A Balm for Exhausted LGBTQ Christians – Justin Lee at The Reformation Project (2019)

A Balm for Exhausted LGBTQ Christians – Justin Lee at The Reformation Project (2019)


[applause] When Matthew mentioned my name, and then there
were some “woos,” I was excited! I was like, “Yay, some woos!” And somebody sitting near me said, “I think
it was all women who wooed for you,” and— [laughter] And I’m like, “Okay, first of all, this
is an LGBTQ conference. You know you can’t tell somebody’s gender
by their voice.” [laughter] But yeah, it was probably the moms. [cheers and applause] You know, truly, I am so grateful to the “mama
bears” who have been there for our community, for so many of us, and for me personally. After my mom passed away, there are a number
of moms of LGBTQ kids who have just been like surrogate moms for me and have encouraged
me so many times. I’m so grateful to all of you for what you’ve done for me, but
also for what you’re doing for all of us. And also to the dads, thank you for all that
you do as well. You moms and dads are moving things forward
in spaces where many of us LGBTQ folks don’t have the ability to be heard yet. I’m so grateful to you. But with all due respect to the moms, you
know, as a single guy, I wouldn’t mind getting some woos from some eligible Christian guys
once in a while, but it’s okay. [laughter] [audience member: woo] [more laughter] Well, this talk just took an unexpected turn. But no, I kid. I am so honored by the warm reception and
so thrilled to be here. Some of you know, I have been organizationally
homeless for a couple of years now, so it’s wonderful to be here at The Reformation Project,
witnessing history in the making the way that we have this weekend. I just have such tremendous respect for Matthew
and for the work of TRP, and there’s no place I would rather be right now, so thanks,
Matthew, for all that you do and for being such a faithful advocate. So most of the time when I speak, I start
off by sharing my story, because I believe stories are powerful and important; I think
there’s a reason the Bible is largely made up of stories and that Jesus often taught
through stories; stories matter. But since it seems like most of you here already
know my story, I’m not going to spend a lot of time on my story this morning. But for those of you who don’t know my story…it is
available for sale in the lobby, so um— [laughter] If you hurry and speed read, you can get caught
up before the end of the talk. Short version: I received Christ at a young
age, I grew up Southern Baptist, I was very anti-gay— And for me at the time, it was “gay,”
I didn’t think in terms of “LGBTQ” at that time—but I was very anti-gay at the
time, I thought that being gay and being Christian were sort of polar opposites, and then I realized
I was gay, surprise! God has a way of doing these things we don’t
expect. I tried not to be gay, discovered that didn’t
work, and eventually after a lot of prayer and Bible study, I became fully affirming. That is the super-short version. Since then, I’ve spent the last 20-plus
years of my life doing ministry work, much of it speaking to people who are not affirming
and are not even supportive, often, of LGBTQ folks—trying to be patient with their misconceptions,
taking it step by step to help them understand. Because I get it. I believed for a long time that gay Christians
weren’t real Christians, that they were just activists—in the worst sense of that
term—whose activism and unbridled lust was more important to them than their faith. So once I realized that wasn’t true, I wanted
to help other people understand by patiently explaining the stuff that I wished someone
had explained to me. And that’s where my book Torn came from. And my organization The Gay Christian Network
that I spent 16 years running was both to answer those questions for those folks and
to provide support to folks who needed it. By the way, running an organization called
The Gay Christian Network had the lovely side effect that I had a corporate credit card
that the bank couldn’t fit the full name of the organization on, and so I walked around
with this credit card that said, “Justin Lee, The Gay Christian.”
Which— [laughter] It was always interesting checking into a
hotel for work purposes in Podunk, Alabama, and handing over that credit card, and getting
that sort of— I’m like, “Yeah, I’m the one you’ve
been hearing about.” But thankfully it wasn’t just me; there
were folks who came before me, there are folks who’ve continued the work after I started, and
folks who’ve been doing this work in public and private ways in so many different ways,
not just in terms of gay Christians, but LGBTQ+ Christians and family members and friends
and pastors and—all of us working for a better church that is more fully living
out the Gospel of Jesus Christ. And so I am no longer with that organization,
but I am thrilled to be here fully in support of The Reformation Project and Matthew’s
work. Matthew, I so admire his integrity, his commitment
to Scripture and theological orthodoxy, and his incredible work ethic. And I think this conference is amazing. So, Matthew, thank you to you. [applause] People have asked me, since Torn came out,
if I would consider writing a sequel to talk about all the stuff that’s happened since
in my life and in the church. And, you know, I did write another book called
Talking Across the Divide, but it wasn’t exactly a sequel to Torn. I’ve played around with the idea of, if
I did write a sequel to Torn, what it would be called. I thought maybe like, “Torn 2: Bits.” [laughter] Or I considered, “Torn: A New One.” [laughter] People have tried to dissuade me from that
title; I don’t know why… But I want to do something a little different
this morning. Because you know, very often, the speaking
that I do is to conservative Christian audiences that are either not affirming or somewhere
on the fence or tiptoeing into being affirming—folks who really need me to do some LGBTQ Christian
101 with them, to answer a lot of really basic questions. And it’s not very often that I get a chance
to speak to an audience where there are so many just LGBTQ Christians in the audience
who are already affirming, where we get to talk about the stuff that maybe we don’t
normally talk about. So there are a few things that I do want to
share this morning, just to be a little open about where I am right now in life. I started watching—Apple’s got this new
show, I don’t know if you’ve seen it, called The Morning Show.
Has anybody seen The Morning Show? [silence] There’s uh—Well, that shows how well Apple’s
doing in promoting their new stuff. They have this show called The Morning Show
and there’s this scene in, I think, the first episode, where one of the characters
who’s a reporter is talking about the state of politics in America. And there’s this moment where she gets caught
on camera, she doesn’t know the camera’s rolling, and she’s yelling at this person
and she says, “I am so exhausted!” And I was watching this show and I was like,
“I feel you. I am exhausted with this world.” Being LGBTQ and Christian is exhausting sometimes. And you know, I think it’s wonderful for
us to come to a place like this and talk about all the good stuff and all of the hope
and all of the blessings from God, but sometimes we’re just exhausted. I get tired of having to explain myself or hide
myself or come out every moment of every day. It’s like— People who are not LGBTQ often don’t realize
that LGBTQ folks, you don’t just come out one time. You keep coming out over and over and over
and over. If you’re in a relationship with somebody
and you’re at the grocery store and you make a decision about how close to stand to
that person, you’re coming out again to the people around you. And depending on where you live and depending
on who the people are who are around you, maybe it’s not a big deal or maybe it really
is. And that can be a lot of tension to hold all
the time. But especially as a gay Christian, I find
myself tired of having to be “the good gay Christian” all the time. Not that I don’t think that I should be
a good Christian all the time, but it’s exhausting to be always under the microscope. Always representing not just myself, but like,
all of these other people. Like people are waiting for me to make a mistake. It’s exhausting to have to explain myself
all the time. To feel judged by both sides all the time. To hear my LGBTQ friends judge me for being
a Christian, and my Christian friends or other folks I meet in my career judge me for being
gay. I get tired of not feeling safe in Christian
spaces until and unless someone goes out of their way to let
me know that it’s a safe space for me. I’m tired of the default being that I have
to be on guard until someone explicitly says, “You’re safe here.” And even then
being skeptical because of all the times people have told me someplace was
going to be safe and then I found too late that it wasn’t. [response from audience] Yeah, by all means, interact with me,
by the way, right now. Y’all have been sitting there for a long
time and this is heavy stuff, so like, if you want to find your inner Charismatic, I’m
all about it. [audience member: Yeah!] I grew up Southern Baptist, where you sit
very quietly when people are talking, and I’m done with that. So. [laughter] But I get tired of finding that safe spaces
aren’t always safe. And by safe space, I don’t mean I want places
where I’m not going to be challenged. As a Christian, I want to be challenged in
my faith. What I mean is I want places where I can worship
without having to be a personal guide to LGBTQ 101 to everyone all the time—and treated
as if I’m guilty of all the negative stereotypes everyone has about gay men until I somehow
prove myself innocent. I’m tired of feeling like I have to be twice
as pious as a straight Christian to be taken seriously. [applause] Because here’s the thing: I can never live
up to those expectations of perfection, because I’m human. And I’m gonna screw up. There’s a Christian, somewhat obscure but
pretty awesome, Christian rock band I listened to back in the 90s, and I still listen to
them today, called The Choir. And they have a song with these lyrics: “I’m nobody’s angel, I’m not that
good. “I’m no red devil in the wicked wood. “I’m a dedicated minister
and a downright sinister man. “I’m a whole lot better and a whole lot
worse “than what you think I am.” And I know how that feels. To be held up as an angel…
or condemned as a devil. And I’m neither one. I’m a human being. And I’m fallen, I’m a sinner, and I’m
forgiven and sanctified by the blood of Jesus. [cheers and applause] The thing is, none of us are ever going to
be good enough in this life, and that’s the whole point of Christianity. That God sent Jesus Christ to be good enough
for us. And I do think, though, that what we believe
and what we do matters. I think it’s important that those of us
who are LGBTQ Christians not be Christian in name only. And you know, that’s part of the problem,
too, because I want affirming Christian spaces where I can worship and feel welcome, and
yet not every affirming Christian space feels to me like a Christian space! And yet outsiders tend to assume that any
affirming Christian space in the world is a representation of me and what I believe. But just like any other Christian space, there
are spaces that I think are doing it better and spaces that I think are not doing it as
well. There are leaders that I say, “That person,
I really agree with the vast majority of what they say,” and other people I say, “You
know, this person and I, we may share some beliefs, but not the vast majority.” LGBTQ Christians struggle, many of us, with
shame as well. I find that even after more than 20 years
of ministry as a gay Christian, there are still times that I hear that little voice
from all the bad stuff I was told about gay people growing up. And it’s something that I’m kind of—I
hate to even admit in public. Because I always have this fear, since I’m
always under the microscope, I always have this fear that a non-affirming Christian is
going to say, “A-ha! If you feel a little voice of shame, that’s
the Holy Spirit convicting you.” Right? Sometimes you feel like you can’t admit your
weakness without somebody seizing on it. But here’s the thing: There is a huge difference
between shame and conviction. They are not the same thing. [applause] I know what it feels like to be convicted
by the Holy Spirit, because there are many, many times in my life that the Holy Spirit
has convicted me of my own sinfulness. And sometimes I listened and sometimes I didn’t. Sometimes I did this kind of, “la la la
la, I’m not listening” thing. But that’s not what this is. This shame that many of us have struggled
with in our lives is, I think, a result of having grown up hearing so many negative messages
about who we are from the same people who gave us the positive messages about who Jesus
is. And it’s very hard to disentangle those
two. But, you know, it’s not just “being LGBTQ
and Christian” stuff that exhausts me. Secular gay male culture exhausts me. [laughter] No one else has had that experience. Clearly. Dating is exhausting in the gay male world
and especially as a gay Christian. And there’s this thing in gay male culture
that bugs the heck out of me, where a lot of gay men seem to have taken their cues about
how to behave as gay men from reality TV shows. Like they’re living out RuPaul’s Drag
Race at every moment. And this, like, cattiness. This mean cattiness toward other people. Which is not strength; it’s meanness. The gay male world is filled with racism
and ageism and bigotry and fetishizing and
dehumanizing people. And, you know, I want to be clear; I think
the secular LGBTQ world as a whole certainly has some significant strengths and things
we can learn from, like its commitment to diversity. But I get exhausted by the factions and the
call-out culture and the lack of healthy boundaries, sexual and otherwise. And can I be honest? Too often, our community confuses one kind
of pride for the other. The word “pride” in English can mean two
different things. Right? Pride can be the opposite of shame: “I’m not ashamed of who I am;
I’m proud of who I am.” That’s a good kind of pride to have. But pride also can mean not the opposite of
shame but the opposite of humility. And that kind of pride is the kind of pride
the Bible warns us against. It is a sin. The kind of pride that goes before a fall. The kind of pride that says not “I am glad
to be who I am because God created me as something good” but the kind of pride that says “I
am so good that I don’t need God.” That’s the kind of pride that led Adam and
Eve to decide that they should eat the fruit and be gods themselves. When we talk about pride as LGBTQ people,
we often don’t distinguish between these two kinds of pride. What does it mean to us to go to a Pride march
or Pride rally and talk about how “proud” we are? Does it mean that we refuse to be ashamed
of who God created us to be? Because if so, that’s good. But when we allow that to slip into this idea
that we’re so good we don’t need to change in any way, that’s bad. And you know, those are mistakes I expect
of a secular world. But they’re mistakes that we as Christians
should not make. And yet sometimes we do. But you know, I’m also exhausted by the
current state of our polarized world. You ever look at the world and think to yourself,
”We seem to be in some kind of a giant handbasket…” ”…and I’m not sure where we’re heading,
but I’m pretty sure it’s not the Good Place.” If it is, though, I want to get Ted Danson’s
autograph. Because that man… Like if this were a video game, this is the
point where I’d be going, “You know, let me restore from a previous save.
