Share

--

--

LAURIE GARRETT: I’m Laurie Garrett. Some of you know me from my previous life, where I was one of you and was the president of the National Association of Science Writers [NASW]. I hope you have a terrific conference this week and that it proceeds very smoothly. I have to ask your forgiveness. I have a cold, and I’m a little out of it. So if I sound a bit rambling, I apologize in advance. Well, now I’m in a new incarnation. I am senior fellow for global health at the Council on Foreign Relations in the New York office, and I have—March 8th will mark my one-year anniversary in that position.

So what are we doing here, talking about science, medicine, technology in the context of the Council on Foreign Relations? What does all this have to with foreign policy? Before my colleagues and I start to try to answer those questions, let me first say that for what it’s worth, everything we’re saying tonight is on the record. And also, please switch off all your mobile phones, pagers, et cetera, to vibrate or off. Thank you. If I see any of you wiggling a lot, I’ll know you’ve got it on high vibrate. [Laughter]

I doubt that most of you have ever been to the Council on Foreign Relations before or have given it much thought, because I know that when I was a science writer, this was far afield from the sorts of publications I found myself poring over every single day and the sorts of things that are about your day-to-day pressure on the job. What is the Council on Foreign Relations? Unlike many other think tanks, it actually is a two-headed monster. One head is the think tank, and in that context, a couple of things are worth noting. The Council on Foreign Relations does not accept American-government funding and does not do U.S. government-funded studies. This is a nonpartisan, truly independent institution and has been [independent] since it was created in the 1920s.

The second head that is on the hydra, if you will, is membership organizations. And actually the Council began as a membership organization, later coming to have a sort of think tank studies component to it. That membership organization is fairly awesome, to use an overwrought word. And if you want to have an inkling of what I’m talking about, just in your spare time go to www.cfr.org and take a look at who some of the members are, who’s on the governing council. You’ll basically see that it’s every living former secretary of state, pretty much; every living former head of the Joint Chiefs of Staff, pretty much; every living former national security adviser, et cetera, et cetera. It’s that kind of a group. But it’s also a lot of the corporate world, a lot of leaders in the NGO [nongovernmental organization] world, in the United Nations situation, and many of your colleagues, prominent foreign-policy correspondents. Personally, I’d like to see some of you join the ranks and take foreign policy more seriously in your day-to-day work.

I want to introduce you to my colleagues here, and then I’m going to give a few very quick remarks and turn it over to them. And then we’re going to open it up for questions. Our thinking was that the more interesting component will be the questions and how we all end up having a discussion of science, technology, and health issues in foreign policy, particularly in the context of the current administration, which has just been re-elected and is engaged in a new set of strategies, perhaps somewhat different from its first four years.

My colleague on my left, your right, is Dr. Michelle McMurry, who has several hats that she wears. And our bios are in your folders, so I won’t spend a lot of time going through that. She is sharing her time between the Council and being a scholar in residence at the University of California in San Francisco. And yes, that does mean she’s on jumbo jets a lot, between New York and San Francisco.

And on my right, your left, is Dr. Charles Ferguson, who is an expert on nonproliferation and nuclear threat issues, just recently joined the Council from the Monterey Institute. And we’re very happy to have him with us. So let me briefly tell you what I’m working on, and then I’m going to hand it over to Michelle.

My position as senior fellow of global health is a brand-new position for the Council on Foreign Relations. There has never really been a position like it in any of the foreign-policy think tanks. It is a true innovation, which is both exciting and terrifying at the same time, but a very interesting position to be in. What are my responsibilities? Well, among them I’m trying to better define the relationship between such things as HIV, drug-resistant tuberculosis, SARS, avian flu and the like, and national security. What do these emerging diseases and now long-term threats mean to our foreign policy and to global security issues, and where are the lines between national and global security when you’re talking about globalized microbial threats?

