions and we threw the vaccine out. <time begin="00:26:12.99"/><clear/>Well this has been an incredible year for rotavirus and in 2006, last year, <time begin="00:26:18.51"/><clear/>two new vaccines were finally came forward and were licensed. <time begin="00:26:24.08"/><clear/>And these are, one is a Page 19 Glass.txt single strain rotavirus, common human strain, <time begin="00:26:30.73"/><clear/>that was attenuated because it was passage for a long time. <time begin="00:26:34.21"/><clear/>The other was a strain, a vaccine just like the rhesus strain, the first vaccine, <time begin="00:26:39.77"/><clear/>but made with a bovine rotavirus virus that was much weaker and didn't cause, we think, <time begin="00:26:44.84"/><clear/>the same, wouldn't cause the same problems, and so these were both licensed in January <time begin="00:26:52.89"/><clear/>of last year, 2006, major clinical trials <time begin="00:26:57.33"/><clear/>of over 60,000 children were published in the New England Journal. <time begin="00:27:01.34"/><clear/>For each of these, the pentavalent vaccine here and the monovalent vaccine here, <time begin="00:27:07.25"/><clear/>and they were really success and a beginning. <time begin="00:27:11.16"/><clear/>And these were nominated by Lancet as the best papers of last year in the medical literature. <time begin="00:27:16.89"/><clear/>Well, let's look at these two and see where we are. <time begin="00:27:19.96"/><clear/>The pentavalent, just like the rhesus is given in actually three doses, grows poorly <time begin="00:27:25.96"/><clear/>and was highly successful, 98 percent protection against severe disease <time begin="00:27:31.24"/><clear/>in Finnish children and American children. <time begin="00:27:33.96"/><clear/>So it was a good vaccine and it was safe. <time begin="00:27:36.97"/><clear/>The other vaccine, a monovalent, also grows well and it was very safe <time begin="00:27:43.82"/><clear/>as well, and this one was tested in Latin American and Finland, Page 20 Glass.txt <time begin="00:27:48.40"/><clear/>so it's gone, it could go forward. <time begin="00:27:54.48"/><clear/>In March of last year, here's the president of Panama roling <time begin="00:27:58.05"/><clear/>out the first national immunization program for rotavirus in Panama. <time begin="00:28:02.31"/><clear/>Another program took place in Brazil last year. <time begin="00:28:06.04"/><clear/>So now there're over 90 countries that have a licensed rotavirus vaccine. <time begin="00:28:11.36"/><clear/>But are we home yet? <time begin="00:28:12.29"/><clear/>Do we raise the flag again and greet success? <time begin="00:28:15.43"/><clear/>Even though I don't have much of my hair left, is it time to celebrate? <time begin="00:28:21.18"/><clear/>Well, the vaccines are licensed in many countries, but we still can't celebrate completely. <time begin="00:28:27.38"/><clear/>Well, why not? <time begin="00:28:28.37"/><clear/>You know? As I get older you'd always like to move the celebration date up, <time begin="00:28:32.24"/><clear/>but sometimes it's hard. <time begin="00:28:34.33"/><clear/>We've tested these vaccines in the U.S. and Latin America. <time begin="00:28:38.93"/><clear/>We haven't tested them on African children or on Asian children, <time begin="00:28:42.97"/><clear/>for instance in Bangladesh or India. <time begin="00:28:45.27"/><clear/>And for oral vaccines, for parenteral vaccines, injectable vaccines, all children behave more <time begin="00:28:51.42"/><clear/>or less the same in their immune response and the routine vaccines <time begin="00:28:55.15"/><clear/>that we give to children are all work pretty well. <time begin="00:28:59.01"/><clear/>Oral vaccines are different. <time begin="00:29:00.90"/><clear/>You know, the virus has to be swallowed, it has to Page 21 Glass.txt go through the stomach's acid and survive, <time begin="00:29:06.68"/><clear/>it has to be given in the presence of breast milk, in breast milk and neutralize the virus. <time begin="00:29:13.32"/><clear/>Mothers in Bangladesh and in South Africa have high titers of maternal antibody <time begin="00:29:18.15"/><clear/>that can make the immune response work less well. <time begin="00:29:21.37"/><clear/>So until we get a global recommendation for these vaccines, <time begin="00:29:25.77"/><clear/>we really have to know if they work. <time begin="00:29:28.12"/><clear/>Trials of the Merck vaccine are just starting in five countries in Africa and Asia, <time begin="00:29:32.89"/><clear/>Bangladesh, Vietnam, Kenya, Mali and Ghana. <time begin="00:29:38.25"/><clear/>And trials of the GSK vaccine, that monovalent, has just been completed in South Africa. <time begin="00:29:43.95"/><clear/>So we hope that these will work, but the immune response in the South African trial is <time begin="00:29:50.00"/><clear/>about half of what it is in Finland, and that suggested the efficacy may be less <time begin="00:29:56.19"/><clear/>than we want, less than anticipated. <time begin="00:29:59.50"/><clear/>If we have a vaccine that's only 50 percent protective, <time begin="00:30:03.81"/><clear/>30 percent protective, would we use it? <time begin="00:30:07.19"/><clear/>And what could we do to improve it? <time begin="00:30:09.31"/><clear/>So that's the next challenge before us now and whether by withholding breast feeding, <time begin="00:30:14.27"/><clear/>by raising the dose of the vaccine by giving it a little bit later, we can do, <time begin="00:30:19.28"/><clear/>by changing the buffer, by changing the dose, we might make it better. <time begin="00:30:24.36"/><clear/>Alternatively, like with polio, we might try Page 22 Glass.txt a parenteral vaccine, an inactivated vaccine, <time begin="00:30:30.40"/><clear/>and see if we can induce the same immunity that we get with polio <time begin="00:30:34.54"/><clear/>with an inactivated parenteral vaccine. <time begin="00:30:37.50"/><clear/>So here's where we are now with vaccines, we have two vaccines, the Merck and the GSK <time begin="00:30:44.84"/><clear/>that have been tested and licensed but they still are