I think—” [laughter] We live in a world that mistakes hardheartedness
for strength. That mistakes self-centeredness for self-respect. That mistakes self-righteousness for actual
righteousness. A world divided by tribalism, where we’re
quick to condemn those who disagree with us and slow to empathize with them. An “all or nothing” culture where if you’re
only 99% in agreement with me, then you’re the enemy, and you need to be “called out”
or “canceled” because that 1% isn’t up to my standards. And you know what, there are times when someone
is doing something harmful and they don’t respond to attempts to bring it up privately
with them, and so bringing public pressure may be the only option to stop further harm
from being done. But we’ve turned this into a cottage industry,
everyone on Twitter building their reputation and their follower count by pointing fingers
at everyone else for not living up to this standard or that standard. And that is toxic and exhausting. Because the thing is, deep down, we all know
we can’t stand up to that level of scrutiny, because none of us is perfect. Every single one of us has parts of ourselves
we would rather not share with the whole world. We say #nofilter but of course there’s a
filter. There’s always a filter. Get the right lighting, get the right angle. Don’t let people see your flaws. I read this article last week written by a
news anchor in Texas who, for years, smiled and projected confidence on TV as he kept
the secret of how he and his sister grew up in squalor, living amidst cockroaches and
dog feces. And I was thinking, how many of us have lived
our lives under a perpetual burden of shame? Shame for our upbringing, for our past mistakes,
for experiences of sexual abuse or assault, for our inner lives, for mental illness, or
simply for who we are… And we present a version of ourselves to the
public, the version we want people to see, but we hide the truths that make us feel unlovable,
the things that make it hard for us to even love ourselves. And so people try to counter that with a message
that you JUST need to love yourself, but then they do THAT in a toxic way. They behave selfishly and call it “self-care,”
and if people complain about their bad behavior, they say things like, “Hey, if you can’t handle me at my worst,
you don’t deserve me at my best!” Which is just a fancy way of saying, “I
don’t want to be held responsible for the impact my actions have on other people.” Meanwhile, studies show that we’re getting
lonelier and lonelier. And our always-on internet connections and
always-available social media aren’t helping matters. And they’re not helping us get closer to
the truth either. We live in this Information Age where— You know, before, we got information in little
bits. Right? Like little drops of water, take what you
can get. And maybe you might believe some falsehoods
that come from well-meaning trusted sources. But that was the way information came. You got information where you could. And as the internet started to open up, we
started to have access to this little stream of water, where we had access to more information
but still plenty of time to fact-check it. Now there was no excuse for being wrong about
checkable things because you could just search for the right information. But now we have not a stream of water but
a firehose of water. It’s like that scene in the movie UHF, those
of you who ever saw that. Where he opens up the firehose— Yeah, okay, thanks to the one UHF fan. This guy’s got a children’s TV show and
he says, “Now you get to drink from the firehose!” And the kid comes up and he opens up the firehose
and the kid shoots across the room. It’s way too much for anybody to consume. And so there are plausible, true-sounding
arguments for just about anything you want to believe. So we all just search for whatever we want
and truth is lost amid the noise. I think the church ought to be a purveyor
of truth in the world. A trusted source in the midst of
that firehose of information. But how do we stand out amid the noise? I think one of the ways we can do that is
to invest in people emotionally. This generation invented the term “ghost”
because for the first time, technology made ghosting a regular widespread phenomenon. People just disappear because there are always
more people waiting. Social media…I mean, normally you might
think social media would make us less lonely. But the thing about social media— Actually, um, speaking of which, I need to
Instagram this. Hang on a second. [laughter] [continued laughter] Uh, Matthew, wherever you are, you want me
to tag you in this? Go ahead. I‘m—
Keep talking, I’m listening. Yeah, keep talking, I’m listening.
I‘m listening. Reformation Project…speaking at the Reformation
Project…Conference… #nofilter Okay. So. [applause] So anyway, the thing about social media… Oh, I got likes already. I’m listening. No, I love my phone but these things become
addictive. And it leads to a fake kind of connection. Our attempts to connect make us more lonely. Because it’s shallow. It’s like being thirsty and drinking gallons
of saltwater. And it just makes things worse and worse and
worse. The thing that you think is going to help
you is slowly killing you. What kills me though is that the church has
something to offer to address all of these things. And yet we’ve lost our salt and light in
the world. We’ve become known for so many bad things—for
the anti-gay pastor who turns out to be gay, the trusted leader who was abusing members
of the flock, the hypocrisy, the self-righteousness, the ex-gay movements…. …that for so many of us, the world out there
and the folks in here, the church is no longer a safe space. And so people are leaving. They’re falling away. Years ago, back when I was in middle school,
so a lot of years ago, I had a math teacher who knew that I was a
math geek, and he gave me this sort of extracurricular problem. And it was this algebra sort-of proof. He started with givens and then ended up with
“one equals two.” And I’m like, “I know that can’t be
right. One doesn’t equal two.” And so I went through every step of the problem. But it all seemed right. So I went through every step of the problem
again. Every step made sense. “Yeah, you add to both sides, subtract from
both sides, you multiply, you divide. You do this, you factor it, and… one equals
two.” I couldn’t figure it out. Imagine if we gave people that problem and
they said, “Well I know one doesn’t equal two, so clearly math is bunk.” “The answer’s wrong, so…I’m giving
up on math.” “Clearly you can make math say whatever
you want it to say.” And the danger is we start to believe it. But here’s the thing. Math isn’t the problem. Math is the solution. The solution to bad math is better math. And I finally figured out where the trick
was. It involved division by zero, for the math
geeks who really care. But it was a cleverly disguised division by
zero. The math wasn’t the problem. It was that the math was being applied incorrectly. Jesus isn’t the problem. Jesus is the solution. But misuse of Jesus is the problem. Because you misuse the name of Jesus often
enough and eventually people stop trusting the name. I believe Jesus is the Savior of the world,
and that matters, because even when our fellow Christians let us down, Jesus is the answer
to all of these questions. What Christ offers is not simply one more
option in a never-ending list of competing life philosophies. Jesus says, “I am the vine; you are the
branches. If you remain in me and I in you, you will
bear much fruit; apart from me you can do nothing.” I think about— My favorite Pixar film is
Ratatouille. I love Ratatouille. The little rat is up in the guy’s hat and
like secretly controlling him, because the rat can cook and the guy can’t. And the guy is the vessel by which the rat
cooks. But eventually, the guy starts to think that
all of the acclaim people give him is true. And he leaves the rat by the side of the road. But he’s not the cook. He’s not the chef. Remy the rat is the chef. It’s the Holy Spirit— I don’t know why I compared the Holy Spirit
to a rat. Ignore that. [laughter] It’s the Holy Spirit working in us that
people need to see. [applause] Instead of saltwater that takes more than
it gives, Jesus offers us living water: Forgiveness of our sins, salvation for our
souls, but also a quenching of the deepest longings of our hearts in the here and now;
God with us, bringing peace and joy and all the rest of the fruits of the Spirit. And you know, we’re saved by grace through
faith, not by works. But this doesn’t absolve us of the need
to do God’s will. Luke 8:21, “My mother and brothers are those
who hear God’s word and put it into practice.” I think how we live as Christians matters. Some people have gotten the impression that
LGBTQ Christians believe that because of grace, God’s commandments don’t apply to us. But Jesus came to fulfill the law, not to
abolish it. And that’s not our message; the point is
that we believe the Bible doesn’t condemn being LGBTQ, and for those of us on Side A
like The Reformation Project, we believe the Bible also doesn’t condemn same-sex marriage. And we have Side B Christian brothers and
sisters who would disagree with us on that. But none of us are saying that God’s commandments
don’t matter; they do matter. How we live matters. So how do we live? Well, that would be a whole talk in and of
itself, right? A whole sermon series. That could be Torn 2. But Micah 6:8 says, “What does the Lord
require of you but to do justice, love mercy, and walk humbly with your God?” Do justice, love mercy, and walk humbly with
your God. Do justice. We’re called to do justice, not just
not do injustice. Not just to sit by on the sidelines like the
person who buried his talents in the sand and gave them right back to the master. You remember that parable? No, we’re called to invest.
To DO justice. To get involved.
To make a difference. To put more justice into the world than was
there when we started. That’s a big part of what The Reformation
Project is about. It’s a big part of what it is to be a Christian,
to be DOING justice in the world. Doing justice is about investing something
temporal (our time and talents and money) in something eternal (people, whom God loves). Storing up our treasure in heaven. And we’re called to do justice with boldness
and audacity. Jesus tells this story in Luke: “Suppose
you have a friend, and you go to him at midnight and say, ‘Friend, lend me three loaves of
bread; a friend of mine on a journey has come to me, and I have no food to offer him.’ And suppose the one inside answers, ‘Don’t
bother me. The door is already locked, and my children
and I are in bed. I can’t get up and give you anything.’ I tell you, even though he will not get up
and give you the bread because of friendship, yet because of your shameless audacity he
will surely get up and give you as much as you need.” “Shameless audacity.”
I love that. That’s the NIV rendering. The NASB says “because of your persistence.” The ESV—this is maybe my favorite one—says
“because of your impudence.” [laughter] But notice, the reason the hero of the story
is being so “impudent” is to care for another person. Not, “Hey, knock knock knock, wake up and
give me some cake because I’m feeling a craving coming on.” No, “This other person needs bread; I don’t
have it but you do. Will you give it to me to give to them?” That is a key message for allies. And you know what? All of us are allies of someone. [applause] So we’re called to do justice and then we’re
called to love mercy. “Love” is, I think, a higher order than
“do.“ We’re not just called to DO mercy, but to
LOVE mercy. You know, you can do something but do it begrudgingly,
because you’re required to, but when you love something, you’ve got to be passionate,
you’ve got to be all in for it. And we’re called to love mercy, to be all
in for mercy. And when we truly love mercy, then our every
action, our every fiber of our being should be infused with mercy. Because God has been so merciful to us that
we can’t help but show mercy to others. To those who hurt us. To those who still need to grow and learn. To those who are sinners, just as we are. Done improperly, done the world’s way, justice
and mercy seem to be opposites. I think part of the problem with “cancel
culture” is that it is so often justice without mercy. But the hero of Jesus’ story about the bread
is persistent in what he asks for but doesn’t treat the person inside the house as the enemy. The person says, “Friend, give me this bread.” Not, “You jerk, get up!” You can’t change people’s minds by treating
them as enemies. Mercy means treating people with lovingkindness,
but it also means forgiving those who have wronged us. And you now, that may be one of the most scandalous
things Jesus teaches. Because that’s not how our favorite stories
normally work. You know, in all our favorite Disney classic
films, the villain usually meets a violent end, and we want the real world to work that
way. One of my favorite moments in one of my favorite
films, The Princess Bride… [cheers] …is where Fred Savage’s character, the
kid who’s hearing the story of The Princess Bride, interrupts his grandfather, telling
the story, and says, “Wait a minute.
Who kills Humperdinck?” His grandfather says, “I don’t understand.” He says, “Who kills Prince Humperdinck?”
(The villain of the story.) “Who kills Prince Humperdinck? “At the end! Someone’s gotta do it.
Is it Inigo? Who?” And his grandfather says, “Nobody. “Nobody kills him.
He lives.” And Fred Savage’s character says, “You
mean he wins? “Grandpa, what did you read me this thing for?” We want to see the worst possible thing happen
to our enemies. In the Old Testament, we see David and others
longing for vengeance. “God, smite these people!” And then Jesus comes along in the New Testament
and says, “Love your enemies. Pray for those who persecute you. Forgive as you want to be forgiven.” Jesus says it, the writers of the epistles
say it, we hear it over and over: Love those who don’t treat you with love. Nobody kills Prince Humperdinck. It’s God’s will that Prince Humperdinck
would be forgiven in the end. Now Prince Humperdinck does at least get humiliated
in The Princess Bride. We like the idea of that. But Jesus suggests that the true happy ending
is one where the villain gets forgiven. And that’s one of the hardest teachings
in Christianity. And that, not the LGBTQ stuff, should be the
real reason people get frustrated with Christianity. There’s a scene in a recent episode of The
Good Place, where a character says— Ah, not as many woos as The Princess Bride. Sorry. Where a character says, “When people like
him are ignorant jerks, why are people like us asked to forgive him?” That’s the question the secular world asks. It’s a reasonable and compelling thing to
ask from the world’s perspective, but Christianity says God has a different perspective. Because God sees how far all of us are from
righteousness. But God also sees the good in us. God loves us. When the Bible tells us that all of us are
sinners, the point isn’t for us to go around feeling terrible all of the time; the point
is to give us the perspective that we need to recognize how much God has loved and forgiven
us, in large part so that we can love our fellow sinners. Now, I’m not saying no one is a villain. There are people who intentionally cause harm
to others, but if we treat everyone we disagree with as villains, we run the risk of being
the equivalent of the boy who cried wolf. The LGBTQs who cried “problematic.” And even with the worst villains out there,
God doesn’t give up on them. But mercy must go with justice. Jeremiah 6:14 says, “They have healed the
wound of my people lightly, saying, ‘Peace, peace,’ when there is no peace.” We don’t want to ask people to be “healed
lightly.” You ever had someone wound you deeply and
then ask you to move on as if no wound occurred? Mercy without an eye toward justice is cheap
grace. And yet it’s so easy for use to use that
“peace, peace” passage to justify not forgiving those who have wronged us. But we’re still called to forgive. Because that’s an Old Testament passage
and Jesus shows up in the New Testament and says, “Spoiler alert: mercy wins in the
end.” We’re still called to have mercy, even when
it’s painful. Even when there is no peace. But Jesus was not preaching cheap grace. Jesus understood that to show mercy to one
who has done you wrong exacts a cost. And Jesus said, “I’m going to show you
what it looks like. “Because I’m going to let you kill me. “And with every lash of the whip and every
degrading humiliation and every pound of the nail into my flesh, I’m going to show you
what God’s grace looks like.” In a world where everyone is a victim, everyone
is holding a grudge and pointing a finger, Jesus teaches us this painful, costly, powerful,
redeeming grace. And that is what the world needs to see from
us. And let me tell you something. The LGBTQ people in this room who have been
hurt the most, and all of us who have been hurt the most by the church, are in the best position
to show the world what that grace looks like. [applause] Do justice, love mercy, walk humbly. Walking humbly to me suggests that our daily
lives should be characterized by humility at all times. You know, we live in a culture of self-promoters,
and yet we are called to serve others, as Jesus washed the feet of those who were beneath
him and told his disciples to do likewise. Matthew mentioned earlier this weekend his
friend and mine, Rachel Held Evans. I was at Rachel’s funeral. Rachel was a very good friend to me. Rachel always was willing to take time out
of her day to offer encouragement. I found out after she died that she had a
sticky note on her exercise equipment to pray for me on a regular basis. For me personally. Rachel was way more famous, way better known,
had way more demands on her time than me. And I got to this funeral, and I met so many
Christian leaders there. And every one of them had a story about how
Rachel was like one of their best friends. For all of the ways in which Rachel got public
acclaim and worked social media well and wrote these books and did all these great things,
she took even more time to care on a one-on-one basis for so many other people, in a way that
she never expected to be public. And all of these other leaders, who were struggling
with all these other things in their own lives, had so many stories of how Rachel had been
there for them and supported them and loved them and shown them grace. And never made them feel like a burden to
her. And I truly do not know how she made time
for it all. But that’s who I want to be. That’s what it looks like to walk humbly. Walking humbly also means that we all have
to be open to correction. A lot of us have been so burned by folks in
the church telling us the things that were “wrong” with us that we get like this
sunburn where even a light touch feels like an assault. And so we don’t want any correction ever. But you know, at some point, we’ve got to
heal from that and move on and get to a place where we can accept healthy correction from
our church. We need our church to offer us boundaries
that the secular world doesn’t and help us figure out how to do all this well. We need to be sensitive to the needs of those
who have been burned and hurt by the church, but then we also need to figure out, how do
we heal? So we do justice and we love mercy and we
walk humbly, and that’s not the end. The end says, “Walk humbly…with your God.” We’re so used to hearing that, I think
it’s easy for us to not think about what a powerful phrase that is.