In part of that, I’m looking at the Millennium Development Goals. Those reports were just released, as you all, I’m sure, know, a couple weeks ago, often referred to as the Sachs report, for Jeffrey Sachs. There are—several of them directly relate to health and science, and rather enormous sums of money called for from the wealthy world to go to the poor world, in order to implement them. In that line, I’m looking at quite a lot of proposals now on the table for shifting more wealth from the nine-richest nations to the neediest nations of the world to address global health crises. These include the proposal by [British Chancellor of the] Exchequer Gordon Brown to shift about $350 billion annually from north to south; from Prime Minister Tony Blair to shift a lesser sum, but still quite enormous; [French President] Jacques Chirac’s call in Davos [at the World Economic Forum] for about a $10 billion annual tax on global financing, to shift wealth one direction and the other; our own PEPFAR program, the President’s Emergency Plan for AIDS Relief, calling for about $15 billion to be spent over five years; the Global Fund for AIDS, Tuberculosis, and Malaria; and so on. It would take a half-hour just to list all these proposed ways of shifting wealth to address the global health crises. A good question is whether any of it will actually work. And with that, I turn to my colleague Michelle.

MICHELLE MCMURRY: Good evening, everyone. So nice to meet you. I focus much more on biotechnology issues at the Council and also some on chronic-disease issues and how those impact global health issues and international relations.

I think what we’re seeing right now is a sea change in the global health field. There’s really a renewed emphasis both on building infrastructure and real, sustained health-care development in developing nations, and an emphasis on research and development, not just in the Western world but kind of spreading that research wealth.

There are kind of four points, I think, that are really important to think about. One is the human capital question. We’ve had the scientific brain drain now for quite some time, but we’re also now seeing a brain drain of allied health professionals. In Malawi, there are recruiting offices to recruit newly trained nurses that have been trained by the Malawian taxpayers to work in British hospitals. So what is this kind of wider brain drain doing to the health-care infrastructure in developing countries?

Second and somewhat related to that is the kind of intellectual infrastructure in these countries. There is now a renewed emphasis on trying to grow scientists and researchers in developing nations. There’s a new African, sub-Saharan African consortium for national academies of scientists that hopes to train 5,000 scientists in the next 10 years. And that’s an approach to say we really need to concentrate on science in these nations.

And if you look at countries like Brazil and India and even Mexico, you’re seeing the biotechnology industry is really maturing. They’re no longer just making cheap knockoffs of American discoveries. They really are coming up with new and novel discoveries as well. And the impact of that on health care disparities and trade agreements will be very interesting to watch. In Mexico, for example, they’ve just come up with a de novo cervical cancer treatment, a molecule that was fully discovered and developed in Mexico. Now cervical cancer disproportionately affects African-Americans, Hispanics, and Asian-Americans, but it has—it’s been relatively neglected by the NIH [National Institutes of Health] and the private pharmaceutical industry in the U.S. So what happens when American patients start demanding cures that are available in developing countries, and these trade issues become not just a financial consideration but a civil rights issue as well? I think that’s going to be something to watch in the upcoming years. While the Bush administration has been focusing on free-trade agreements and making sure that cheap versions of American drugs don’t get passed on to other countries, these developing countries are starting to mature their own industries and produce their own cures.

Finally, there’s the issue of the distinction, the blurring distinction between global health and domestic health issues. One of the things you’ll find is that the disparities in health care within the United States are as great as the disparities in health around the world. So, for example, a Native American male in South Dakota will live 40 years less than an Asian-American woman in New Jersey. That is the same difference in life expectancy between the U.S. average and Sierra Leone. So there’s this new focus on what are causing these disparities for the poorest people. And as the Mexican minister of health, Dr. [Julio Jose] Frenk [Mora], said last week in a talk, the problems of the poor are not the only problems the poor have.

So there’s also a renewed focus on chronic diseases, such as cardiovascular disease. And if you look at cardiovascular disease worldwide, it’s responsible for as much loss of healthy years as diseases such as HIV—more than tuberculosis, for example. So people are starting to focus on what this is going to mean, not just for developed countries but for developing countries as well. And if this problem is continuing to be ignored, will we be hindering the development and the economic progress in those nations?

Now since I spend some of my time in California, I have been looking a lot at the stem-cell research issue, which has just been fascinating. Not only is it a new example—one of the few new examples of new ways to fund medical research, government-funded medical research in this country, but it’s also a shift from investigator-driven research to patient-driven research. Their oversight committee for the stem-cell research initiative is heavily dominated by patient advocates, and patient advocates were the ones that were responsible for the passage of the bill. So you have this huge statewide initiative that’s going to spend $3 billion over 10 years.