waiting a WHO recommendation <time begin="00:30:49.95"/><clear/>for global use until these trials are completed. <time begin="00:30:53.45"/><clear/>And a bunch of other trials of other vaccines that are in development and we hope <time begin="00:30:59.22"/><clear/>that by having vaccines made in China and Australia and India, in Germany, <time begin="00:31:05.22"/><clear/>that we might have cheaper vaccines that would be suitable for the world's children. <time begin="00:31:09.93"/><clear/>So we have now six candidate vaccines being made by 12 companies in five countries with a hope <time begin="00:31:16.75"/><clear/>that in a few years, we might have vaccines for the world that will be cheap and affordable. <time begin="00:31:22.16"/><clear/>And that's our current research agenda. <time begin="00:31:25.44"/><clear/>Well, when I went to ask ministers of health if rotavirus was important for them, <time begin="00:31:31.77"/><clear/>most of them had never heard of rotavirus. <time begin="00:31:35.05"/><clear/>So in Vietnam, I went in 1978, 1998 and I asked the minister <time begin="00:31:41.95"/><clear/>if he was interested in rotavirus vaccine. <time begin="00:31:44.17"/><clear/>He said we don't have rotavirus here. <time begin="00:31:46.71"/><clear/>I said have you ever tested for rotavirus? Page 23 Glass.txt <time begin="00:31:49.37"/><clear/>He said no. <time begin="00:31:50.07"/><clear/>So he said well, why don't we do a little study and we got a grant from WHO to do this study. <time begin="00:31:56.83"/><clear/>We looked at four cities of Vietnam, north and south, six hospitals, and we went out <time begin="00:32:02.75"/><clear/>and we screened 5700 children under five who came in with diarrheal disease <time begin="00:32:09.16"/><clear/>for rotavirus with a very simple, but sensitive test. <time begin="00:32:12.74"/><clear/>56 percent of those children were positive. <time begin="00:32:16.75"/><clear/>So the minister saw this and he scratched his head and he said this means <time begin="00:32:21.57"/><clear/>that if I use the vaccine, I could decrease my diarrhea hospitalizations in half. <time begin="00:32:27.44"/><clear/>I could cut my diarrhea mortality in half or some fraction of that. <time begin="00:32:31.56"/><clear/>So this would be a fabulous and important vaccine for us. <time begin="00:32:36.17"/><clear/>So part of our efforts at CDC was then to go out and set up surveillance and let many ministers <time begin="00:32:42.27"/><clear/>of health, like the minister in Vietnam know the importance of this disease in his setting. <time begin="00:32:48.23"/><clear/>We started out with nine countries of Asia and again, Myanmar,Malaysia, <time begin="00:32:53.29"/><clear/>56 percent of their children had rotavirus as a cause of diarrhea hospitalizations. <time begin="00:33:00.66"/><clear/>And the like high rates from 39 to 60 percent all around Asia. <time begin="00:33:05.81"/><clear/>We now have surveillance all around the world in more than 50 countries <time begin="00:33:10.26"/><clear/>that report monthly their rate of rotavirus detection <time begin="00:33:14.33"/><clear/>and their rates are averaging Page 24 Glass.txt 40 to 50 percent. <time begin="00:33:17.32"/><clear/>So this is clearly a global disease and just by doing surveillance we've educated ministers <time begin="00:33:23.72"/><clear/>and pediatricians of the importance of this disease in their setting. <time begin="00:33:28.68"/><clear/>We've also educated Bill Gates. <time begin="00:33:31.57"/><clear/>You know, Bill Gates in 1997 was trying to figure out what to do with his money. <time begin="00:33:37.48"/><clear/>He read the World Development Report and in <time begin="00:33:40.48"/><clear/>that report it said rotavirus kills a half a million people a year. <time begin="00:33:45.41"/><clear/>Our data from CDC put into the World Development Report. <time begin="00:33:50.27"/><clear/>He says I don't believe rotavirus can, well, what's rotavirus? <time begin="00:33:52.67"/><clear/>I've never heard of it. <time begin="00:33:53.53"/><clear/>How can it kill this many people? <time begin="00:33:55.33"/><clear/>What's going on here? <time begin="00:33:57.27"/><clear/>He also said if a 747 crashed today, you'd hear it around the world. <time begin="00:34:03.48"/><clear/>If rotavirus kills a half a million, no one hears about it. <time begin="00:34:08.35"/><clear/>What's wrong with this picture? <time begin="00:34:10.35"/><clear/>And so it was rotavirus that got him to invest the first time <time begin="00:34:14.13"/><clear/>in the accelerated development and introduction of four vaccines. <time begin="00:34:19.22"/><clear/>Well, after Bill and Melinda Gates got interested in this, <time begin="00:34:22.37"/><clear/>they put some of their money, 750 million Page 25 Glass.txt dollars into the Global Alliance for Vaccines. <time begin="00:34:27.98"/><clear/>And that went to, and rotavirus was prioritized with pneumococcal vaccine, <time begin="00:34:32.98"/><clear/>as one of two vaccines for accelerated development and introduction. <time begin="00:34:37.01"/><clear/>And, of course, the international finance committee, Gordon Brown, <time begin="00:34:40.77"/><clear/>Tony Blair have gotten the Europeans behind financing this. <time begin="00:34:45.64"/><clear/>So we've gone from an impoverished activity for a very important global disease <time begin="00:34:50.64"/><clear/>to an activity now which is well funded for further development <time begin="00:34:54.66"/><clear/>and introduction, should the vaccine test show that the vaccine is effective <time begin="00:34:59.79"/><clear/>in those poor, developing countries. <time begin="00:35:01.99"/><clear/>So that answer is gonna wait for us all to see. <time begin="00:35:05.78"/><clear/>So we're beginning now a great experiment now to see if we can control <time begin="00:35:08.87"/><clear/>and perhaps eliminate rotavirus through the use of vaccines. <time begin="00:35:13.08"/><clear/>And for future funding, I thought we might call upon the Rotarians, for instance. <time