“Walk humbly with your God.“ I mean, imagine if I said to you, “Hey,
could you do this task, I need you to do this thing. Could you do this
thing…with Meryl Streep?” [laughter] “I’ve got a little thing, if you don’t
mind doing this…with Beyoncé. She needs some help.“ The God of the Universe says, “I want you
to do this…with Me. I’m gonna walk with you.” And that should give us both the humility
of recognizing that we are in no way worthy to walk in the presence of the Creator of
the universe, except through Christ… …and the confidence of knowing God has our
backs. And LGBTQ folks, we need that confidence,
because we need to recognize something important: We are not standing outside the church knocking
on the door, hoping someone will let us in if we’re persistent enough. We already are the church. We already are the Body of Christ. [applause] We are the salt and the light. And the eye cannot say to the hand, “I don’t
need you.” Jesus says, “Whoever believes in me, as Scripture
has said, rivers of living water will flow from within them.” Some translations say, “from out of their
hearts.” John continues: “By this he meant the Spirit,
whom those who believed in him were later to receive.” So the living water Christ gives us isn’t
only to quench our thirst. It’s also to flow out of our hearts and
into the lives of others. At the end of the day, when we put Jesus at
the core of it, not relying on the church that has sometimes
gotten it wrong, not relying on the secular world that sometimes
exhausts us to tell us how this is supposed to be done… When we put Jesus at the center of it, Jesus
says in Matthew, “Come to me, all who are weary and heavy-laden, and I will give you
rest.” If you’re exhausted, hear that message this
morning. “Come to me, all who are weary and heavy-laden,
and I will give you rest.” There’s this beautiful illustration in another
one of my favorite films, Contact. If you haven’t seen it, with Jodie Foster
and Matthew McConaughey, it’s a great film. And if you haven’t seen it, go see it with
no spoilers. Don’t read about it, don’t watch the trailer. It’s such a good movie to just go in blind. It deals with science and religion. The main character is a scientist who is also
an atheist but she’s pursuing the idea of life in outer space and she meets this religious
figure— He’s, it’s… You know, he doesn’t always behave the way
that I would hope that he would, but it’s a Hollywood film. But… He challenges her on this: “You don’t
believe in God but you believe in this other stuff you also have no evidence of.” And there’s a moment in this film where
a new, important piece of equipment has to be built. And the ones doing the building are not the
ones who did the designing. And the builders notice that in the original
design, the safety features are apparently not up to code. And so they add a piece to this machine for
safety’s sake. But when they fire up this new equipment,
something is not working right. And it shakes and shakes and shakes and it’s
terribly uncomfortable to use… …until the piece that they added, this extra
piece, this extra burden piece for safety, this piece that they added falls off. And then everything works smoothly. When we go and add burdens onto people that
God didn’t give them to begin with, we find that things don’t work the way that they’re
supposed to. I challenge people— In Genesis 3, I’ve talked about this before,
but people challenge me that, “Well, in Genesis, the serpent says, ‘Did
God really say…?’ “And Justin, that’s what you’re doing,
you’re questioning the words of God by being an affirming Christian, saying, ‘Did God
really say…?’” But if you go and read the passage, what the
serpent says is, “Did God really say… …that you couldn’t eat from
any tree in the Garden?” And the answer to that is “No!” God didn’t say they couldn’t eat from
ANY tree in the Garden; God said, “Don’t eat from this one tree.” The serpent wasn’t questioning the words
of God; the serpent was subtly adding burdens and making God seem unreasonable. “Did God really say you couldn’t eat from
ANY tree in the Garden? How unreasonable is God!” When we as a church put extra burdens on folks,
things don’t work the way they’re supposed to. And some of us have spent a lot of years apologizing,
feeling like we have to escape from these burdens on a loophole, but secretly feeling
like if we were stronger and more able to cope, we would be able to fit within the stricter
rules. But Jesus doesn’t offer that kind of burden. Jesus says, “I want to take these burdens
off of you.” So if you’ve been carrying that burden… As we close, just close your eyes for
just a moment. Whatever burdens you’re carrying, whatever
that tension that is that you’re feeling… The exhaustion… The feeling of not living up… The frustration with the world… The feeling that you have to somehow carry
it all on your shoulders… I want you to hear this morning that God loves
you. That God knows about that thing that you are
frustrated with… That thing that you feel shame about,
whatever it is… God knows about it and God loves you… And God knows your burdens… And God wants to give you rest. Take a deep breath and feel that rest. And as God lifts those burdens off of you,
God says, “Let me take you where I want to send you. “Let me use you. “Let me put people in your path and give you
opportunities to change the world, one person at a time. “And you may suffer. “And there may be a cost. “But trust in me, and I will keep renewing
your spirit. “Do justice. “Love mercy. “Walk humbly with your God. “For my yoke is easy and my burden is light.” Amen. [applause] Thanks for watching. For more,
subscribe on YouTube and visit GeekyJustin.com.

Oscar Höglund, Epidemic Sound – NOAH19 Tel Aviv

Oscar Höglund, Epidemic Sound – NOAH19 Tel Aviv


So, my name is Oscar the co-founder of And I love my job. I have the best job in the world and It’s made quite easy because we’re a company on a mission. We’re in a mission to soundtrack the world and We used to have a smaller mission which was soundtrack the Internet, but that turned out to be a bit easier I found myself like 10 years ago having this vision where my grandkids were sitting in my lap and saying that granddad granddad Your generation you invented the internet, right? And I go yeah, that was us and the grandkids goes. So what was your contribution? and prior to that I was BCG consultant I did television I did other stuff But I had nothing to do with the Internet and I decided that I want to be able to tell my grandkids We soundtrack the Internet and this is how it went down. So Initially we defined ourselves as a music company but as we’ve grown now, we tend more to talk about are two different networks that we have and We have two sides of our business on the one hand. We have our customers and we call them storytellers People subscribe to our service because they have incredible stories that they want to tell We turned ten this year and we have over a million customers around the world And the way we see them is that we’ve come to a point now where our customers in their own right create massive Distribution for our music so our music just on the online video platforms gets played 250 million hours every single month so tens of billions of interaction every single month and The storytellers who use our music they vary from the very very big to the really really small So if we have sound with us, this is what it sounds like when youtubers use us on a daily basis We got no mic on this, but I’m pretty cool right now, I can’t feel my fingers I can’t feel I can’t feel anything. We are in the middle of nowhere in Sweden. We’ve been taking photos all day a little bit I’ve been asked to keep it short. So this is what it sounds like when Hollywood studios use our music They oh and you can talk content without mentioning that public enemy number one in the United States is drug abuse The cartel is controlled everything from the plea So we’re sound tracking millions of million stories across the world from the smallest youtuber to the biggest Storytellers of our time that’s one side of our network The other network is the network of musicians of creators who create incredible tracks that not only power their careers But power the careers of the storytellers Currently we have something like 400 hits So we define a hit as when a track has more than a million streams on Music streaming services like the Spotify and the apples and the diesels of the world And that music sounds a bit like this Put a Russian Neutron make your comfortable So we come a 200 different genres in the interest of time. I’m gonna keep this a bit short skip on I Think you get their picture So, how do we get to the point where were more or less sound tracking the entire Internet Well, we reinvented stuff and we identify two major problems from a storytelling perspective They wanted to be able to find great music to bring their stories to life But this was made very very difficult Because there wasn’t a legal model that worked the one any products which scaled to the needs that they had There wasn’t any music that was adaptable that you could use in the visual stories that you wanted to tell There was a financial transaction which didn’t make sense there was reporting which was really really inhibiting so the system didn’t work and so weary engineered everything we built a music industry of our own but we didn’t invite the Piero’s the Publishers the traditional let record labels because using technology we didn’t actually need their help The other side of the equation was looking at musicians how would their lives changed and how can you make their lives much much better? And we realized that people didn’t want to be paid based on an album You wanted to be paid based on a track that you wanted to make you wanted a flexible contract You wanted upfront payments you wanted the opportunity to collaborate without the musicians you wanted freedom You want it to be a digital Nomad in the sense of being a creator that could own your own decisions? And so we changed that as well When stuff started getting really interesting was when we saw how can we start to link these two different sides of equation together? Is there a network effect that we can start to build around this? I’m gonna play you a short video Now that illustrates what happened when stuff went totally ballistic and we became public enemy number one in the entire music industry Volume We tried again I’ve been feeling so small Watch the clock ticking off the wall But tonight up let it go Spend my coin for show I’m gonna beat myself to be someone else. No stop I’m gonna skip my break we’re gonna make mistake. I just wanna feel bad It’s just what I do when I Because it turns out the number one question on all YouTube videos across the entire world is I love the track you used in the Video, why can’t I find it on Spotify? These are Apple? I want to listen to it when I work out when I do my homework when I go to a conference and I have to Listen to Oscar and so what we did is we identified that and so we took our tracks and we put them on to the music streaming platforms a bear in mind that our music gets played roughly about 40 billion times every single month across Facebook YouTube and Instagram Number one question is where can we find that music? So we started providing links to the online creators in this case. It’s a 15 year ago called athma who uses one of our tracks faster car as the intro to all of her vlogs that she used to upload this on youtube and We started seeing millions of people clicking on these links. So we start seeing tens of millions of plays on Apple These are Spotify and all these different music streaming platforms there was Tons of revenue suddenly coming into us because there was so much royalty due for all this music that was being placed on the music Streaming platforms. We took that revenue. We split it 50/50 with the with the musicians historically that had not been the case normally Labels and publishers would take about 85 percent of the revenue and the artists would get much much less But we split everything 50/50 despite the fact that we already paid upfront for the music so suddenly we were turning out Enormous amounts of money to the creative artist industry and the record labels and the publisher went ballistic Because they’d never heard of us before because we’d been busy sound tracking the internet for 10 years So everyone on the internet knew exactly who all are musicians and who all the stars were but the music industry was totally taken aback by this We found ourselves evolving our business model because suddenly our musicians were now becoming artists in their own, right But they didn’t have digital online profiles because they’ve been busy making music for the Netflix and for the Hulu’s and for the online visual Storytellers. So now we were starting to launch artists So we helped them launch artist careers and social and some how do you present yourselves and build build your following? We’re now at a point where we’re looking at how do we balance these two networks? Which one do we focus on do we focus more on the online craters or on the music craters? And the answer is that they’re one and the same there’s been a generational shift. So they all define themselves as creators So what they’re doing now is we’re starting to see how they can collaborate with each other Drive traffic drive revenue drive understanding and this is a short clip showing two of the biggest Youtubers within fashion collaborating with one of our musical artists and how they start making content together Hey guys, so we just got to the studio we’re here with yeah She’s the pretty server highlighting and we were talking about earlier super dope. I can’t wait to like see you to yourself Hey guys, what’s up? So we’re here with Sarah. She Actually makes beads for epidemic sound and we’re obsessed. Yeah, we’re so happy to Finally meet you and just like see your creative process and stuff. We’re gonna go make our own beat Let’s do it’s called a native instruments maschine. Yeah, it’s actually based from Germany, but I really like it because We’re gonna end on that note thank you for listening to me. I’m spoken about epidemic sound and we’re sound tracking the world by You

Contagion | 1 of 5 | Infectious Disease || Radcliffe Institute

Contagion | 1 of 5 | Infectious Disease || Radcliffe Institute


[MUSIC PLAYING] – Good morning, everyone. It’s great to see you all here. I’m Liz Cohen. I’m Dean of the Radcliffe
Institute for Advanced Study. And I am so pleased to welcome
you to our annual science symposium which focuses
our attention this year on modern epidemics. Radcliffe is Harvard’s
Institute for advanced study, and we have a two-fold mission. We are dedicated to advancing
deep inquiry and pathbreaking research that cuts
across the boundaries of traditional
academic disciplines. And we are also
committed to sharing this multi-disciplinary
work with a broad public through a full calendar of free
events like today’s symposium. I am especially glad to
have science teacher John Ruggiero and his students
from Eugene Wright Science and Technology Academy in
Chelsea here with us today. If they’re here,
would they wave? Have they come? There they are. [APPLAUSE] It’s never too soon to
come to an event like this. Epidemics is an ideal topic for
interdisciplinary exploration. Today, we will probe challenges
and innovations in epidemiology with the help of
epidemiologists, data scientists, physicians,
journalists, public officials, infectious disease
researchers, and sociologists from across the United
States and around the world. We at the Radcliffe
Institute are particularly proud of our long tradition
of supporting programming and research in
the sciences, not only at an annual
symposium like this one, but throughout the year. For example, we have an
ongoing lecture series on epidemics that complements
today’s symposium. Last week, Dean Sandro
Galea of the School of Public Health at
Boston University delivered the first installment
to a standing-room-only crowd. In the spring, we will continue
the series with lectures on fibromyalgia, poverty,
obesity, and Alzheimer’s. For more information on these
and other upcoming events, please visit the Radcliffe
Institute website or take one of
our calendar cards which are available at the
back of the room or downstairs at the registration table. All of Radcliffe’s
events are made possible by our supporters, many of
whom are here with us today. And I’m particularly
happy to see members of the Radcliffe Institute’s
Dean’s Advisory Council this morning. Thank you all for
your generosity which ensures that
we can continue to make our lectures,
our exhibitions, our conferences like today,
and many other aspects of our programming free
and open to the public. Now, today’s topic
is urgent and timely. Our panelists will offer
insight into the science and the social roots
behind the epidemics that we read about
on a regular basis, from Ebola, Zika, HIV/AIDS,
malaria, and Lyme disease, to gun violence, opioid
addiction, and depression. We all come to this subject
with our own perspective. As an historian,
my orientation is to locate events in the larger
social and historical context in which they arise. Whether an epidemic unfolds
during China’s Tang dynasty or amid preparations for the
Rio Olympics just last year, a society’s response to
a fast-spreading illness is shaped not just by the
capabilities and limitations of medical science at that
particular moment in time, but also by complex social
factors such as race, class, gender, and religion. For an historian, epidemics
can provide a revealing window into a society at a
particular moment in history. Let me give you one example
from our own backyard here in Boston, the smallpox
epidemic in Boston of 1721. By the 1700s,
smallpox inoculation had been practiced for
centuries in parts of Africa, as well as in
China and in India. In colonial Boston,
however, the practice was virtually unheard of. That changed when an enslaved
man, called Onesimus, told the Puritan religious
leader, Cotton Mather, about a practice common among
his tribe in North Africa, a procedure that protected
him against smallpox, leaving only a small scar on his arm. A few years later, when
a smallpox epidemic broke out in Boston
in 1721, Mather recalled Onesimus’s words. And he became an outspoken
advocate for inoculation. Many white Christians
in Boston mocked Mather for relying on the
testimony of an enslaved man and denounced inoculation for
its roots in Africa and Asia, calling it a heathen practice. Other Bostonians simply
rejected the idea of deliberately infecting
healthy people with a disease. By August of 1721,
the controversy had become so heated that
someone threw a grenade through Mather’s window. The grenade didn’t
detonate, but Mather found a note attached
to it, which read, and I quote, “I’ll inoculate you
with this with a pox to you,” end quote. A few Bostonians did
support immunizations, including Dr.