At the same time, on Friday, the U.N. will be debating a treaty to—I’m sorry—a convention to ban stem-cell research worldwide. And you have the Bush administration lobbying in favor of such a ban and American scientists banding together, along with state governments such as California, to argue against the ban. So you now have a situation much like you see in the EU [European Union], where you have different states engaging in this type of research work and the union trying to keep control over it. The same thing is happening in the U.S. You see different states trying to really do some of this research and move forward, and the Bush administration trying to hold them back. So that’s going to be an interesting issue to watch as well.

GARRETT: And I can’t wait to read everything you’re talking about. [Laughter] Charles.

CHARLES FERGUSON: Thank you, Laurie. And good evening. Thank you all for being here. As Laurie mentioned, I tend to focus on nuclear issues, and I look at my job as kind of all things nuclear. And before I arrived in September, the Council didn’t have a full-time fellow in the Washington office working on nuclear nonproliferation issues. And I know time’s limited, so let me try to give you some kind of headlines, hopefully stimulate some Q&A in just a few minutes.

When I think about nuclear weapon threats, I tend to group them into three categories. And I’ll give you my list of threats from the most damaging to the least damaging, but the least likely to occur to the most likely to occur. And the first threat I’ll mention will probably come as a surprise to you, because you might say, “Isn’t that a relic of the Cold War?” And this is the concern that we could trip into an accidental nuclear war with Russia. We still have hundreds, if not a few thousand, nuclear warheads in both the United States and Russia that could be quickly re-targeted at each other. Yet back in the Clinton administration, President Clinton said more than a hundred times to many audiences, “You can rest easy at night because I signed a de-targeting agreement with Russia.” But what he didn’t tell you is that we could easily re-target these missiles within a matter of a couple of minutes and they would revert back to their old targeting coordinates, and because the Russian early-warning satellite system is becoming very decrepit, because other elements of the Russian early-warning system are also tending to crumble, and here’s where we see interface between science and engineering in certainly an international security concern. So even though I don’t think it’s likely that we would have an accidental nuclear war with Russia, and I think it’s far, far unlikely we would have a deliberate nuclear war with Russia, we still have the mechanism of the doomsday device in place. So that’s threat No. 1.

The second threat that concerns me is the threat of nuclear proliferation, so-called horizontal proliferation, to new states, like Iran and North Korea. And I think it’s, you know, justified that we focus on those particular nations. As we’ve recently seen in the press, North Korea is now proclaiming they have a nuclear arsenal, and we’ve heard similar statements the last few years from them. I think we need to take a hard look at the evidence. What scientific evidence do we see that North Korea really has a nuclear arsenal? But beyond Iran and North Korea, we need to also look at what I call the not-so-usual suspects, and I hope to get into that more as I proceed here in the Council, and hope to direct a study, do a Council special report, looking at the issue of the not-so-usual suspects, states like Egypt and Saudi Arabia, Syria, Nigeria, states that do have some experience with nuclear technology, that may have some serious concerns and that if the conditions were right, may decide to develop a clandestine nuclear weapons program.

It’s often said that some 30 to 40 nations have the technical capability to build nuclear weapons, but I think the list is actually much broader than that. I stopped a few months ago to look at the list of states that have nuclear-research reactors, who want to have nuclear-research reactors, and the list is much longer. There are some 69 nations that have that capability. It’s not that all of them can quickly develop nuclear weapons, but I think this indicates that a significant fraction of the world’s nations could, if they decided to, quickly proceed down the road of developing a nuclear weapons program, not in a matter of maybe a year or two, but maybe an order of a decade or so. And I think we need to do more long-range planning to head off that kind of development.

And the third threat that concerns me is the threat of nuclear terrorism. And I think now we’re in a condition where, because of the increasing threat of international terrorism, the drive toward higher body counts and greater damage on the part of some terrorist groups—not all terrorist groups; we have to be really sober here and not say all terrorists are out to get us, all terrorists are out to conduct a 9/11. Only certain groups want that kind of damage, but it’s those groups that are also trying to develop unconventional weapons—chemical, biological, radiological, and nuclear. And it’s the nuclear that is particularly damaging. Biological is also very damaging, as Laurie can tell you. But nuclear can more than ruin your day; I mean, it can kill tens of thousands of people in just a microsecond, and that’s something that you really can’t see with even a biological weapon that would take days or weeks to perhaps do that kind of damage.