begin="00:35:18.18"/><clear/>Doesn't that look like a Rotary sign? <time begin="00:35:21.03"/><clear/>I thought that after the polio eradication, I need your approval on this, <time begin="00:35:24.63"/><clear/>because I haven't shown this to the Rotarians yet, but they've done so well <time begin="00:35:28.01"/><clear/>with polio eradication that I thought we might just change it to the Rotary Virus <time begin="00:35:32.76"/><clear/>and continue their global Page 26 Glass.txt efforts. <time begin="00:35:35.62"/><clear/>Now, with that said, I wanted to go on and just give you a little, I've made a change <time begin="00:35:42.06"/><clear/>of careers this year, and I'm still working on rotavirus at CDC, <time begin="00:35:46.51"/><clear/>but I've decided after 30 years of CDC, I should try to, I was an inch wide <time begin="00:35:52.29"/><clear/>in rotavirus and a mile deep. <time begin="00:35:55.04"/><clear/>We've worked on rotavirus and we've gotten it into national use <time begin="00:35:58.37"/><clear/>in the U.S. It was licensed and used now. <time begin="00:36:01.23"/><clear/>We have global clinical trials. <time begin="00:36:04.11"/><clear/>What else could I do to improve the impact of global health <time begin="00:36:08.43"/><clear/>and to make global health an important study, even on the campus of UGA, <time begin="00:36:15.50"/><clear/>what could you do for global health here? <time begin="00:36:17.45"/><clear/>I think part of the reason I'm here is to get you all excited about global health. <time begin="00:36:20.89"/><clear/>I hope I can do this. <time begin="00:36:22.65"/><clear/>So I went on to, I went on to the Fogarty position, where I'm the director <time begin="00:36:28.07"/><clear/>of the Fogarty International Center at NIH. <time begin="00:36:30.91"/><clear/>This center is really dedicated to address global health challenges through innovative <time begin="00:36:35.95"/><clear/>and collaborative programs for research and training. <time begin="00:36:38.98"/><clear/>All stemming from the work of a bricklayer, John Fogarty, who became a union representative <time begin="00:36:45.94"/><clear/>and then went to congress, Page 27 Glass.txt and his passion was global health, for reasons we don't understand. <time begin="00:36:52.15"/><clear/>But because of him, we got a program 39 years ago at the Fogarty on the NIH campus <time begin="00:36:58.52"/><clear/>that addressed issues of global health. <time begin="00:37:01.87"/><clear/>Well on the campus at NIH there are 27 institutes and centers <time begin="00:37:05.87"/><clear/>like the National Cancer Center, the Heart and Lung Institute. <time begin="00:37:10.64"/><clear/>Fogarty is the smallest, oops, let's see, Fogarty is the smallest of all the centers. <time begin="00:37:17.85"/><clear/>We have a budget of about 70 million dollars, which represents, get this, for global health, <time begin="00:37:23.93"/><clear/>one quarter of one percent of our NIH budget. <time begin="00:37:28.56"/><clear/>This is global health. <time begin="00:37:29.63"/><clear/>This is what we have for global health. <time begin="00:37:31.34"/><clear/>So it's a nice budget, but it really means that we have to be pointed <time begin="00:37:34.83"/><clear/>in what we do and how we address this. <time begin="00:37:37.40"/><clear/>And we also have to work with all the other centers because what part of healthcare <time begin="00:37:43.15"/><clear/>and health research is not global in some aspect. <time begin="00:37:46.39"/><clear/>It's gotta be everything. <time begin="00:37:48.15"/><clear/>So we have to deal with everyone and be really creative and partner. <time begin="00:37:51.92"/><clear/>Well, we have research activities in over 100 foreign institutions and 60 US institutions, <time begin="00:37:59.40"/><clear/>but ours are primarily in the developing world. <time begin="00:38:02.71"/><clear/>Well, I got to Fogarty in Page 28 Glass.txt June of last year and I was greeted <time begin="00:38:06.22"/><clear/>by this portfolio that I call alphabet soup. <time begin="00:38:09.27"/><clear/>You see all these different letters and acronyms in here, <time begin="00:38:13.49"/><clear/>I didn't know what they all were and you probably won't either. <time begin="00:38:16.92"/><clear/>But I did know that coming out of this soup was collaborative research, <time begin="00:38:20.56"/><clear/>research training for foreigners in the U.S., research training for U.S. students overseas <time begin="00:38:27.51"/><clear/>and development of institutional capacities. <time begin="00:38:30.08"/><clear/>About 68 million dollars in budget with 400 grants overall. <time begin="00:38:35.51"/><clear/>So I said well, what does this mean? <time begin="00:38:37.09"/><clear/>Let me put some flesh on to all of these alphabet soups, okay? <time begin="00:38:43.85"/><clear/>And so the first thing we did was to look at the first program that we started <time begin="00:38:47.93"/><clear/>in 1988, which was called the AITRP. <time begin="00:38:50.59"/><clear/>I didn't know what AITRP meant either. <time begin="00:38:51.96"/><clear/>But it's our Aids International Training and Research Program. <time begin="00:38:56.13"/><clear/>We started in 1988, if you'll remember, maybe before some of you were aware of AIDS, <time begin="00:39:02.76"/><clear/>AIDS was a disease of the United States, of Haitians, of homosexuals and of hemophiliacs. <time begin="00:39:10.31"/><clear/>And we don't think beyond our borders of the important, <time begin="00:39:13.65"/><clear/>that AIDS would have that we Page 29 Glass.txt know today. <time begin="00:39:16.57"/><clear/>So Fogarty, as a center for global health, got a grant to invest in AIDS education <time begin="00:39:23.55"/><clear/>and the importance of AIDS overseas. <time begin="00:39:26.80"/><clear/>And we invested in some of these young researchers. <time begin="00:39:29.70"/><clear/>Well these researchers have stayed with AIDS <time begin="00:39:31.80"/><clear/>and AIDS has become an incredibly important disease globally, as you all know. <time