Zabdiel Boylston, who would go on to perform
America’s first inoculations on his own child and
two enslaved people. But Mather’s appeals
were largely ignored. Smallpox spread unchecked. And by the end of the
epidemic in 1722, over half of Boston’s population
had fallen ill. More than 800 died. The story of Boston’s
smallpox outbreak reveals much more than
the spread of a pathogen. It is a story about racial
prejudices in colonial New England, about the rigidities
of Boston’s society, and about the
forgotten contributions of enslaved Africans to
American medical practice. Still today, how
epidemics unfold around the world is shaped by
complicated interactions between medical advancements
and the social and political factors that inform
and complicate the work of epidemiology. 50 years ago, many
scientists considered the age of infectious
disease to be over. The rise of antibiotics
and vaccines was considered a triumph
of modern medicine. But today, diseases
we thought were gone seem to be reappearing. For example, mumps
went from being common to being unheard
of after the introduction of the measles, mumps, and
rubella vaccine in 1971. But it has returned to Harvard
and elsewhere in recent years. Other contagious diseases
are also on the rise, thanks in part to globalization
and global travel, environmental change, population
growth, and many other factors. In addition, we are increasingly
aware of non-infectious disease epidemics, often with
complicated social roots. We will explore these topics
during our afternoon session today with experts on guns,
opioids, and mental health. With all of that
in mind, I am very grateful that today’s symposium
will offer us a chance to wrestle with these
complex issues which are no less urgent and
less challenging today than they were in 1721. Today, however, we are
armed with big data, new analytical tools, new
technology, and new expertise, which our distinguished
panelists, I am sure, will bring to bear. Here’s how the day
is going to work. Professor Janet Rich-Edwards,
the symposium’s organizer, will offer framing
remarks in just a moment. And then we will dive
right into the first panel. After each panel or
individual speaker, we will open the floor
to your questions. We’ll put a microphone
in the center aisle. We invite you to step
up to introduce yourself and then to ask your question. During the lunch
break, I invite you to pick up a bag lunch, which
we will have available for you downstairs, and then to
join us for a student poster session next door in Fay House. Students from the Harvard TH
Chan School of Public Health, Harvard Medical School, the
Faculty of Arts and Sciences, and the Division of
Continuing Education will be present to
share their research with you, with our speakers,
and with other guests. The poster session
will be open as well during the reception, which
will also be in Fay House at the conclusion of
today’s symposium. And I very much hope you
will stay and join us for that as well. Finally, I want to
express my deep thanks to Janet Rich-Edwards
for organizing such an outstanding symposium. Janet is Radcliffe’s Faculty
Director for the Life Sciences, as well as an alum of Harvard
and Radcliffe colleges. She is an epidemiologist with
dual faculty appointments at Harvard’s Medical School
and the Harvard TH Chan School of Public Health. She also serves as director
of developmental epidemiology at the Connors Center for
Women’s Health and Gender Biology at Brigham
and Women’s Hospital. So, please join me now in
warmly welcoming Janet. [APPLAUSE] – Thank you, Liz. I am so thrilled to
see a full house today because this is going to be
a really exciting program. I’m going to take just a few
minutes to frame the agenda and give you some context
for our young science of epidemiology. Chances are when you
think of epidemics, you think of infectious disease. And indeed, you’d be correct
that the roots of epidemiology lie in concerns about diseases
like the bubonic plague, cholera, and the flu. These diseases
have long captured our imagination and our fears. Here is a 17th century
painting by Flemish artist, Michael Sweerts of one of the
first epidemics ever recorded in history. The date is 430 BC,
and we’re in Athens, in the middle of the
Peloponnesian War. 1/3 to 2/3 of the
city of Athens was struck by a strange disease. And most who became ill died. Thucydides, the
historian, himself survived to describe
the epidemic, a disease so severe and
deadly that no one could recall anywhere it’s like. And naive physicians were
the first to contract the disease due to their
contact with the sick. Thucydides recounted tales of
terrifying social upheaval, of the disappearance
of social morals, because people felt they were
living under a death sentence. Citizens started spending
money indiscriminately. Plus, some of the
poor, he noted, unexpectedly became wealthy
by inheriting the property of their relatives. Got to watch out for
those nouveau riche. [LAUGHTER] In fact, the disease
changed history. Although the Spartans,
seeing the funeral pyres burning in Athens,
retreated rather than come in contact
with the disease, Athens itself was weakened. Pericles, the general,
succumbed, and was followed by a series of weak leaders. The next offensive Athens
launched was a disaster. But Thucydides was
no epidemiologist. So the cause of the plague
of Athens was, and still is, a medical mystery. Epidemiologists today debate
what caused the epidemic, whether it was the
bubonic plague, typhoid fever, or
perhaps even Ebola. It wasn’t until the
mid-18th century before Westerners began to take
a systematic look at epidemics. John Graunt, here, the
son of a London draper, had a native curiosity and
a knack for statistics, and made his way into the
Fellowship of the Royal Society. He published the first analyses
of the bills of mortality, London’s death registry. Here’s what he recorded for
December 1742 to December 1743. The leading causes of death, you
can see here, are convulsions, which I’m wondering if
that might be heart disease because it’s so prevalent;
consumption, which, of course, we know of as tuberculosis–
see if I can see this here– fever, no surprise,
old age, smallpox– they apparently hadn’t
heard of the vaccine yet– and, horribly, teeth. I think that must be a
terrible way to go, frankly. Conspicuously absent are our
modern diseases– cancer, only 61 deaths, and
diabetes, one death. In fact, you were more
likely to die from evil than you were from diabetes. [LAUGHTER] Some exotic
diseases, including– I can’t read that from here– headmold shot, horseshoe
head, and water in the head. And my favorite, I
think the only way to go is a rising of the lights. [LAUGHTER] John Graunt made these
lists in an attempt to predict waves of the
plague, which he didn’t quite manage to do. But he’s the father of
the most fundamental of epidemiologic tasks,
the classification and counting of disease. Some hundred years later
in London, John Graunt would be followed by one
John Snow, a physician. Now, the epidemiologists
in the audience would be permitted
a collective groan because this story is the
equivalent of our Washington and the cherry trees. This is our first known
use of medical statistics to actually resolve the
cause of an epidemic. It focuses on a particular
neighborhood of London which was experiencing
an outbreak of cholera. At the time, the advice
of the Medical Council was to avoid vegetables
and unripe fruit and to abstain from cold water
when heated and ardent spirits, unless, of course, habit
made that impossible. In fact, boiled water
and ardent spirits may have been the safest
beverages in London to drink at the time. But the prevailing theory
among the people of London was that cholera arose
from miasma, or vapors from the Thames. This is 1854 London. And although the
concept of germ theory had been proposed by Wu Youke
at the turn of the 16th century in Ming Dynasty
China, in 1854 London, the germ theory of
disease wouldn’t grab hold for another 50 years. John Snow took it
upon himself to obtain a map of the effected district
and to plot every cholera death on that map. This is what we call
shoe-leather epidemiology, the close, geographic
investigation of outbreaks. The basic principle of
shoe-leather epidemiology is one we still
use, whether we’re tracing syphilis contacts,
the spread of Ebola, or investigating the
quintessential foodborne illness we classically call
the church picnic problem. John Snow went one step further
than just mapping the cases. He also mapped the lines that
supplied London’s drinking water through
neighborhood pumps. There were two companies
supplying water to the neighborhood. The Lambeth Waterworks,
here in blue, drew its water upstream from
the London sewage effluent in the Thames, while the
Southwark and Vauxhall Company, shown here in gold,
drew its water downstream from the Thames sewage. Snow traced the source
of cholera to the latter, and in particular, to a
hand pump on Broad Street. Now, you might ask
about the women who died from cholera– those
who lived next door to a pump from the cleaner Lambeth line. Turns out she had just moved
there from Broad Street and sent for water daily from
the old Broad Street pump because she preferred its taste. Famously, John Snow removed the
handle of the Broad Street pump and cured London of cholera. He’s considered
by most Westerners to be the father of
modern epidemiology. Here is a map of modern London. And you could still visit
the old Broad Street pump– it’s now Broadwick Street– which is located right between
the Anthropologie store and Chipotle Mexican Grill. [LAUGHTER] But the second greatest
plague the world has ever known– the first was
actually the Black Death, the plague itself, bubonic
plague in the 14th century. The second greatest plague
is the influenza of 1918, also known as the Spanish flu
It swept the globe, infecting nearly a third of all people
and killing between 20 and 50 million, more than died
in all of World War I. Downton Abbey fans
will recall that the Spanish flu with the
demise of Miss Lavinia Swire. Critics of the show complained
that the entire household of Lord Grantham would
have been gripped in fear of catching the disease. And dear Matthew
would probably not have been quite as
attentive as pictured here. [LAUGHTER] In fact, the decline of
infectious disease mortality due to the advent of
antibiotics and vaccines in the mid-20th century
is one of public health’s great triumphs. You can see here that
diphtheria, typhoid, and whooping cough,
also known as pertussis, declined quickly due to the
DPT vaccine we give children. Measles, too, is
prevented by vaccine, and scarlet fever is
treated by antibiotics. But we are still in
the grip of contagion, including some new diseases
and modern causes of mortality. Can anyone guess
which one this is? Feel free to call out. And if you have a– Zika. Very good. This is Zika. We’ll be hearing today
about the Zika virus from Dr. Celina Turchi
Martelli in the first panel. How about this one? No fair calling it out
if you have funding. – Lyme. – Lyme, exactly. Lyme disease. Dr. Kevin Esfelt
of MIT will tell us about Lyme and some
provocative ways to combat it. This one, which
has local issues– here is our dear commonwealth
2011 to 2013, 2014 to 2016– exactly, opiates. These are deaths
from drug overdose. We’ll be talking about that. Dr. Andrew Kolodny will
join us in the afternoon in a session devoted to
epidemics with social roots. And this one. – Gun violence. – Good guess, gun violence. This his gun ownership. But owning a gun does not mean
you will be injured by a gun. Here, you can see homicides by
firearms per 1 million people. We really– oh, bad choice
of words– trump everybody else in this arena. Dr. Andrew Papachristos,
a sociologist from Yale, will address the application
of epidemiologic principles to understand and combat
the spread of gun violence. The good news is that we have
new tools as epidemiologists. Through our understandings
of pathogens and DNA, we now use techniques with names
like molecular epidemiology and genetic epidemiology,
about which you’ll hear throughout the day. We also have new
techniques of manipulating the genome of disease vectors
like mosquitoes and mice. You’ll hear about the concept
of gene drive before lunch. And after lunch,
the panel will– well, after lunch, a panel
will address the exciting gains and the analytic
challenges of big data epidemiology, where everything
from the legions of bacteria in the microbiome of your
gut to cell phone records can be used to trace,
understand, and predict epidemics. We’ll also discuss
the tension between private and public sector
data and the concept of open science. At the end of the day,
our keynote speaker, Laurie Garrett, author
of The Coming Plague and member of the Council
on Foreign Relations, will address the role of
international politics, of globalization and isolation
in the role of countries responding to epidemics. This is CDC’s list of
the top 10 public health victories of the 20th century. Epidemiology, the young
science, played a central role in achieving all 10 of them. After all, epidemiology is
the science of public health, whether we’re talking
about diseases caused by pathogens or diseases
with pathogenic social causes. I’m excited about the chance
to learn about the coming challenges, and hopefully
victories, of epidemiology in the 21st century. And now, it’s my pleasure
to invite our first panel to the stage. Why don’t you guys come on up? And I will introduce to
you Dr. Marcia Castro. Throughout the day,
we’ll just give really quick introductions. You’ve got in your program
full bios for each speaker. So, Marcia Castro is
an Associate Professor in the Department
of Global Health and Population at the Harvard
TH Chan School of Public Health, and a Faculty Associate
at the Harvard University Center for the Environment. She’s published extensively on
the epidemiology and control of infectious diseases,
environment and health, spatial methods, and health,
particularly in Brazil. Please join me in
welcoming Marcia Castro. [APPLAUSE] – Thanks, Janet. Good morning, everybody. Once again, thank you so
much for putting together an event with such an
incredible and important topic. And our first panel
we will go straight into infectious diseases in
this new era of epidemics. And I think what really makes
it a new era is that we’re not discussing anymore of if we’re
going to have another outbreak. We know we will. It’s just a matter of
when and what pathogen is going to be this new outbreak. We live in a time that
everything moves faster– people, information,
goods, but also pathogens. And that makes it
really challenge when we have one of those outbreaks. And in the very first
moment of an epidemic when cases are going up and
everything is under chaos, we have many challenges
that we have to address. How do you find those cases? How do you contain? Do you have tools to
be able to treat them? How do you deliver
this treatment? Do you have health systems
that are strong enough to be able to be in the
field finding the people and delivering the response? We can’t forget
all the challenges of blending the different
institutions in the government. But also different bodies,
national and international– they’re going to be in the field
of responding to this epidemic. Let’s not forget also
about the ethical and the legal challenges
in prioritizing responses depending on the epidemic
we are talking about. So there are also another
phase that comes afterwards, which is when people basically
say the outbreak is over, which raises the
question, when is it over? Is it ever over? Which is an important one– tends to be neglected, which
is to look at the aftermath. So what happens after
the epidemic is not in the spotlight anymore? What are the consequences? What are the sequela
of the disease? But above all, let’s look
at the social, the economic, and the broad, demographic
impacts of the epidemic. We don’t have much
attention to that, but we are lucky that we do
have some research groups that stay on the ground and
try to bring information about this aftermath when
everybody thinks it’s over, but we’re not quite there yet. So, our panel has
three stellar speakers that will talk a
little bit about this. I’m not going to read their
bios you have in your program. And you should read
because they are terrific. But I’ll give you
an overview of what they are going to touch
upon in those issues that I briefly mentioned. So, we’re going to start
with Dr. Christian Happi. And he’s going to bring how this
top-notch technology that we have now can help us
in those epidemics. So, he’s going to talk
about how genomics can be used for
pathogen discovery, but also for surveillance. Then we’re going to move
to Dr. Anne Rimoin, who has one of those
research groups that actually stay on the ground when
everybody is saying, it’s over. And she’s going to talk to
us about her phenomenal work of tracking the survivors of the
1976 Ebola outbreak in the DRC and share with us
some of the findings that she had about the
long-term effects of the Ebola outbreak, the long-term
sequela that those people are experiencing. Then we are going to