And an ancillary threat to nuclear terrorism is the threat of a so-called dirty bomb, or a radiological dispersal device. Now RDD, or a radiological dispersal device, that term just hasn’t really caught on. It’s too much of a policy-wonk term, and I know why the news media has seized on “dirty bomb,” because it’s very easy to visualize. But unfortunately, it embodies a misconception; that is, that you must have conventional explosives to disperse radioactive materials. There are other techniques that are probably far more effective that a relatively intelligent terrorist could use to conduct this kind of attack. But still, let’s keep that particular threat in perspective. An RDD or dirty bomb is not a weapon of mass destruction. Many experts like myself consider it a weapon of mass disruption. At most, it will probably kill a few people from the radiation, if any. You might see dozens or so people being killed by a conventional bomb blast if that’s used. You could see a lot of radioactive contamination, which would pose psychological, social, and economic effects.

And a couple of you I’ve talked to during the dinner, and you are quizzing me on this “Dirty War” movie that the Council recently teamed up with HBO, and the BBC also helped produce this movie. It’s an incredible collaboration. And you may have seen the movie on HBO just a few weeks ago, and as you may know, it’s going to be rebroadcast on PBS on February 23rd. And we’re continuing to do events about this movie. In fact, as I speak, we’re showing the film to a group of about a dozen congressmen to try to educate them about this issue. And we’ve had events here in DC, also in New York.

And on March 1st, I’ll be in New York and we’ll be showing the movie on HBO studios to the Fire Department of New York [FDNY], senior members of FDNY, and we’ll also include the FBI, West Point’s counterterrorism center, and other experts in the New York region to try to help them prepare for a possible dirty-bomb attack. And I’ve been an adviser to the fire department to try to develop their detailed response plans to deal with both a dirty-bomb attack and a crude nuclear weapon detonation that a terrorist group may be able to pull off. So maybe let me stop there. Hopefully that’s enough to whet your appetite, and I’d be interested to hear your questions and thoughts.

GARRETT: I should add that one colleague that is not with us tonight, Steve Flynn, is really quite an expert on homeland security and has written extensively about the weaknesses in our basic homeland security safety net domestically and the misappropriation skewings of money that ought to be directed properly. And Steve and I are working together on some bioterrorism-related issues at the Council as well. Maybe just to provoke and whet your appetite, I will ask each of my colleagues one question, and then throw those hands in the air. And when you do ask a question, please let us know who you are.

First, Michelle. My question to you is: The Blair administration just gave the fellow who invented the cloned Dolly sheep [Professor Ian Wilmut] the go-ahead to clone human cells. And we have, as you said, the California initiative. Massachusetts just came out and said, “Hey, wait a minute, we’d like to get into this game too.” Has this all hit the point where on the one hand the U.N. is following the French lead and so on, and saying, “Pooh-pooh to this technology;” and then in the states, you know, it ends up at the U.S. Supreme Court, a court that historically is a states’ rights court, and yet also not happy about stem-cell research? Where do you see this going?

MCMURRY: It’s very, very interesting, particularly if you study the history of IVF, or in vitro fertilization, research. Basically the same debate we’re having about stem-cell research took place 30 years ago in that context. And the Nixon administration did what the Bush administration has done, which is basically said no federal funds for that type of research. And what happened is this spurt of private-sector research that filled the void and filled the consumer need for that technology. And I think you’re going to see the same thing in this setting, either with states becoming very entrepreneurial, like California, or with private companies or with other nations stepping in to fill the void as well.

And the real dangerous part of this whole thing is that this research may not be the panacea that we hope it is, but because Americans don’t like being forbidden to have something, we are going to spend a large amount of money on it. And what’s at stake is not just the money, the tax dollars, but also American trust in biomedical research as a solution. And that’s a form of trust that we as scientists really can’t disrupt, because we need it for many other things as well.

GARRETT: Charles, let me ask you. You know, Pakistan kind of set up a model, and the model is you tell the world that you’re building nuclear-power plants and that you desperately need nuclear power, and then it turns out you’re making nuclear weapons. And now the allegation is that’s precisely what Iran is doing in, what, 30 different sites, or more?