begin="00:39:36.40"/><clear/>And these youngsters who we invested in 18 years ago have really become the leaders <time begin="00:39:41.91"/><clear/>in their field today. <time begin="00:39:43.41"/><clear/>So when you look at PEFAR programs, the president's emergency fund for AIDS relief <time begin="00:39:49.14"/><clear/>and many other AIDS research activities, these people who had early grants <time begin="00:39:54.98"/><clear/>from Fogarty are now the leaders. <time begin="00:39:56.97"/><clear/>They were very important grants. <time begin="00:40:00.45"/><clear/>Well, when we look at American leaders today in global health, what do we see? <time begin="00:40:05.98"/><clear/>There's a common feature just like my own experience. <time begin="00:40:09.59"/><clear/>One is that they all had what I call early childhood experience. <time begin="00:40:13.60"/><clear/>And I would encourage all of you, if you're interested at all in global health, to travel, <time begin="00:40:19.54"/><clear/>to find someplace to sit yourself in an international setting and spend some time <time begin="00:40:25.31"/><clear/>to gain the experience of what it is to work in a developing country <time begin="00:40:29.56"/><clear/>or to address a problem Page 30 Glass.txt that's really a problem of child survival or adult survival, <time begin="00:40:35.88"/><clear/>something that's really important. <time begin="00:40:37.91"/><clear/>That experience will open your eyes, will open your hearts, it will open your careers <time begin="00:40:43.57"/><clear/>to opportunities that you probably have never thought about before and engage you. <time begin="00:40:48.71"/><clear/>And I would, the first thing I would say is that all of the people who are now leaders <time begin="00:40:52.38"/><clear/>in global health have had, like Al Sommer, who was the dean at Hopkins, spent a couple of years <time begin="00:40:57.94"/><clear/>in Bangladesh and Indonesia before early on in his career. <time begin="00:41:04.10"/><clear/>Jeff Koplan, the former head of CDC also spent time in Bangladesh early on. <time begin="00:41:09.52"/><clear/>Helene Gayle was in Uganda as a baby, as a young physician epidemiologist working on HIV. <time begin="00:41:17.23"/><clear/>So the first important point is that early childhood experience. <time begin="00:41:21.85"/><clear/>You're all children, you're all students. <time begin="00:41:23.73"/><clear/>Look and seek for these opportunities because they will really change your career <time begin="00:41:28.64"/><clear/>and what you wanna do, especially when you're trying <time begin="00:41:31.35"/><clear/>to scratch what would be important or interesting. <time begin="00:41:33.88"/><clear/>These opportunities are huge and they will entertain you for a career. <time begin="00:41:39.00"/><clear/>The second is that all of these people up here work in infectious diseases. <time begin="00:41:43.59"/><clear/>Aren't there genetic diseases overseas? <time begin="00:41:46.19"/><clear/>How about cancers? <time begin="00:41:47.63"/><clear/>How about heart disease? Page 31 Glass.txt <time begin="00:41:49.69"/><clear/>All of that. <time begin="00:41:50.70"/><clear/>In the past, infectious diseases have been king of international health. <time begin="00:41:55.51"/><clear/>But I'm gonna tell you why that's changing in the 21st century. <time begin="00:42:00.17"/><clear/>And third, what's the gender of all these people? <time begin="00:42:04.72"/><clear/>They're all men. <time begin="00:42:05.42"/><clear/>And there are tremendous opportunities today. <time begin="00:42:08.81"/><clear/>When these people were in medical school, women were an incredible minority. <time begin="00:42:13.65"/><clear/>Today, women are about half of the medical students we have around the country <time begin="00:42:18.26"/><clear/>and so I expect that in the future women will play a much greater role in these activities. <time begin="00:42:23.84"/><clear/>Well we have a program at Fogarty to send medical students between their third <time begin="00:42:29.79"/><clear/>and fourth year overseas. About 25 students a year matched with a student in a developing country. <time begin="00:42:36.38"/><clear/>16 placements in India, Asia, Africa, Latin America and these kids go off for a year <time begin="00:42:42.90"/><clear/>to do a mentored research project. <time begin="00:42:45.95"/><clear/>When they come back, they are different students. <time begin="00:42:49.64"/><clear/>Their orientation as to what we can do to go back and solve the problems we solved. <time begin="00:42:54.68"/><clear/>So again, this is, opportunities are building and in fact, about 50 percent, <time begin="00:42:59.73"/><clear/>over half of medical students entering school today want an international experience as well <time begin="00:43:05.71"/><clear/>as many people in residencies and fellowships. Page 32 Glass.txt <time begin="00:43:08.97"/><clear/>Well the second area that we tried to build up is to build up the constituency <time begin="00:43:14.07"/><clear/>of universities around the world. <time begin="00:43:16.31"/><clear/>We have about 19 programs in the U.S. and this isn't the idea of bringing together schools <time begin="00:43:21.84"/><clear/>of public health, schools of nursing, graduate schools, schools of veterinary medicine, <time begin="00:43:27.03"/><clear/>journalism, medical schools, all together around the theme of global health. <time begin="00:43:32.03"/><clear/>And I think this is an incredibly important way to build a constituency in the United States. <time begin="00:43:37.59"/><clear/>Global health isn't just medicine. <time begin="00:43:39.74"/><clear/>If we want to deliver vaccines, you need a business approach, you need ethics <time begin="00:43:44.00"/><clear/>and legal questions addressed, you have the ecology of these infectious diseases <time begin="00:43:49.46"/><clear/>that requires ecologists and you need nurses to deal with the issue <time begin="00:43:54.26"/><clear/>of administering anti-retro virals. <time begin="00:43:57.84"/><clear/>Everyone can be