have Dr. Celina Turchi Martelli from Brazil,
who played a really important role in the
Brazilian response to Zika. And in the middle
of all the chaos, she is going to tell us how you
can actually design and conduct epidemiological studies, how
you can foster collaborations between many different
bodies of research– and everybody wants to come
first and be the first one to say something new– and how you actually
promote sharing of data. All those three issues are hard
to do in normal conditions. Under an epidemic, they
are way much harder. So Celina is going to tell us
how she managed to do this. So together, those
three different talks, we’re going to walk us through
three different aspects. So the first one is how we
can mobilize researchers to do the right thing
at the right time and generate much-needed
evidence to be able to respond with the right policies. Second, we’re going to
see how we can better track new and
re-emerging pathogens, leveraging on the very best
technology we have available. And last but not
least, we’re going to see how we can assess
the long-term consequences of epidemic, largely neglected,
but extremely important. So without further
ado, let’s get started. Dr. Happi. [APPLAUSE] – Thank you, Marcia. And also, I want to
use the opportunity to thank the Radcliffe College
Institute for this invitation. So basically, I will
be talking about how we use genomics to characterize
and set up a surveillance system in West Africa and
how this has helped us and especially in
Nigeria dramatically to contain the last
Ebola outbreak in 2014. So, and we do this
within a framework. And that is the African Center
of Excellence for Genomics of Infectious Diseases. And the center is a consortium
of academic and clinical studies in Africa. But in addition to that, we
have partners here, especially at Harvard at Broad Institute,
Tulane University, and then also partnering in the industry. And we work together
with these partners in order to not only
develop genomic technology, but also translate those high
court technologies into tools that enable us to develop
rapid diagnostic tests to track these outbreaks, to track
diseases in the field. So this partnership
is actually built on a very solid foundation
on the strong long-term collaboration between partners. And this partnership, because
of its success as a [INAUDIBLE],, it has attracted
new collaborations within the region. So, and why do we
focus on genomics? Basically because
of one single thing. It’s the fact that the genome–
the whole genome project, and then the sequencing
of various organisms has brought tremendous progress
in the field of health, for instance. And Africa, you know,
really is not participating. And the lack of
participation of Africa is basically due to the
fact that there’s no scale. There’s no know-how. And there’s a huge divide
between the West and Africa. And that’s the
reason why we just decided to use the
genomic approach in order to narrow down the
gap, and also provide a needed knowledge in order
for African scientists to participate in the
genomic revolution. So our mission
actually is twofold. One is educational,
as I mentioned. And that is actually to
create a vibrant environment that is free of
external influence and that transcends
national boundaries in order to ensure relevant,
responsive, ethical, and high-quality genomic
research in Africa. And the specific
aims of the program is actually to develop– you know, train a critical
mass of well-trained African scientists to use
genomic knowledge to address important issues such
as elimination or eradication of infectious disease, and also
to create genomic curricula on the continent to address the
issue of infectious diseases, and also to engage communities
in prevention and public health education. And this particular
aspect of this program that I’m going to be presenting
[INAUDIBLE] the achievement is actually supported
by the World Bank. But the research
component of this program is supported by NIH. And the goal is actually
to use field-deployable, state-of-the-art technology
to identify pathogens driving febrile illnesses. The reason why we talk
about febrile illness is that fever is
actually the denominator for pretty much all infectious
diseases in the continent. In Africa, most of the time,
when you go down to hospital with a fever, the first
culprit is malaria. And after malaria, if
you’re not getting better, they say it’s typhoid. And when you go
through that process, if you have any other infection,
then the disease progresses, and eventually, you end
up in a very bad situation or you end up dead. And we’ve just
realized over the years that malaria is what
I call over-diagnosed and also anti-malaria
drugs are over-prescribed. And that actually
drive the whole process of drug resistance
on the continent. And we’ve heard that there
are many other pathogens circulating around that are
truly responsible for fevers that we see in 60% or 70%
of African patients that find themselves in hospitals. So and as such, this
goal is actually to create a foundation
for Africans to actually carry out
very [INAUDIBLE] research on the African continent. The reason for
creating the foundation is basically because we’ve
noticed over the years that not– I mean, Africans are
really not participating on the research involving
diseases on the continent. Samples are often
shipped out of Africa. And then they lose track. They have no idea of what’s
going on with a sample band. And then the next thing they see
is actually publications out. So, and it is high time
that we can actually set up on the continent facility
to enable diagnosis and enable research so that
Africans can start addressing their problems. These two programs that I
just mentioned, if you see, actually cross in
one particular area, and that is the area
of capacity building in the field of genomics. And what we do with
these two programs is basically to just ensure that
we have genomic teaching labs that we’ve set up
on the continent. Develop that core
diagnostic facility to track infectious
diseases, and then also encourage
sustainable careers among African scientists. Through this program,
with our [INAUDIBLE],, we’ve made some major progress. We’ve been able to add value
to what happens in Africa by reversing the brain drain. I also make what
I call brain gain. We’ve been able to track some
from young Africans in diaspora returning back and then
working together to address these major challenges. So overall, the overall goal
is actually to develop– I mean, to build the next
generation of African pathogen hunters. The reason being
that because we’ve been playing defense in Africa. And I think it’s high time
to start playing offense. We’ve always been at
the receiving end. We’ve heard about it. Zika, malaria, typhoid, Lassa
fever, Ebola virus disease– name it. We’re always at
the receiving end. I believe that now
it is high time to use the knowledge and
the technologies that are available to go down in
the dead bushes of Africa and hunt these pathogens,
characterize them, and of lab diagnosis
against them before they come hunting us. I think it is high time. And that is one of–
that is a major goal, and the ultimate
goal, of our program. So, what are our achievements? I will take you back as just
the 2014 Ebola outbreak. As far back as March
2014 when Ebola was brewing in the [INAUDIBLE]
confinement of Guinea. And the world was looking away. The major health organization
were not bothered about this. We’re very ambitious. I invited a group
of friends of mine from Harvard from
the Broad Institute, from Tulane, and some
other institution. You can see the picture here. We sat in my lab. And we thought that we could
solve the Ebola problem if it ever spread. We were very ambitious. We thought that
with a little skill and knowledge that
we have, we could address that major problem. But there was something that
came out of that meeting. And that thing was we had
a premonition that Ebola was going to spill over. And if Ebola spilled
over, what could we do? We identified diagnosis
as one of the major gaps. And what we did was
actually to go back on the side of
developing diagnostics– better diagnosis
for Ebola, and then train people in Nigeria,
Sierra Leone, and Senegal to diagnose Ebola. And as we rightly predicted, by
May 20, one of the technicians that we trained diagnosed
the first case of Ebola in Sierra Leone. And subsequently,
on July 22, I led a team in [INAUDIBLE] that
knew the first case of Ebola in Nigeria. The fact that we were
prepared and the fact that we were ready, for the case
of Nigeria, that single act, or that single fact
that we had this, was very critical to avert
one of the major health disasters that
could have happened in the history of mankind. That is preventing
the spread of Ebola in the city of 20 million,
22 million individuals in Lagos, Nigeria. We provided a
result within hours. And then we activated what I
call an emergency operation center. I worked with the
government for isolation and the containment
of individuals. And that alone
was very critical. The other thing that
we did was actually what I call
[INAUDIBLE] because we had the technology, because
we believed in ourselves. So when the agencies that
were parachuted in Nigeria– you know [INAUDIBLE]
had control– arrived, we told them that
we knew what we were doing. And then we were able
to contain the outbreak. [APPLAUSE] Interestingly, we went
on in the first three weeks of the outbreak. But we were able to
do this basically because we’ve been able to– we
achieved this feat in Nigeria because we were working on
a pathogen, a Category A agent like Lassa fever. And this agent is also supposed
to be as deadly as Ebola. But we were actually doing
this in [INAUDIBLE] facilities because we devised
ways of working with these pathogens in very
poor and limited-resource cities. And this is what you’ll see
what we’re doing in Sierra Leone and in Nigeria. What we did in
Sierra Leone that was unique was the fact that because
we’ve been working on Lassa fever, when we identified
our first case, we also activated what we call
a contact-tracing mechanism that we used Lassa fever. And they were able to trace
the first case of Ebola in Sierra Leone to a
traditional healer who thought that he had all the
power to do to cure Lassa, not to cure Ebola, and
through that process, was spreading that
across the region. But what we did in the
process was for the fact that we were actually
using– doing some research and then understand use
metagenomics, for instance, as a way to understand what
was responsible for fevers during the outbreak. As you can see, one of those– I mean, as you can see
that in the diagram below, you see many of
the cases that used to come to the Ebola
treatment center were not necessarily Ebola. But they were things like
malaria, HIV, and everything. So what happened in the
outbreak is that there’s a lot of sense of panic. And everybody that
comes down with fever actually is sent to the
Ebola treatment center. What happened– I mean, and then
the danger and the consequence of that is that you leave
your home very healthy, but then you come back. You’re actually
infected with the virus, and then spread an outbreak. So what we also did
during the outbreak was actually to
convert a process that used to take a very long time
in a laboratory that would take a few months in laboratory. We did that in 10 days. That is basically from
collecting the sample to generate sequence data. And we were be able to
achieve this in 10 days. So we generated about
99 sequence data. Within 10 days, and within the
first few days of the outbreak, I made these sequences available
to international community. We’re not concerned
about generating data for publication. We’re not concerned about fame. We’re more concerned
about making information available to the
international community so that they can
use the sequence data to generate drugs,
develop vaccines, or develop diagnostics. And the publication
came back months after. We’re also in the process– you know, went on and then
work on developing methods to sequence Ebola
and then Lassa fever. I mean, this was
in collaboration with colleagues at Harvard
and at the Broad Institute. And this method will actually
publish more or less like SOPs where anybody could
actually use it actively to repeat or
replicate what would we were doing in the laboratory. And that was also
very important. We use genomics
actually to understand the spread and the transmission
of Ebola in Sierra Leone during the outbreak. And as you can
see in this chart, you could see that you have
two different strains of Ebola entering Sierra Leone in-between
March and June 20, 2014. And I could see it through
the process by June 2013, the third strain that actually
entered, SL3, has taken over. So this was a strain
that was better adapted and had a better
transmission efficiency. We identified multiple
snips the strains. And they [INAUDIBLE]
confirmed from human-to-human transmission,
and also confirmed the fact that there was no sources
outside the human-to-human transmission. Over time, we were able
to use genomic data to actually reconstitute
transmission in the region. And I don’t know this
map will show it, but this was just
a video actually to show how this happened. The outbreak in Nigeria
was a little bit smaller– four months. But within the four
months, we were able to actually
use genomic data and then use contact tracing. As you can see in those
two panels, A and B, you can actually
superimpose very well the genetic data and then
the contact-tracing data. And that actually
shows the power of genomics,
actually, in the field in order to understand
epidemiology and transmission of disease. So what we’ve been
doing over the years is actually to identify a
pathogen based on sequences and then use these
sequences as a way to develop new
tools for diagnosis. And that also was
being very helpful. During the four months of
the outbreak in Nigeria, we worked with partners, having
these sequences, in Africa, having the Ebola
sequences to generate a rapid diagnostic
test that could diagnose Ebola in 10 minutes. The reason why we actually
spent a lot of time developing that test is basically
because during an outbreak, we need to two main
things, speed and accuracy. We realized that it would
have taken about four hours to do one single diagnostics. And then we have
to think about– be creative about
ways of actually producing diagnostic
data almost in real time. And that– when we actually did
that, we actually realized– I told them it was major
game changer in the field because clinicians
could actually have this information
in near real time. We also used the– I mean, what we’re also doing
is basically use genomic data, actually, to understand and
then discover pathogens. And in this case,
for instance, we’re looking at patients
with febrile illness. And as you can see
in these two panels, you see healthy patients
and in febrile patients, you could see that you have
more in febrile patients in terms of viruses, 8%– you know, 2% in people
that are healthy. So that shows that
viruses actually also could be very responsible for
many other febrile illness that I would see. And in the process, because
we also see some pathogen that have no heat. In this study, this is just
to illustrate how it’s really what you use [INAUDIBLE]
to make a major discovery, for instance, Nigeria. And in this case, control
study, for instance, we discovered two new
viruses in Nigeria. And these two new
viruses, we actually called them the
ipomovirus 1, it’s a rhabdovirus that’s
similar to rabies. And these viruses share
some very strong similarity to the [INAUDIBLE] virus
that was discovered in DRC Congo in 2012. And that is all–
that was shown to be responsible for some kind
of viral hemorrhagic fevers. But then that shows,
actually, the power behind the public
discovery platform that we have because having
discovered these viruses, we also went on and then
developed new diagnostics for them. But what is interesting
about this story is basically that when we went
back to develop the diagnosis and went back to the community,
even though these viruses were new, 80% of people in those
communities were highly exposed and had a lot of antibodies
against this virus. So it shows clearly that
there are many pathogens that are circulating in our
community– are circulating around that we don’t know about. But then we need
to use technology to actually discover them and
see how we can actually develop diagnostics and [INAUDIBLE]. So using, again,
genomic technology, we are able to understand– I mean, the origin and the
spread of a very old virus in Nigeria– not very old, but a
Lassa fever virus that is very similar to
Ebola in many ways. And this diagram
actually shows you– and this is a study
by Kristian Andersen, a friend, a colleague of mine. So, and here, we could show
you that this virus that we’ll call Lassa fever
has been circulating in present-day Nigeria
about 1,600 years ago, and circulating within
Nigeria for 600 years, and then moved out of
Nigeria about 400 years, moving westward. And then in the