FERGUSON: Probably at least, and probably a lot we don’t even know about.

GARRETT: And of course, North Korea started out saying they were making this nuclear power, and then, bingo, we have their announcement—pictured, I think, today in a cartoon of the president’s head exploding—that, yes, we’re making nuclear weapons. Is this a trend? Is this now going to be sort of the way proliferation happens; you just tell the world, “We need nuclear power, we have a right to be part of the energy world”?

FERGUSON: Well, this is the dual-use dilemma you bring up. It’s been with us for at least 50 years, ever since President Eisenhower launched the Atoms for Peace program in December of 1953. And a Swedish physicist, Hannes Alfven, who won the Nobel Prize, said many years ago that Atoms for Peace and Atoms for War are like Siamese twins; you just can’t separate them. But is it as dire as Laurie makes it out to be? I don’t think so, because—you have to stop and think about it.

Is there a technological imperative that will drive nations to nuclear weapons, so if a nation develops the infrastructure to make nuclear weapons material under the guise of a civilian nuclear program, does it mean that they will inevitably produce nuclear weapons? No, it doesn’t. I mean, we can point to dozens of nations that have the technological capability to cross that nuclear threshold but have decided not to do it. So there’s much more of a political imperative at work. The technology is a necessary but not a sufficient condition to lead to the path of nuclear weapons.

But still, we’re faced with this problem right now with Iran and North Korea, and they can point to Pakistan and a couple other states that have gone down a similar pathway. Look at Pakistan. In 1998, when it tested nuclear weapons, the world essentially slapped them on the wrist, saying, “Naughty.” You know, “You shouldn’t have done that.” We put some sanctions in place. Now Pakistan’s a major non-NATO ally. [Laughter] And so they’ve risen above this nuclear stigma and they’ve remained outside of the nonproliferation regime since the very beginning.

GARRETT: OK. It’s up to you folks. So if you’ll hold your hand up and wait ‘til the mike gets to you—let’s start right over here.

QUESTIONER: Thanks. Hi. My name is Ralph Brave. I’m a freelance. And just a quick comment: I’m happy to hear about your research on the stem-cell initiative in California and the consumer and patient involvement, but it is true that the research scientists, public and private, made sure that they were in the majority on the committee overseeing the expenditure of the $3 billion. So, you know, I think [inaudible] wants to help people, but he’s not stupid about it and controlling the money.

I wanted to ask Laurie a question just because of your expertise in this area. There’s almost now a weekly article about the avian flu, and it always contains two things. One is, scientists fear it will mix with a human influenza and lead to a new global pandemic; and two, it will quote some scientist saying, “Yes, and we’re overdue.” And I wondered what your perspective is right now in terms of where the research on that particular flu or where the level of real concern should be at the moment.

GARRETT: Yeah, thanks for that. Well, the striking thing about avian influenza and influenza generally is that despite the fact that it claims thousands and thousands of lives every year, and it’s guaranteed we’re going to have flu every year, we know remarkably little, comparatively, about the ecological origins of influenza and exactly how to predict how avian flu will become human flu, how swine flu will become transmissible in humans, and so on. We know enough to say, “Look, the native habitat, the original ecology is southern China; it will spill over into a few neighboring areas; and that the Chinese destruction of their ecology has so destroyed the flyway for migratory birds that are the normal carriers of influenza that they’re now landing in agricultural areas and transmitting their virus to domesticated chickens, pigs, goats, what have you.”

We also know that the GNP [gross national product] growth rate for China is the largest in the world and that some of its neighboring states, like Thailand, are also booming. And the result is that per-capita consumption of meat is skyrocketing, so that Chinese families who just, you know, 10 years ago might view chicken as a special thing that you would eat on high holidays and a handful of special occasions, are now routinely eating chicken every day. Pork consumption has skyrocketed. So that where once not that long ago, you know, in the 1970s, even into the ‘80s, we were talking about chickens raised on little family farms, and the paradigm of ecological concern was the farm that had a pig and a few chickens and that the chicken virus would spread to the pigs and then the mammalian recombination would occur allowing for a human-to-human transmissible flu to emerge from the swine, now we’re talking about massive, industrial-scale poultry production that is like a dry hillside in California in August just waiting for somebody to light a match and—whoosh—it just sweeps right across. And we’re now seeing this happening routinely, like dominoes, just flowing through.