involved in this. <time begin="00:43:59.47"/><clear/>And journalists to take out the messages of advocacy and alert the public. <time begin="00:44:04.42"/><clear/>Behavioral and social scientists to figure out why people won't take their AIDS drugs <time begin="00:44:09.74"/><clear/>or how to deal with the stigma of a disease like AIDS, which is incredibly stigmatizing. <time begin="00:44:16.39"/><clear/>Here's what one physician can do working overseas. <time begin="00:44:20.47"/><clear/>Denis Burkitt, everyone wonders Page 33 Glass.txt is it only infectious disease? <time begin="00:44:25.27"/><clear/>Here, a surgeon went off to Uganda in the late 60's and discovered a disease, <time begin="00:44:30.58"/><clear/>a big lymphoma, an African lymphoma of children. <time begin="00:44:34.33"/><clear/>He didn't know what it was, but it was very common and through going to scientific meetings, <time begin="00:44:39.96"/><clear/>he was able to link this with Ebstein Barr virus, a new virus at the time. <time begin="00:44:45.40"/><clear/>It's the first viral cause of cancer identified. <time begin="00:44:49.00"/><clear/>So he did a great thing for oncology and for cancer. <time begin="00:44:52.30"/><clear/>He then went to a meeting at Sloan Kettering in New York and found out they were working <time begin="00:44:56.71"/><clear/>on anti-cancer drugs in the 60's. <time begin="00:45:00.31"/><clear/>Let's try it. <time begin="00:45:01.10"/><clear/>He was in Africa. <time begin="00:45:02.01"/><clear/>He tried them out. <time begin="00:45:03.33"/><clear/>It melted the cancer away in a few weeks and was the first, <time begin="00:45:07.48"/><clear/>one of the earliest successful uses of cancer chemotherapy. <time begin="00:45:12.85"/><clear/>So a lot can be done. <time begin="00:45:14.58"/><clear/>And where's Burkitt's lymphoma now? <time begin="00:45:17.34"/><clear/>Well, there's an African lymphoma belt of Africa. <time begin="00:45:20.39"/><clear/>These kids still fill the wards with Burkitt's lymphoma. <time begin="00:45:24.32"/><clear/>He was disappointed that this lymphoma took his name, by the way. <time begin="00:45:28.95"/><clear/>And we don't have a public health approach to treating the children with Burkitt's lymphoma <time begin="00:45:34.33"/><clear/>or to understanding the mechanisms of their disease. Page 34 Glass.txt <time begin="00:45:37.29"/><clear/>So a lot can be done in other aspects of medicine, not only infectious diseases. <time begin="00:45:43.88"/><clear/>So Fogarty is really funding other projects and trying <time begin="00:45:47.39"/><clear/>to stimulate institutional capacity and long term collaborations. <time begin="00:45:52.84"/><clear/>This year at Fogarty we asked the question, we completed a project <time begin="00:45:57.46"/><clear/>that asked the question how can the world tackle it's most challenging problems? <time begin="00:46:04.50"/><clear/>What would you do as a minister of health if you were given a million dollars? <time begin="00:46:07.91"/><clear/>Where would you put your money? <time begin="00:46:09.89"/><clear/>Would you put it into surgery? <time begin="00:46:11.66"/><clear/>Would you put it into treatment hospitals? <time begin="00:46:13.66"/><clear/>Would you put it into prevention programs? <time begin="00:46:15.87"/><clear/>Where would you put your money? <time begin="00:46:17.86"/><clear/>Done by the World Bank, WHO, population reference bureau and centered at the Fogarty, <time begin="00:46:24.48"/><clear/>this report came out and behind the report was this graph, <time begin="00:46:29.74"/><clear/>which should be incredibly encouraging to all of you, it shows the aging of the U.S. population. <time begin="00:46:36.20"/><clear/>If you're Japanese today, you can expect to live about 85 years. <time begin="00:46:40.87"/><clear/>An American, somewhere between 76 and 85, and in all the areas of the world, <time begin="00:46:47.71"/><clear/>life expectancy has gotten greater. <time begin="00:46:50.40"/><clear/>Let me explain to you Page 35 Glass.txt what this means in real terms. <time begin="00:46:53.18"/><clear/>If you were born in China, 1960, your life expectancy was 39 years. <time begin="00:46:59.36"/><clear/>In the year 2000, your life expectancy, 71 years. <time begin="00:47:04.70"/><clear/>Okay? So the Chinese have gained eight years <time begin="00:47:07.68"/><clear/>of life expectancy per decade for the last four decades, okay? <time begin="00:47:13.11"/><clear/>The longest, largest prolongation of human life in the history of humanity. <time begin="00:47:20.11"/><clear/>What does that mean for disease patterns and priorities? <time begin="00:47:24.15"/><clear/>40 years ago, cancer wasn't a problem in China, <time begin="00:47:27.76"/><clear/>because many people didn't live long enough to get cancer. <time begin="00:47:31.13"/><clear/>Today, if you're a smoker, cancer will kill an estimated third of the Chinese population <time begin="00:47:38.45"/><clear/>by 2050, so as the population ages, cancer, heart disease, genetic diseases, obesity, <time begin="00:47:47.60"/><clear/>traffic accidents will all take a huge toll on the population and the infectious diseases <time begin="00:47:53.50"/><clear/>in that setting will become less significant. <time begin="00:47:57.65"/><clear/>The only place where prolongation of life has not occurred <time begin="00:48:00.83"/><clear/>in the developing world is in Africa. <time begin="00:48:05.21"/><clear/>And it has gone down. <time begin="00:48:06.86"/><clear/>And we were just in South Africa, life expectancy in 1975 was 53 years. <time begin="00:48:14.78"/><clear/>By 1992 it had gone up to 62 Page 36 Glass.txt years, 63 years, it's peak. <time begin="00:48:21.24"/><clear/>And from 1993 to today, 2004, it's dropped 18 years in the last 12 years, the biggest decline <time begin="00:48:32.13"/><clear/>in life expectancy outside of war. <time begin="00:48:34.81"/><clear/>Okay? So clearly HIV has to be reckoned with as a major force <time begin="00:48:40.17"/><clear/>in population dynamics and in development. <time