field, we can actually see the differences
between an old virus that is very old in one country,
and then moved freshly into a new country. When you look at the
pathogenesis of– or philosophy between
Sierra Leone and Nigeria, they are very different. We also used that to
develop new technologies. But then we use the epitome that
we sequenced in those viruses to develop a rapid
diagnostic test. We called it [INAUDIBLE]. And that– we use that now
as a way to help the Nigerian government to look at– to set up a surveillance system. What we’ve done over the years
is not just only do science, but also to train the next
generation of pathogen hunters. So we set up with a
genomic training program. And we do this in
collaboration with Harvard. And then we started in 2014 with
11 students from two countries. As you can see, the list
is growing over the years. And this year, we’re
actually at 23 students from eight different countries. And here, you can
see, for instance, the training programs, the
kind of topics the we cover. And pictures here could
show you very young Africans that we’re training. But apart from just training
them, what we train them to do is– we worked with
the Derek Bok Center here at Harvard to enable
them to use videos. And it is videos
I actually posted. And then they serve as
MOOCs so that people that are not privileged
to be in a place in like Harvard at least could
have access to those videos and then learn and
educate themselves. So, what we’ve done is
actually training them. But not just training them,
but we also accompany them with infrastructure. So we’ve set up
next-generation sequencing in Nigeria, in Senegal, and in
Sierra Leone early this year. So the trainings
actually have facilities that they can go back and use. We also organize workshops
and genomics workshop series in Nigeria or in Africa. And we’ve trained over 600
students over the past three years. And then we have 21
doctoral students and then 46 master’s degree students
within the program. The whole idea is actually to
translate genomic sciences, for instance, into tools that
will enable us in the future. As you could see
here, that it’s coming from a high court,
high-tech technology, and then bring it
down to a level that we can actually
use in the field with small, portable
equipment that enable diagnosis in the field. So, whatever we’re doing
actually is not stopping. What we’ve also done is actually
to set up an outreach program. And this outreach
program that we’ve set up is actually to take it
outside the university and outside the ivory tower. As you can see here,
we have a program where we take it in high
school and inspire the kids at a high-school level. But what we also do is actually
to educate science teachers in Africa because you can’t
give what you don’t have. So we spent time
training these kids, bringing them in
our labs, and then inspire them at that tender
age, and work with their teacher so they can go back with
biology, DNA, RNA, and protein models so that they
can use that to teach. And the students will also
have a summer training program that student comes
in, and then have training in our laboratories. We’ve received support from
many institutions for the work that we’re doing. But this– what we’ve
done is actually– I mean, it has a
lot of challenges. And one of those things,
one of the major challenges in the world is supply chain. Supply chain is a major problem. We’re doing this kind of work in
Africa and we produce nothing. So how do we maintain
the supply chain? So what we do basically to
maintain our supply chain is actually to
convert our trainees that come to Harvard for
the summer training program into courier. So we load them with
[INAUDIBLE] and then with supplies and [INAUDIBLE]. And then when they get back,
then they can take them. But then we’ll
also have problems. When you get back, then you
have an issue with customs. So, and customs will not
allow you to come in. So what we did in 2014
was actually to enable– we’d print them
a T-shirt, and it would say Ebola diagnostic
trainee is coming back. When they got to the border
and they were disturbing them, they all just saw Ebola. And then eventually, customs
asked them to [INAUDIBLE].. [LAUGHTER] So I just want to
end this presentation to thank all my colleagues and
my partners here at Harvard and all over the world. And eventually, I just
want to thank you again for give me the opportunity. Thanks. – Very good. [APPLAUSE] Thank you. OK. Thank you so much, Christian. This was phenomenal. So now we’re going to
move to the following up after the epidemic
with Dr. Rimoin. – Thanks. [INAUDIBLE] – Thank you. – Great. Perfect. All right. Well, thank you very much. I am here to tell you a
little bit about the work that I’ve been doing in
the Democratic Republic of the Congo. The Democratic
Republic of the Congo, for those of you
who are not aware, is the largest country
in sub-Saharan Africa. I spent the last
15 years of my life working on emerging viruses
and doing what many people have told me over and over
again was impossible, which was to do really good
science in one of the most difficult places in the world. DRC, as you can see
from this slide here, just to give you some
context, is really big. It’s a third of the size
of the United States. But unlike the United
States, there’s only about a thousand miles
of road in the entire country, which can make it very, very
difficult to get much done. The DRC is also a place
where we’ve seen Ebola, not just in 2014, but all the
way back to 1976, 40 plus years ago, when the very
first outbreak of Ebola that occurred both on
the DRC side and in Sudan right across the border happened. Now, we all know today
that between December 2013 and April 2016, the largest
epidemic of Ebola to date generated more than 28,000
cases that we know of and more than 11,000 deaths in the large
mobile populations of Guinea, Liberia, and Sierra Leone, and
just barely in Nigeria as well. This outbreak was very
important and provided a lot of opportunity to track
and understand survivors and generated a lot
of new insights. And that’s very, very important. And it’s very, very important
because the outbreak was able to end and did not
create more cases than we originally were worried about. Now, we were all thrilled when
the outbreak was declared over. And we– but we’ve
heard this before– the outbreak is over. The outbreak was over in
Liberia, and all of a sudden, there were several
cases that reemerged. And since that
outbreak has been over, there was actually
another outbreak in the Democratic Republic
of the Congo just in May. So just because the
outbreak ended– this very large
one– doesn’t mean that Ebola isn’t still there. So, let’s see here. How do I do this? OK, here we go. But what we do know now is
that for Ebola survivors, the outbreak isn’t really over. We now know that
more than 50% or so of the infected who pull through
still have long term effects. Many of these people have
resumed their normal lives, but many of them are
still traumatized. They’re struggling to process
the horrors they’ve seen, rejoin societies that
have shunned them. And the after-effects are
not just psychological. We know that there are many,
many after-effects of Ebola. We just don’t know
exactly what they are. The studies that have been
ongoing in West Africa have showed us just a few
years after the outbreak that there are
ocular side effects. There are neurological
side effects, that people are actually
able to carry the virus and potentially shed the virus
from immune-protected sites for much longer than
anybody ever anticipated. And it’s interesting that
nobody ever anticipated this because it turns out there are
a lot of survivors to study. What we know about right now
from these studies from 2014 going forward is there a lot
of things that can happen. But the question is, what else? I think that it’s
important for me to invoke a little
bit of baseball since the Dodgers are
actually in the World Series. But it’s really true that
what we’ve learned about Ebola is that it really– it
isn’t over until it’s over. And the big question
is, when is it over? Well, and there are a lot
more questions about Ebola that we still have to answer. We don’t know how long can
somebody transmit Ebola virus. How long does it
stay in these sites? For example, if
we can still find Ebola in the fluids
of the eye, are ophthalmologists at risk
for acquiring infection long after survival from infection? Are survivors protected
from long term– from future outbreaks? How long does the immunity last? Is there anything
that can be done to reduce these after-effects? And what aside from the
clinical effects are there? We know that there
are economic effects. We know that there
are societal effects. None of these things do
we have any information about further than four
years after this outbreak. Now, one would think there
have been outbreaks since 1976. So we ought to have
a lot of information. But actually, until this
recent Ebola outbreak, the longest study
looking at survivorship was only 2 and 1/2
years after an outbreak. And that was done in 1995. The 1995 outbreak–
there were studies that were done 2 and
1/2 years afterwards. And much like what we’ve
been hearing about, the outbreak happens,
we think it’s over, and we move onto the next thing. Well, we do have cohorts
in the Democratic Republic of the Congo that are there
and can provide very, very important information. In DRC, we’ve had
eight outbreaks– 1976 all the way
through now, to 2017. So what my program
is doing is we’re going back and looking
at these survivors from 1976, 1995, and 2014. So we have three really
unique groups that are roughly 20 years apart. And what we hope is to better
understand the long-term health consequences of infection to
determine if survivors develop immunity that will protect
them from future infections, assess whether previously
infected people can transmit the virus still, to
understand all of these things that I just brought up. We really don’t have
any information. So we think, great, no problem. You just go. You’re going to find
these survivors. You get their phone number. You get their address. Maybe you send them an email. No problem. Well, it’s not so easy in DRC. The ’76 survivors and
the 1995 survivors happened before the
civil war in DRC. And so, all of the
records were lost. There were no records. So I went back to the
original investigators from the ’76 and ’95 outbreaks
and asked them for their notes. Well, for especially
from the ’76 outbreak, there were no
electronic records. And so, I had some
very, very nice help from people like Peter
Piot and David Heymann who went into their garages
and their basements and their attics and found
their handwritten notes. And with this
information and the map that you can see
up here, which was about the same as the
map that still existed in Yambuku in this site,
I went about the business of finding survivors. And to my surprise and
to everybody else’s, we found of 38 people that we
knew were infected in 1976, we found 14 of them still alive
in these very small villages. And so one by one, we
went through the forest, found these people,
and asked if we can study them and understand
their experience a little bit better. Well, but finding
them is one thing. But then you have to take
some samples from them. And we’re not just talking
about taking some blood and putting it on a
dried blood spot card or taking a couple
tubes of blood and putting it in
my refrigerator. You know, it takes a
little bit more than that. And what I think our
study site has proven is that it is possible to do
really good science in very, very difficult situations. So this here is our
nice, little lab that we were offered by the
Ministry of Health in Yambuku. And so we brought all of these
supplies in this nice hut. We cleaned it up a
little bit and made sure that the goats and the
chickens were out of the room. And so that it was really
possible to do great science, to be able to isolate
B cells and T cells, which might be able to lead
to vaccines and therapeutics in these conditions. And we only have the
preliminary data at this point. There’s a lot more to do. But thus far, one of the
very interesting things that we’ve found is that these
survivors from 40 years ago still have strong
antibody responses– every single one of them. And not only that,
50% of these people had the ability to
neutralize Ebola virus all of these years later. We’ve also found that there are
evidence of long-term effects. There’s a lot more
work to be done. But we have just
started to find out all of this very
important information that has the opportunity to shed
light on what these 16,000 plus survivors in West
Africa may be facing, and all the other survivors
from all the other outbreaks. So, once we started
that work, we also realized that there
was a lot of questions about asymptomatic
infection– about people that might get infected but never
show any signs or symptoms and how many of them existed. And over the last couple of
years with the Ebola outbreak in West Africa, we’ve
now gotten good evidence that people who get Ebola
don’t always show symptoms. So I thought, well, health
care workers are a really good population to look at. They’re on the front lines. They’re at greatest
risk for infection, in particular in the
kind of conditions that they’re working
in, without the kind of personal protective equipment
that people in this room may be used to when
they go into a hospital. So we started taking samples
from health care workers in all of these sites
where there had been Ebola outbreaks and a few
sites where there hadn’t been, just to compare. And we found some very,
very interesting results. We found that health
care workers had very, very high rates of Ebola,
surprisingly high rates of Ebola antibody evidence
that they had been previously exposed to Ebola, and much, much
more so than in the sites where there had never been
an outbreak reported, suggesting that not only
did these people have the opportunity to get
infected more often– which isn’t really surprising– but that there is
something going on. Now, “health care worker”
is a very broad term, and can mean many, many things. To most of us here, you
think of a doctor or a nurse or a midwife or a lab tech. But in places like
Central and West Africa, those are not necessarily
the most common providers. We really, really
see a lot more people going to informal
health care workers– to what we would consider
traditional healers, to pastors, to local figures who
can go and help them in a way that people understand
much better. They’re more accessible. They’re less expensive. They may take for
payment instead of money you could work in their fields. You can give them food
that you grow yourself. So those are– those
informal health care workers are actually
very, very important. And once again,
interestingly, we found that these informal,
traditional health care providers were also
people who were highly exposed. What’s interesting is you
think, OK, well, fine. There have been Ebola
outbreaks in these sites. So it makes sense
that people who were in that area at the time
might have been infected. But interestingly, in
Yambuku, where the outbreak happened in 1976,
those people who were born after 1977, after the
outbreak was declared over– and I know now we
all know that “over” doesn’t necessarily mean over– but “over.” Those people that were
born after the outbreak– we found almost as high rates
of antibody in those people as the people who had been
alive during the outbreak, which suggests that Ebola
is still circulating in these populations long
after it disappears from view. So of course, now there are
more questions than answers. We wonder is Ebola virus
circulating silently in DRC? Well, our preliminary
results suggest that that may be the case. How are asymptomatically
infected people acquiring infection? Are there certain
groups that are more likely to be
infected than others? Can asymptomatically
infected individuals transmit the virus as well? What role do they play
in Ebola transmission? And do these people also
have long-term after-effects? We really have no idea. And although we have known about
Ebola for a very long time, we’ve not gotten to the
bottom of these questions. The thing is is we’re
really running out of time. The aperture for doing
these studies is closing. The populations that we’re
working with are aging. And the natural life expectancy
for a Congolese person is 57. The outbreak now
happened 42 years ago. And many of these
people were adults. In fact, when I started
doing this study, I said I found 14 survivors. Those were the 14
survivors that we were able to collect
samples from, where there were two
other survivors that we found and made contact
with, but were not able to get back to in time
before they passed away. One was 95 and one was 59. So the aperture
really is closing to do these kinds
of studies, not just for the survivors
that we know about, but for those asymptomatically
infected survivors from these very,
very early outbreaks. And so, this is the
kind of work that we are trying to move forward