So that’s—No. 1, the ecology is getting worse, more worrisome. No. 2, this particular virus is getting worse. I’m sure all of you saw the recently published paper in the New England Journal of Medicine—if you didn’t, you should go look at it—that clearly demonstrated that there has been human-to-human transmission now of the H5N1 strain [of avian influenza].

QUESTIONER: Human to human?

GARRETT: Yes, in Thailand. I believe from some investigation I did in Vietnam that actually there’s been human-to-human transmission going on for quite some time; it’s just that they’ve been very isolated cases with very poor epidemiology done, so that we really don’t have good documentation until this Thai case.

But the other thing the Thai paper notes is that the virus itself appears to be getting tougher. And WHO [World Health Organization] had a meeting not long ago in which influenza experts determined the virus is now able to withstand environmental exposure for days on surfaces, and so on. So we’re looking at a virus that is changing. Is it changing to become the 1918-scale pandemic that most flu experts have been saying we’re, quote, “overdue” for? I don’t think anyone can absolutely answer that question. If they could, if you could say at this moment, “World, this is the 1918 flu,” then most certainly the scale of mobilization to address it would be much greater.

But one thing’s clear, we don’t have a way right now—we have no global governance sector in health that can say this is how we would mobilize in some equitable fashion to save as much of the world as we could. Indeed, it is officially a matter of record that were there pandemic influenza, the United States would not share vaccine—assuming we had some, unlike this year—but we would not share vaccine even with Canada and Mexico, much less the rest of the world.

QUESTIONER: Have you got that on record?

GARRETT: That’s absolutely on record. [Inaudible] Oh, numerous meetings. It’s out—you can read the official pandemic flu statement from HHS [U.S. Department of Health and Human Services] that came out in August. But you can see it in many prior meetings. We just don’t have the capacity to produce large amounts, and therefore, we’re going to concentrate it right here at home.

So then you think about the foreign-policy fallout. The pandemic has passed. The United States had a relatively high survival rate because of the combination of Tamiflu and vaccine, while allied nations and poor nations around the world witnessed terrible carnage from this flu. How will we deal, then, with the foreign-policy fallout, the reaction against us for having, you know, basically allowed our wealth to mean that we survived and they did not? And these are beginning to be the kinds of questions that people are asking here in this town, people in influence. The answers are hard to come up with.

UNKNOWN: And just in response to your stem-cell comment, while you are correct that there are a greater number of scientists on the oversight committee, like most legislation, the devil is in the details. And at this point, a yet-to-be-selected scientific-advisory committee is supposed to read all the proposals and make the first awards by May. If anyone’s heard of an NIH study section, let’s move that quickly. I’d love to hear about it. So I would suggest the compressed time schedule is going to move away from the influence of good science being funded. But maybe that’s a short-term problem. I hope so.

GARRETT: In the back there. Can we get a mike?

QUESTIONER: Hi. This is, again, a question for Laurie.

GARRETT: Could you please identify yourself?

QUESTIONER: Erica Check, I’m with Nature. You were talking about the various mechanisms to set up the movement of wealth in the developed—developing countries. And I know in the U.S. we’ve heard a lot of debate about PEPFAR, particularly in whether it’s living up to what it was billed as. And I wonder if you feel that the developed nations are fulfilling their promises that they made through these mechanisms, and you’re looking at evaluating how well these are working?

GARRETT: Yeah. One of the hardest things to do is to answer that question right now because nobody’s published anything. So if you take the sum total of, for example, all the American pharmaceutical companies that have done projects overseas related to antiretroviral distribution or anti-malarials, what have you, couple that with PEPFAR, with DFID [Department for International Development] from the U.K., with the Canadian effort, the French effort, the EU—all of that combined, virtually none of it has been published. So we’re dealing with literally trying to count heads and determine if everybody’s claiming the same 200,000 people as, you know, we helped treat them, or if in fact it’s a larger number.

WHO recently, here in this town, had a joint meeting with PEPFAR and they released a statement saying they estimate at this time 700,000 people in developing countries are getting antiretrovirals as a result of all the various programs out there. Now, that falls far short of the “3 by 5 goal”—meaning 3 million in treatment in poor countries by the end of 2005. To achieve that goal, we’d have to be enrolling more than 200,000 people a month from now till the end of 2005. That would probably mean you’d have to test more than 2 million a month to capture the 200,000 a month. I mean, it’s just not going to happen, let’s face it.