begin="00:48:44.61"/><clear/>Well, this means that when we think about the best buys <time begin="00:48:48.08"/><clear/>in this disease control priority project, some have an infectious basis <time begin="00:48:52.53"/><clear/>like stopping the AIDS pandemic and tuberculosis, malaria, <time begin="00:48:56.64"/><clear/>some that are very cheap are combating tobacco use, reducing injuries, <time begin="00:49:02.68"/><clear/>reducing deaths from cardiovascular disease. <time begin="00:49:05.82"/><clear/>So we really need to think about new strategies for public health <time begin="00:49:09.57"/><clear/>and global health as we think forward. <time begin="00:49:12.06"/><clear/>And the website for this book, it's a 250 dollar book, but you can get it for free by downloading it <time begin="00:49:19.43"/><clear/>from the website and reading the chapters that you want. <time begin="00:49:22.54"/><clear/>DCP2.org. Lancet said in the October issue, <time begin="00:49:30.18"/><clear/>health is now the most important foreign policy issue of our time. <time begin="00:49:34.69"/><clear/>And I was struck by this, because here we're doing global health. <time begin="00:49:38.06"/><clear/>Foreign policy, global health, today? <time begin="00:49:40.84"/><clear/>I mean, you think of Page 37 Glass.txt different things for foreign policy. <time begin="00:49:43.91"/><clear/>And then I began to think, and actually, <time begin="00:49:46.97"/><clear/>in this administration there's been the largest investment <time begin="00:49:51.49"/><clear/>in major overseas programs of any administration ever. <time begin="00:49:57.19"/><clear/>The PEPFAR program committed 15 billion dollars to treatment of AIDS. <time begin="00:50:02.21"/><clear/>The President's Emergency Program for AIDS Research, AIDS relief, 15 billion dollars <time begin="00:50:07.26"/><clear/>over five years to introduce anti-retro viral treatment throughout Africa. <time begin="00:50:12.99"/><clear/>The president's malaria initiative, 1.2 billion dollars for malaria bed nets and treatment <time begin="00:50:19.94"/><clear/>in Africa, efforts to control emerging infections in avian flu. <time begin="00:50:24.61"/><clear/>So there have been tremendous investments, even by this government in global health. <time begin="00:50:31.16"/><clear/>So where's this led us? <time begin="00:50:32.89"/><clear/>We also have worked intensively with the Indians and the Chinese. <time begin="00:50:37.50"/><clear/>These were countries, that 40 years ago, were impoverished. <time begin="00:50:40.84"/><clear/>And today, tehy're major economic middle income countries with funds to invest in research. <time begin="00:50:49.19"/><clear/>And the Indians and Chinese are both investing heavily in research. <time begin="00:50:53.59"/><clear/>What they need are ideas and direction. <time begin="00:50:56.19"/><clear/>And so we have lots of collaborations with both the Indian government and with the Chinese to enrich <time begin="00:51:02.54"/><clear/>and direct programs and Page 38 Glass.txt research priorities in health, areas where we can all benefit. <time begin="00:51:08.75"/><clear/>Here's a group of Iranians. <time begin="00:51:10.33"/><clear/>We had a delegation of Iranians who came to visit NIH, <time begin="00:51:13.29"/><clear/>Arash Alaei was the leader of the delegation. <time begin="00:51:15.73"/><clear/>We discussed what are we gonna do with research in Iran? <time begin="00:51:23.31"/><clear/>We think about Iran in different terms, as you know. <time begin="00:51:26.64"/><clear/>It turns out that they are a centerpiece for surveillance <time begin="00:51:31.70"/><clear/>of extremely drug resistant tuberculosis. <time begin="00:51:35.08"/><clear/>It's the newest pandemic on the planet, tuberculosis strains <time begin="00:51:39.96"/><clear/>that resist all antibiotics, so if we had it here we would have a hard time stopping its <time begin="00:51:45.72"/><clear/>spread or getting rid of it. <time begin="00:51:47.08"/><clear/>No antibiotics work. <time begin="00:51:49.07"/><clear/>In Iran they form a window on the surrounding countries, Turkmenistan, Afghanistan, Pakistan. <time begin="00:51:58.58"/><clear/>They get refugees in and they have the diagnostic ability to make, <time begin="00:52:02.55"/><clear/>to identify extremely drug resistant TB, make a diagnosis and think <time begin="00:52:07.82"/><clear/>about clinical trials when new antibiotics. <time begin="00:52:10.74"/><clear/>If we wanna stop XTB in the world, we have to open up our eyes to all sentinels. <time begin="00:52:17.17"/><clear/>And so whether this is in our own self interest to know where XTB is, <time begin="00:52:22.01"/><clear/>or because of the Page 39 Glass.txt possibility of research opportunities <time begin="00:52:25.89"/><clear/>to test new antibiotics, this would be a place to go. <time begin="00:52:30.36"/><clear/>So even in places like Iran, there're opportunities for research. <time begin="00:52:35.35"/><clear/>Well, Fogarty, I said, is not a rounding error of our budget, it's a , we have a budget <time begin="00:52:40.05"/><clear/>but because it's small we have to work with all of these partners. <time begin="00:52:43.96"/><clear/>And it's really through partnerships with all the money that's now going into global health <time begin="00:52:49.08"/><clear/>that we can provide some direction and some leadership. <time begin="00:52:52.21"/><clear/>We have foundations like the Gates and the Wellcome, the private sector, <time begin="00:52:56.85"/><clear/>multinationals working overseas, government agencies, universities, and the like, <time begin="00:53:02.79"/><clear/>as well as our own institutes on the NIH campus. <time begin="00:53:06.12"/><clear/>So we are really trying to help, from our leadership <time begin="00:53:09.20"/><clear/>and coordination for these global efforts. <time begin="00:53:14.36"/><clear/>Dr. Zerhouni, when he recruited me, is an Algerian by birth. <time begin="00:53:19.33"/><clear/>He speaks French and Arabic and is really committed to global health. <time