with as quickly as we possibly can to gather as
much information and to be able to capture
samples in history and epidemiologic data– everything that we
possibly can and archive it so that as technologies
improve, as we understand more about Ebola in general, not only
can we make use of the samples that we’re collecting
now and the information we’re collecting now,
but that we’re banking it for the future
so we don’t again have this problem of forgetting
to look at what we should have looked at a long time ago. Thank you. [APPLAUSE] – Terrific, Anne. So now, we’re going to move
to our last speaker, Celina Turchi, who is really
going to talk about how you respond to a
major epidemic when you are in the middle of it. – Good morning. What a challenge to
talk after those two. But I would like to first
thank the organizers for this opportunity, To name
a few, crews in Pernambuco, Brazil, and the Microcephaly
Epidemic Research Group. I’m here to present some
insights of the public house response in the
recent Zika outbreak. And I love the title of
this symposium, “Contagion– Exploring Modern Epidemics.” Because I think that Zika
was a very good example. So first, I would like
to have a brief context. What are vector-borne diseases
in complex, urban areas? So, in 2015, dengue
was considered a major problem in Brazil. 1.5 million cases, 900 deaths
for dengue in one year. Since the ’80s, we have been
having dengue epidemics. And Brazil was one of the
most affected countries in Latin America, with the
four circulating serotypes from DEN-1 to DEN-4. So what we could say that
urban environments, climate– and favors all-way
around transmission of dengue with marked
seasonal patterns and explosive epidemics in
different areas of the country. That was the
scenario for dengue, and was the public
health’s concern in 2015. But there was an alert
about the introduction of another virus that were
coming from the Caribbean. That was the chikungunya
virus that’s an alpha virus. But this alert was just that
this disease was important because it gave– it brings this ability and could
cause these large epidemics. That was really known. And then something comes
as a mystery disease that was called by the public and by
the media, a mysterious disease that was a benign disease. It was a fever like most
of infectious disease. People didn’t feel ill, so
it was considered kind of, don’t worry about this disease. Let’s call it
dengue-like illness. That’s how doctors were
taught by the public house at the moment because
we knew nothing about the neurologic
context of the effects. So, that what happens. I need to go to this
map just to show you. Actually what we had– the green circles
is chikungunya. And red circles is Zika. And imagine in 2015, there was
The Lancet journal just wrote, Zika virus with a
question mark, following dengue and chikungunya. There was still
this question mark. Was it going to occur? And if we look at
the map, the alert was for chikungunya,
not for dengue. The big circles in
Brazil and elsewhere was for chikungunya
in the Americas, not for the dengue epidemics. But here, it is very
important to say that we’ve been hearing the
last speakers about Africa. Zika was known to be
in Africa since 1947. But for 60 years, the
epidemiology world just knew very little about it. I may say that we had
14 cases in humans published for 60 years. That was really a
medical curiosity. I imagine that moves
think infectious disease and trained
epidemiologists never heard about Zika, like myself. I had never heard about Zika. And virologists, the book– virologists had
just one paragraph saying about the zoonoses. But the first epidemic– the history of the
epidemic is started in [INAUDIBLE] of Ireland
and French Polynesia Islands. But they were a small
population areas. There were cases. There were cases. There were a lot of
asymptomatic cases. And the French
Polynesia reported the first neurologic
effect of Guillain-Barre. So if we go to that
dark spot here, that’s Recife, the
northeast of Brazil. That’s where we were at the
beginning of the epidemic. It was August. So, what was going on? The capital of
Recife in Pernambuco, northeast of Brazil,
was the epicenter of this microcephalic epidemic. We were at the front line. And what– there
was a microcephaly with unknown etiology. We didn’t know what to
look for because all the infectious disease and all
of the genetic disease supposed to cause microcephaly
were negative and didn’t test positive
among these babies. So for that time, it
was an unknown cause. And remember when
those babies are born, and when the mothers were
affected several months before. So we couldn’t get genetic
proofs at the moment to find it, nor we
did have lab tests so we could test immediately. Lab– they weren’t lab tests. There were lab tests in the CDC
that would take weeks to get. And even if we get
them, IGM and RTPCR aren’t always positive
after such a long time. So looking back
in retrospective, we may say that Zika virus found
a large pool of susceptible individuals, abundant
presence of Aedes, good environmental conditions
in a densely urban population. This is good enough,
OK, to make it possible a range of possible
neurological outcomes, including Guillain-Barre
[INAUDIBLE] syndrome and also microcephaly in babies. So, the timeline is almost
like an old epidemic. Good doctors spot something
that they see that’s not usual. They contact health
authorities, there’s something very
important going on. And in November 2015, the
Brazilian Ministry of Health declared a situation of national
public health emergency. We saw very few evidence. We just have short evidence,
some cases, some stillbirths with virus in their brain. But there was a no
epidemiological study to think about causality. Causality is very important
for us epidemiologists. It’s a very serious business. So, what I want to say is
that the emergency in Brazil was a turning point for
the public health response. It really was a turning point. Researchers and health care
workers working together, they developed new protocols
and research instruments for field work. The magnitude of the
event to put attention on this [INAUDIBLE]. I mean, it was so
important that broke personal and
institutional barriers, creating a collective
solidarity feeling, a commitment of sharing data and knowledge. That was the status. Nobody wanted to publish a
paper first like said before. We want to have a group. We want to be known as a group
that just could do things as a group, as a team,
independently in which institution [INAUDIBLE]. So, I think here that I have to
say the intense collaboration of several institutions around
the world and within Brazil. And this morning, I had some
very nice thoughts like, epidemiology is a sign of
[INAUDIBLE] public health. And I fully agree. And that’s what we saw on the
field exactly where we were, trying to do good
epidemiology in the situation. And I always learn
a term– yesterday, a terminology that
I found it very appropriate for this moment. We were not doing
peacetime research. We were doing wartime research. So time was so important. Collaboration was so important. So I wanted to just briefly
to show that was the features. We had almost like a phenotype. I can’t go into details. But you can see the
disproportional face and how bad– how small these children,
and how bad it was. Here, you can see the
tomography of these children, it’s so easy to see the
calcification and the damage of the brain and how
important and how would be the developing of
these children considering this situation. So we entered this– the Ministry of Health
proposed for the group– for our group to design
and do a case-control study that was funded by the Brazilian
Ministry of Health and Pan American Health Organization. The idea is that
epidemiologists, in our toolbox, we have
the case control as one of the first options because
we can get from the outcome to the exposure. It means almost doing
like research in reverse. You don’t expect
things to happen. But you just go from
back to going to– next page. So we had many hypotheses. And two of these
hypotheses were very– let’s see– very important
considering public health. One was that a larvicide
that the government had put in the tank water that
was called pyriproxyfen was the cause of
the microcephaly. So this was a very
important issue because during an
epidemic, you would have to take out
the control measure because it was supposed to be
the cause of the microcephaly. And the other very important
[INAUDIBLE] hypothesis that came about
was about vaccine. So it got really in the media
that vaccine, like the rubella vaccine, was something
that was doing again– kind of having an epitome. Like, say, we have an outbreak
due to the vaccination. So you can imagine
what the panic and the what the amount
of confusion and rumor that was going on. So those pipe waters
had to be tested. Of course, our main hypothesis
was really the Zika virus infection. Why? Because it had been proven to
be very neurotrophic in animals, we had the right temporal
sequence, and so on. So we designed a
case-control study that was the first
case-control study we designed. We couldn’t get
retrospective [INAUDIBLE] because we had to be sure that
they were congenitally infected and we choose the
right controls. And laboratory confirmation–
it just brought it here because it was so important. We didn’t have good lab tests. We still don’t have
a good lab test. And what do I mean is that
Zika and dengue, being from the same virus,
like the same flavivirus, they cross-react. So remember that this population
had been exposed to virus for 30 years for dengue. So when you get a positive
serological result, you don’t know if it
was dengue or not. But we are very lucky to
have in our institutions– like you said before– preparedness, like
with this lab, it was a reference
lab for flavivirus, and could do more lab
[INAUDIBLE] tests like PRNT Just for Zika and
for dengue in order to know for sure if we’re
having a Zika-positive case or a dengue-positive case. I’m just going to show
that these factors– I just made a big jump and I
excuse the epidemiologists. So you can see the odds one
doesn’t have any difference between cases and controls. So you can see here
smoking was a confounder– actually was a confounder. Alcohol, vaccine,
and larvicide had nothing to do with
this epidemic at least. And when we have
this cartoon here, what we see in
this case-control– it’s something very strong,
a very, very powerful association– only
cases had been infected or had been congenitally
infected with microcephaly. So we’re talking about in that
day’s epidemic of microcephaly and not all microcephalies. And another very important
result from this case-control study– then we measured the past
exposure of this Zika in the mothers of
control that will be kind of our population control. Even if it’s not such
a large sample size, 60% of these mothers
had been exposed. What does it mean? It means that in the
first wave of Zika virus, there was these huge exposures. I mean, we did have a naive
population, a huge population, that were struck by
this wave of Zika and become infected
and were infected and had an antibody response. So those are published papers. The ones who work in research
know this is very fast. I mean, we did it in
a fast-track approval that went under the emergency. And so, that’s
the situation now. And what now? You’ll see the first map
shows the first wave. When you see the first,
very focused point, the epitome just in the first
in the northeast in two very spots in the south. And later on in
the next year, you can see that it’s not
too much transmission. It doesn’t look like
too much transmission. If we think about
surveillance, we just have surveillance data for 2016. That’s the red line that
means the Zika infection. And we can see in this pic what
we see is seasonal epidemics, and you have a flat plateau. That transmission– we don’t
see too much transmission there. Now it’s chikungunya time. It’s not Zika time anymore. But what we see now– is it going? This is what I found. It was more surprising
of the epidemic was the use of WhatsApp
for good and for bad. I mean, for good,
for communication between the doctors
and patients, and for bad, for
rumors, for fake news, for everything you can imagine. So this was kind of a nightmare. So, just brief remarks here. What were the challenges? I think there are now ongoing
cohorts all over the world monitoring pregnant
women and newborn babies. We know very little
about the risks. I mean, if the risk is a
stable or we have varying risks according to
different populations. We don’t know very little about
this fraction of the disease we’re talking about. We don’t know how these
children are going to develop. There are a lot– there’s much, much
room to improve in diagnostics for management
and also for research. I think that we are in a point
that we really need improvement in this kind of diagnosis. And there are other
very important research being carried on. Now, I want really to
thank our group here and to present our group. That’s Microcephaly
Epidemic Research Groups. I mean, a lot of people
from many institutions, many public institutions,
from all over the world, and especially from Brazil. A special thanks to
Dr. Laura Rodrigues from London School of Hygiene
and Tropical Medicine. And here are all
the institutions. And here are all
of our supporters– NIH, there is a cohort of
pregnant women with NIH and a lot to work with
ZikaPLAN in many fields. Thank you very much
for your attention. [APPLAUSE] – OK, so we’re going to have
just a brief discussion. And then we’re going to open
the floor for questions. So please start thinking
about your question because we’re going to need
your participation in a moment. So, I think there are
sort of three things that became pretty obvious across
the three presentations. One is really the importance
of local capacity. That’s absolutely crucial. And it’s not that we are
solving all the problems for the next outbreak, but as
you build up the local capacity to respond, to
have the knowledge, to have the tools, that’s
absolutely crucial. The second one is each one
of this work is basically about overcoming challenges. And they are many. either because everybody tells
you you can’t work in the DRC or because you are in
the middle of an outbreak when nobody knows what to do,
but you have to do something. And I think, to me, the
most important thing that comes across– and fortunately, this
is true for many of us– is that if you really want to
do the right thing in the middle of an outbreak, you really have
to go against the brutal tenure system and focus about saving
lives and not writing papers. And this is crucial. And some of us do that. We may get– I’m not saying
what I’m going to– anyway. [LAUGHTER] We may not be very
successful at the end, but at least we can
sleep well at night with our head on the
pillow because we are trying to save lives, not
to get a paper in [INAUDIBLE].. This is crucial. And I cannot thank you
enough for bringing that up. So, I’m just going to have
one question for each speaker just to warm us
up, and then we’re going to open to the floor. So, Happi, I want to
ask you a question. You do all this training. You have people coming from
all those different countries. Training there, training here
and abroad, then those people go back to their countries. You can guarantee
what goes to Nigeria. Are they able to actually build
the same kind of infrastructure and have the same
kind of response fast as you can
provide in Nigeria? So, is this training
that you’re providing being translated into really
resources in the countries when they go back? Anne, I wonder if
you’ve found something on sort of the social side. So how about stigma? How about social consequences
in the lives of those people? And many of them
have been surviving for more than four years. So were you able to learn
something about this? And one thing that
got me curious is, do we know anything if
the asymptomatic infections– if those people are infectious? Because if we do have
so many transmission is still going on although
everybody think it’s over, why don’t we have
another outbreak? And Celina, I’m kind of
going to put you on the spot, but we are both Brazilian
so I think I can do that. – Friendly fire. [LAUGHTER] – So, I think another
thing that is obvious is context matters always. We are never going to
have two outbreaks that are going to be the same in the
way they happen and in the way we respond to them. So, I think you
highlighted the importance of the front-line workers,
of the government declaring an emergency even not
with so much evidence, but he did, and
in supporting you to lead this incredible work,
this epidemiological work, to respond to the epidemic. The context now, 2017,
is very different. The leadership, both in the
government and in the ministry is different. So I would like you to reflect
how this whole crisis would unfold if Zika had
arrived in Brazil not in 2015, but in 2017. I told you I was going
to put you on the spot. [LAUGHTER] So, Christian. – All right. I don’t– – Oh, you have your