begin="00:53:23.10"/><clear/>And so I was delighted that he has taken this upon himself as a mission for the future. <time begin="00:53:29.99"/><clear/>My own experience, will this help? <time begin="00:53:31.77"/><clear/>When I went to Bangladesh in 1980, <time begin="00:53:35.83"/><clear/>under five mortality was about 120 per 1000. <time begin="00:53:39.50"/><clear/>One in six or seven children died Page 40 Glass.txt before they reached the age of five. <time begin="00:53:43.79"/><clear/>Family size was about six and there were over half a billion dollars invested <time begin="00:53:50.23"/><clear/>in family planning programs to no real avail. <time begin="00:53:53.63"/><clear/>There was not having an impact. <time begin="00:53:56.26"/><clear/>Immunization coverage was under five percent. <time begin="00:53:59.27"/><clear/>Lots of diarrheal deaths and ARI deaths due to malnutrition. <time begin="00:54:02.53"/><clear/>It was a terribly poor developing country. <time begin="00:54:07.25"/><clear/>I've been going back every year or two and working with Bangladeshis. <time begin="00:54:12.07"/><clear/>In 2005, the pattern is quite different. <time begin="00:54:17.20"/><clear/>Under five mortality has been reduced almost in half in 25 years. <time begin="00:54:21.89"/><clear/>Family size has gone from 6.3 to 2.6. <time begin="00:54:27.15"/><clear/>how did that happen in 25 years in a society where women have been kept indoors, <time begin="00:54:32.93"/><clear/>they didn't go out after menarche, they stayed at home, they were uneducated. <time begin="00:54:39.95"/><clear/>What happened? One thing that happened was that women entered into the garment industry at the age of 13 <time begin="00:54:46.33"/><clear/>to 21, they had a job, they had a reason to be with other women, to talk, they had healthcare <time begin="00:54:53.29"/><clear/>on the job, they had a reason not to get married at 13 because they had a salary. <time begin="00:54:58.96"/><clear/>They had a reason not to marry a man who didn't have a salary. <time begin="00:55:02.49"/><clear/>They had a way to say no, because they were empowered by a little money. Page 41 Glass.txt <time begin="00:55:06.01"/><clear/>They had a reason to delay pregnancy until they really wanted to get married. <time begin="00:55:10.64"/><clear/>So I've seen this major change in Bangladesh society in 25 years, <time begin="00:55:15.88"/><clear/>just watching. It's been nothing less than a real miracle. <time begin="00:55:19.35"/><clear/>Diarrheal deaths have come down. <time begin="00:55:20.86"/><clear/>Women only have two or three children. <time begin="00:55:23.59"/><clear/>And the causes of death are changing. <time begin="00:55:25.87"/><clear/>And some of these chronic diseases are becoming important. <time begin="00:55:29.59"/><clear/>So now, at Fogarty, we're involved in our strategic plan and it really is based <time begin="00:55:34.16"/><clear/>on my own experience, as I told you, from Bangladesh. <time begin="00:55:37.38"/><clear/>First, that we really see what is critically important is to train the next generation <time begin="00:55:41.92"/><clear/>of American and foreign researchers. <time begin="00:55:44.19"/><clear/>And this is what I call early childhood education. <time begin="00:55:47.63"/><clear/>This is all of you in the audience. <time begin="00:55:49.75"/><clear/>Okay? There is a future in global health. <time begin="00:55:52.58"/><clear/>There's a lot to be done in the developing world, and I would encourage you <time begin="00:55:56.42"/><clear/>to seek opportunities, which are becoming more numerous, and funding, <time begin="00:56:00.81"/><clear/>which is skimpy, but which is available. <time begin="00:56:02.93"/><clear/>Because these are Page 42 Glass.txt opportunities that'll change the way you think about the world. <time begin="00:56:07.30"/><clear/>We wanna build sustainable capacity <time begin="00:56:09.51"/><clear/>for health science research in overseas, building centers of excellence. <time begin="00:56:14.20"/><clear/>In your group here at UGA are working intensively, <time begin="00:56:17.55"/><clear/>for instance in Kenya on parasitic diseases. <time begin="00:56:20.76"/><clear/>And those centers of excellence will be wonderful places <time begin="00:56:23.42"/><clear/>to be mentored for research careers. <time begin="00:56:26.60"/><clear/>Implementation, we have lots of tools in science that we don't use, new vaccines, <time begin="00:56:32.86"/><clear/>an understanding of the hazards of smoking, <time begin="00:56:35.28"/><clear/>how to control hypertension, how to treat Burkitt's lymphoma. <time begin="00:56:40.03"/><clear/>All of these need to be implemented if we're going to have their impact. <time begin="00:56:43.98"/><clear/>If they don't come out of our tool chest, they're not of great use. <time begin="00:56:48.97"/><clear/>We're trying to provide reentry support for foreign scientists to go home <time begin="00:56:52.96"/><clear/>and make an impact in their home countries. <time begin="00:56:56.02"/><clear/>Training, institutional capacity, and providing leadership and collaboration for the future. <time begin="00:57:02.05"/><clear/>Well, Tony Fauci, head of allergy and infectious disease has always said why do we get involved <time begin="00:57:08.48"/><clear/>in global health, why should we be interested? And he presents this slide <time begin="00:57:13.20"/><clear/>which is very important of Page 43 Glass.txt all the emerging infections that have arisen around the world <time begin="00:57:18.40"/><clear/>which are a threat to the United States, to our homeland and I've scratched my head with this <time begin="00:57:23.22"/><clear/>because this is clearly a high priority. <time begin="00:57:26.36"/><clear/>But beyond that when we think about genes, if you look around at all <time begin="00:57:31.37"/><clear/>of your neighbors and students here. <time begin="00:57:33.46"/><clear/>400 years ago there were very few Americans in Georgia, okay, all of us brought our genes <time begin="00:57:41.03"/><clear/>from