microphone, so go for it. – Yeah. I think one of the
questions was are there facilities for trainees
to use after training so that they can respond as fast
as we did in Nigeria in 2014? The answer is yes. In [INAUDIBLE],,
you saw we ensured that the trainees actually
get back and use facilities. So one thing that we did
basically in the countries where we have this [INAUDIBLE]
network across a region. We’ve set up a
reference laboratory with state-of-art
facility, for instance. In Nigeria, we have
next-generation sequences installed. We have the same in
Sierra Leone and we have the same in Senegal. And those operating
those systems received the same training. And we use the same protocol
for any eventuality. So [INAUDIBLE] apart from
using those high-end equipment, we’ve also translated this
into middle-end and low-end facilities that it can use. For instance, for the
rapid diagnostic tests, we’ve done extensive training
for high-tech workers that can use those for diagnosis. And we also have the
medial [INAUDIBLE] that can use that
qPCR for diagnosis, for confirmational purposes. And in [INAUDIBLE],, for
instance, or Nigeria or in Dakar, you’ll see
the very high-end equipment where we can actually
do confirmation. And that is the reason
why, for instance, because we have that– we’ve had cases in [INAUDIBLE]
suspected cases of Lassa fever in [INAUDIBLE] weeks back. Those were sent to those
facilities in Senegal. And actually, we confirm
it wasn’t Lassa fever. Presently in my lab, we’re
dealing with monkeypox outbreak in Nigeria. So, and we’re basically
confirming cases and also responding
to the outbreak and facilitating
government intervention in all those areas. I think in a way– I think in a way, we’ve
kind of addressed that. And that’s one of the reasons
why we’re not just framing, but we’re also ensuring that
there are facilities that will accompany the trainees. – Wonderful. Thank you. Anne? – OK, so you asked me
two different questions. Is this mic– OK. I think this mic’s on. So, you asked me two
different questions. The first one was about the
social effects of Ebola. And I just recently came
back from the 1995 outbreak. So this is something that’s
very, very fresh in my mind right now. I spend a lot of
time doing interviews and talking to these people
about their experience. And I think it’s very,
very interesting. First of all,
meeting these people and giving them the opportunity
to talk in this case just 22 years later, it’s the
first time anybody had come to them in
20 years to ask them. You know, in West Africa–
and this was a point that they made and really
was driven home to me. In West Africa
after the outbreak, there are 16,000 survivors. And so, there are
support groups. There are social services. There is a huge investment
on the part of the US and other governments to study
them, to enroll them in trials, to enroll them in studies,
which also gives them the benefit of having quality
of care, whereas people in West or in Congo,
all of these cohorts– there’s nothing. There are no studies. There are no trials. There’s no support. And even to go to these
sites and to do these studies in ’76 and ’95 outbreaks,
we needed to have labs. And we had big negotiations
with the hospitals and the local government because
they didn’t want the survivors all in the same place. And they were worried
about what happens when the survivors come. And in fact, the survivors
were very nervous about coming to the hospital. They felt the issue of
stigma is so great even in trying to do
studies with them. It’s something that’s
very, very important. And so even just the fact of how
hard doing these studies were is all attributable to
this issue of stigma. And the stories that
still need to be understood in greater detail– and we hope to do much more
with ethnographic studies and really delving
into their experiences so it doesn’t happen again. So yes, stigma is
very, very important and not explored at all. The second question
you asked me about was asymptomatic infections. And you asked a very
important question which is something that we
hoped to be able to answer, which is do people are still–
what role do these people play in transmission. And we don’t know
the answer yet. But we hope to learn. – Thank you. Celina? – Well, you asked me a
very difficult question because prediction
what’s going– what could have happened if you
have a different government. But it gives me the
opportunity to say that when the Zika
epidemic started, we were in an intense
economic and political crisis. I don’t know if you remember. It was under Dilma
Rousseff’s impeachment. So it was right to– and of a period and
starting a new government. And at that time, it was such in
intense scientist mobilization. I mean, we were asked
to write reports and to look and go to the front
line to see what was going on. So it just got to
the point that I think the scientists
influence when they can. And when the situation– to take responsibility. There is nothing
that you can call for in a situation like this. But I think we must be concerned
about the next government that’s cutting the
public health– I mean, support and
research funding. So we must be concerned
because we’re just starting to understand
the full development and the full spectrum
of the disease now. And I don’t think that we could
say that transmissions stopped and it shouldn’t worry
about it any longer. I think we must watch out
because arbovirus epidemiology arbovirus is changing,
and is changing fast. So, the first maps
we saw in the world, we just have the tropical
areas saying the vector-borne with population. Now it’s much wider. I mean, we have different
things, which just give me the opportunity also to see what
range of intervention actions were proposed since the
first, and were very hard to keep for a long time. The range of interventions
for the epidemic was mosquito control strategies,
postponing pregnancy, travels recommendations,
safe sex, and so on. So, you really need
to build knowledge to make these recommendations
in long term possible. So thank you for giving me
this opportunity to complete. – OK, so the floor is open. Please state your name
and frame your question. – Thank you, yes. Paul Beninger. I’m at Tufts. And I want to thank you for
your groundbreaking work with regard to the
lookbacks in ’76 in ’95. In both the groups
that you looked at– the survivors as well as
the health care workers– what do you know about the
families of the survivors and health care workers? Do they have titers? Do they have any
histories that are suggestive of any type
of communicability, particularly with close families
and the intimacy and the food preparation and all the
other types of activities? And of course, sex with
spouses and the like. So the question is,
is there anything that you know about
those close contacts and families of the survivors– children, grandchildren,
and health care workers? – Thank you. Let’s take three questions
and then we’ll answer. So the next one. We’ll take another question
from the person behind you. Thank you. – Just real quick. – Got it noted. – I’m James Wilson. I’m one of the speakers
in the next panel. Christian, we talked
about the differences between the Nigerian
experience with Ebola, which was superlative and
the Guinea experience, right? And so, I want– I think it’s important
to maybe raise that with the audience
as to why were there tremendous differences. Because obviously the gaps
in diagnostics and response and the intelligence failures
that we observed in Guinea were very important to
precipitate all the outcomes we saw in West Africa. And then Celina, we talked about
the intelligence out of Tahiti and the emergence of Zika there. And could have,
should have, would have– if we had known
what was going on in Tahiti before the
experience in Brazil, how could that have
changed the outcomes? So again, focusing your
comments on how can we improve our intel? How can we improve our
ability to anticipate these kinds of problems? Thank you. – Thanks. So, one more question, and
then we’ll have answers. – How would your
role of a researcher change if you were to
propose to the folks that you’re trying to get the
information a stipend to combat this war? In other words,
you would pay them to enter the area without
being harassed or freely– – Can you say your name, please? – Oh, sure. I’m not a clinician. – That’s fine. – My name is
[? Gladiver ?] Santiago. – Thank you. – OK. – All right, so Christian,
you want to start? – OK. Yeah, the question is
what was the difference between the Nigeria and the
Guinea experience in terms of Ebola response. Well, there are
two major things. One was yes, we understand
that in the case of– I mean, infrastructure was one. But then I think what I
saw there as most important in that was in the case of
Nigeria, there were two things. One was probably an element
of luck in the sense that when the [INAUDIBLE]
case arrived at the airport in Lagos, he was already sick
and he stumbled at the airport. Then at that moment and at that
time, he was probably a VIP. He was taken to one of the
best hospitals in Nigeria. It also happened
that at that time, the health sector
in Nigeria was– public sector was paralyzed
because the doctors were on strike. So he had no choice but to
go to a private hospital. And he received treatment there. But the difference
though, is the fact that in Nigeria,
we had that ability to diagnose on the ground. In Guinea, it was
the other way around. In Guinea, the samples
were from over to France and diagnosed in France
and result turned down to Conakry, and
then from Conakry down to the
confinements of Guinea. And that on the average,
was taking 10 to 14 days. So within that period, then
the disease was spreading. But in the case of Nigeria, we
had all that it took on-site. But then most importantly,
it was self-reliance. The Nigerian health authority
believed in themselves, unlike happened in
Guinea, where they were pretty much dictated upon. In Nigeria, for
instance, when we did our diagnosis and many of
the international organizations came in with their
views and their opinions with their suggestion that
they need to confirm first before we decide what to
do, the Nigerian government told them we do things
the way we want. And that was a major
game changer because for a long time, if you
went to WHO website, it was still unconfirmed. But if you were
going by WHO rule, we’d have been in big trouble. So we’re very,
very self-reliant, very confident about
what we’re doing. And we went and then
took the bull by the horn and addressed those
things immediately. And eventually we
were vindicated. Thank you. – Anne? – Thank you. So, the question
that you asked was about what do we know about
long-term sequelae in family members, in health care
workers, and what do we know about transmission,
essentially. And the answer is not much yet. And I hope you’re
on my study section for the grant I’ve submitted
to be able to really understand in greater detail about this. You know, one of
the big issues is when you talk about asymptomatic
infection is what does that really mean? I mean, asymptomatic
infection means that we’ve found that
there were seroreactive. But one of the questions that
we did ask these people as well is, did you have signs
or symptoms of anything during that time period
or at any point later? Some people would
remember some things. Some people might not. And so the question is, were
they symptomatically infected? Did they truly
not have symptoms, or were they
minimally symptomatic, or was it just something
that was unrecognized? Because what we now know
about the Ebola outbreak or about Ebola as a disease
is that it can manifest itself in a variety of ways. It’s not just the apocalyptic,
hemorrhagic version that has been so well publicized. So there’s a lot to
understand, first of all, whether or not people actually
were symptomatic, minimally symptomatic, asymptomatic,
or unrecognized, and then what that will mean. – Celina? – OK, I was just about improved
ability of seeing or detecting an outbreak. If you think about very
urbanized places that were environmental,
in Brazil, we do have quite a
public health system, and with family practitioners
and there was a structure. So if you have those people
at the front line, well aware and knowing that if
they report something, it’s going to be looked– [INAUDIBLE] something that’s
going to be investigated. I think that’s the
beginning of everything of what community approach. Maybe there are some now with
big data or things like this. I think I’m going to
join your section just to see what you’re
going to say about it. But normally, what
we tend to see is the patient when he
comes to, and someone just spots that something different
or unusual in large numbers, or whatever. So, I feel that training and
having good house workers and good community support– all those things
are essential for– I mean, if we can
improve this ability to see the outbreaks
in a shorter time. – Universal health care, primary
health care, the backbone of the SDGs? So, let’s get two or
three more questions. – Hi, I’m John [? Rigero. ?] I’m
representing the Eugene Wright Science and Technology Academy
in Chelsea, Massachusetts and Northeastern University. My question is you talked about
a plethora of transmission factors, both environmental
and genetic, in your respected epidemics. What my question is is
that is there any research or is there any research
you’re aware of being done on the epigenomic factors
in these disease transmissions? Thank you. – Thank you. The next one? – If Zika virus
creates complications for pregnant women and birth
defects for their children, what are some ways mothers can
prevent this from happening? – OK. One more and then I’ll
go to the answers. – My name is Ethel Jackson. And I just have to say
I’ve had a 40-year career in molecular
genetics of microbes in university and in
industrial settings. And I am awed and humbled by
what I’ve heard from this panel this morning. I congratulate
you and thank you. A quick question
though going forward about how technology might help. Is there work ongoing
to develop vaccines against Ebola and Zika? Do you think that is
a promising approach, or do you think that it
will be in the future solely up to public health
and epidemiology to protect us from
these diseases? – Thank you. So, folks, we have three
minutes when you [INAUDIBLE]—- if you want to answer. – Well, as far as the epigenomic
factors involving transmission of disease is concerned, there
may be some work out there, but not that I am aware of. But it’s very possible that
there is work going on. But often, I think, in the
context in which we’re working, the context of outbreak, it’s
very difficult at that time to sit down and then design an
experiment that will actually take into account all of this– I mean, investigate
the epigenomic– especially in the context of
an Ebola or Lassa outbreak. But it’s very possible that
there is some work out there that I’m not aware of. – I’ll respond to the
question about vaccines and therapeutics. Certainly, there have
been major strides in the last several years
with vaccines of therapeutics with regard to Ebola. And certainly there are
candidates out there. We also believe that the
people that we’re working with may have very, very
interesting antibodies that are developed long over time. But the bigger question
that you asked was, do you think that this
is the way forward? And we had a long discussion
about this yesterday. And I think that while
vaccines and therapeutics are very important and something
that does need to be pursued, the real issue is
lack of infrastructure in these countries and
the ability of the people in these countries to be able
to have infrastructure required to have adequate disease
reporting so that people understand what’s going on
in real time in the places where you need to
understand it most, and have the well-trained and equipped
people on the ground who have the ability to respond quickly. And if you have those
things, then the vaccines and therapeutics are a
nice secondary response, but they are not the primary
thing that will save us. – OK. – Thank you. Celina? – OK. Prevention– I think that from
now we have recommendations for pregnant women. If you go to a CDC– I mean, all sites. I mean, there are preventions. And you should not– if you want to be– if you’re planning
to be pregnant, you shouldn’t visit areas
with the virus circulation. Without a vaccine,
that’s what we can do. Think about transmission by
vector-borne, by a vector, by a mosquito, and by
sexual transmission. So if you have a partner
that visits an endemic area– so, you have to have safe sex
for six months, whatever– we don’t know
exactly for how long. [LAUGHTER] So, I think that vaccine
is something to look for and to see how transmission
is going to progress during the following years. – Thank you. So, I want to thank
all the speakers because we are right on time. So we’re not going to get a
red card from the organizers. Look at that. So, thank you for
your participation. And please join me in thanking
all the speakers for really a phenomenal discussion. [APPLAUSE] [MUSIC PLAYING]