Africa, from Asia, from Europe and it's those genetic diseases <time begin="00:57:45.33"/><clear/>that we're now understanding are the basis for many of the illnesses in our society today. <time begin="00:57:50.14"/><clear/>If we're going to understand these genetic diseases, it's really through global health. <time begin="00:57:56.59"/><clear/>If you think of one in particular, Huntington's chorea, a terrible genetic disease, <time begin="00:58:01.73"/><clear/>spread in family, a dominant gene. <time begin="00:58:04.48"/><clear/>Where were the genes identified? Venezuela, offspring of a single woman <time begin="00:58:11.61"/><clear/>who had Huntington's genes who went to Venezuela in 1824 <time begin="00:58:16.37"/><clear/>and has had several thousand offspring, <time begin="00:58:20.71"/><clear/>infected and expressing the disease or not infected and it's by understanding the gene <time begin="00:58:27.63"/><clear/>in this type of population that with the sequencing of the human genome, <time begin="00:58:32.20"/><clear/>we've actually been able to identify the gene, <time begin="00:58:34.77"/><clear/>begin to think about what Page 44 Glass.txt we could do about the disease. <time begin="00:58:39.50"/><clear/>When a therapy becomes developed and available for testing, <time begin="00:58:43.71"/><clear/>Maracaibo area of Venezuela may be one of the first places to have an impact <time begin="00:58:50.08"/><clear/>and see if it works, they are genetic diseases. <time begin="00:58:53.38"/><clear/>How about environmental diseases? You know when I worked in Bangladesh on that tube well, <time begin="00:58:58.17"/><clear/>remember the tube well? We put in the tube well to stop cholera. It turns out that a quarter <time begin="00:59:03.73"/><clear/>of those tube wells have high levels of arsenic in that water, heavy metal, that's a poison. <time begin="00:59:10.21"/><clear/>We never thought of this 25 years ago, but with arsenic in the water, <time begin="00:59:15.22"/><clear/>if we ever want to study a problem of chronic arsenic poisoning and figure out how <time begin="00:59:20.17"/><clear/>to address it, to cure it, to remove arsenic, to remove the risk in the water. <time begin="00:59:26.71"/><clear/>Bangladesh is where we would have to go and this is true for many other diseases. <time begin="00:59:31.70"/><clear/>Remember the problems in Bhopal with Chernobyl with the radiation disaster. <time begin="00:59:38.45"/><clear/>Where disasters occur, we can actually learn a lot about the diseases that will be important <time begin="00:59:43.93"/><clear/>for those people as well as for ourselves. <time begin="00:59:48.80"/><clear/>And of course adult cancers that I just shaded in the Burkitt's area red and as one <time begin="00:59:53.91"/><clear/>of many cancers which have high incidence, high incidence areas, where by going <time begin="00:59:59.08"/><clear/>to these areas and studying high risk cancers, Page 45 Glass.txt we can understand the etiology of the cancer, <time begin="01:00:04.09"/><clear/>whether it's genetic or environmental and we can think about new modes of treatment. <time begin="01:00:09.35"/><clear/>10 years ago the Institute of Medicine came out with a report on America's Vital Interest <time begin="01:00:14.05"/><clear/>in Global Health. We're back with the IOM updating this report because much has happened <time begin="01:00:20.36"/><clear/>in the visibility of global health issues in the world today. <time begin="01:00:24.40"/><clear/>We think that global health is now at a tipping point, a time when major things will happen <time begin="01:00:32.33"/><clear/>because so much has changed in the society. The introduction of the Gates funding <time begin="01:00:36.75"/><clear/>and the other foundation funding, of the rise of India and China <time begin="01:00:40.73"/><clear/>as contributors to global health research, <time begin="01:00:43.39"/><clear/>the visibility of global health problems, the idealism of youth, <time begin="01:00:47.43"/><clear/>that we can really make things happen in global health as we've never seen before. <time begin="01:00:53.17"/><clear/>So some themes for Fogarty, we've been working on our strategic plan, <time begin="01:00:57.48"/><clear/>one is that science anywhere helps people everywhere. <time begin="01:01:00.28"/><clear/>Do you like that one or should we try the other one, <time begin="01:01:03.28"/><clear/>take science where the problems are or science for global health. <time begin="01:01:08.88"/><clear/>We're having an award for whoever comes up with our best brandname and we're trying to get <time begin="01:01:13.37"/><clear/>our strategic plan done by June or July of Page 46 Glass.txt this year, so any ideas will be accepted <time begin="01:01:20.33"/><clear/>for brands and we'd be happy to see them. <time begin="01:01:22.79"/><clear/>This is my, I've lived in Georgia for 30 years and this is my first visit to UGA. So I want <time begin="01:01:28.71"/><clear/>to thank all of you crazy people who invited me here to speak to you, I'm really delighted <time begin="01:01:32.92"/><clear/>to be here and I'm amazed at the quality of the research and the efforts <time begin="01:01:37.25"/><clear/>that are going on in global health. <time begin="01:01:39.09"/><clear/>I wish you well and I would encourage all of you to go over to that department and see the dean <time begin="01:01:44.28"/><clear/>and make sure you sign up for some kind of a project in global health and most important, <time begin="01:01:49.54"/><clear/>go overseas to some project or some place where you can actually learn from your experiences. <time begin="01:01:54.72"/><clear/>Thanks so much for letting me speak with you. <time begin="01:01:57.51"/><clear/>[ Applause ] Page 47

Glass.txt <time begin="00:00:00.50"/><clear/>[ Silence ]<br/> <time begin="00:00:28.35"/><clear/>>> Welcome to the third

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Glass.txt <time begin="00:00:00.50"/><clear/>[ Silence ]<br/> <time begin="00:00:28.35"/><clear/>>> Welcome to the third