But the larger question is: Have we actually even treated 700,000? I’ve found many cases where PEPFAR is counting to their credit having treated X number; but the government of, say, Haiti, is saying the same numbers and claiming them as their treatment achievement. And you start to realize that many people—many heads are getting counted multiple times. So it’s a damn good question: How many people are actually in treatment, just for HIV alone. And if you put into it—add to it, you know, how many kids are getting bed nets for malaria and from whom, and on and on down the list, we don’t know the answers. And this is something that actually I’m going to be aggressively working on at the Council over this year. Over here.

QUESTIONER: Hi. I’m Jill Wechsler. I’m the Washington editor for a biopharm magazine and a group of magazines for the pharmaceutical and the biotech industry. And I was interested in Michelle’s comment about the new biotech treatment that had been developed in Mexico, I think you said for cervical cancer. And that seems like a very promising development. I just saw something about some new biotech treatment coming from New Zealand, and it seems to be proliferating around the world.

But you seemed to be concerned that somehow this treatment would not be available to people in the U.S. or other markets, which I didn’t quite follow, because it seems if it’s a promising or successful treatment that some biotech or pharma company would jump on it and license it and rush it to market here, and also in Europe. Is there—what is your concern about this development?

MCMURRY: Well, hopefully that would be the case. And I actually—if I sounded concerned, I’m more excited, because I think that this is going to be an economic engine for many of these countries, not just in traditional pharmaceuticals but in biologics as well. Mexico is also starting a genetic medicine research institute.

But I think what is possible, there’s a potential that these countries will develop drugs that may seem very similar to U.S. products, and you can see pharmaceutical companies in this country being a little bit reticent to cede intellectual property ground to a cheaper, perhaps related drug developed elsewhere. And then there’s the question, as well, of how are these drugs going to be approved, how is their safety and efficacy going to be determined? What is the FDA [U.S. Food and Drug Administration] going to demand to make them available on the U.S. market? And will the U.S. pharmaceutical industry be willing to foot the bill for that perhaps additional research, if the markets in the U.S. are either very small or very poor. So we have to start looking at those patient populations as well.

GARRETT: There’s a converse point to that, that kind of ties what you’re looking at in with the question about how many people are actually getting treated with antiretrovirals, and so on, and that is that we’re heading toward a future in this country where the baby boomers may find their opportunities through Medicare greatly diminished, compared to their parents, and where more and more drugs are unaffordable to the average citizen in the United States. To then turn around to the taxpayers and say, “But as a matter of humanitarianism and appropriate foreign policy, we want you to foot the bill for us to treat several million people for free with this disease or that disease in developing countries,” becomes a very politically difficult position to take. And if you then compound it with the current tensions between generic manufacturers in countries like India and Brazil, and the arrival of the WTO [World Trade Organization] and the soon-to-be implemented World Trade Organization provisions, the very strong likelihood that a country like India, that’s a major generic manufacturer, is going to be pushed to basically shut down their own generic industry and try to shove those generic manufacturers towards original production, towards developing new biotechnology or pharmaceutics, then you can begin to see a scale of tension in the world, both the consumer market and the development market, that definitely means the U.S. is no longer the only game in town and Europe is not the only game in town.

We are definitely looking at a more globalized situation in terms of both who gets access domestically within a country, not just the assumption that Americans get access while the poor world doesn’t, but that poor Americans don’t get access, some rich Americans might; that drugs might be made in India that actually are not for Indians, and that are specifically profit-making material targeting wealthy Americans and Europeans. I mean, the ball game is shifting very radically and very fast. And WTO is going to reshape it in ways that I don’t think most people have even imagined. Questions? Over here.

You know, usually at the Council on Foreign Relations, I have to tell you, the audience for most Council affairs is overwhelmingly male and a lot of white hair, and women are reluctant to ask questions. So it’s very refreshing tonight that we’ve seen quite the opposite here.

QUESTIONER: Hi. My name is Kim Krieger and I’m a freelancer. And I wanted to follow up on Laurie’s question regarding new nuclear power leading to nuclear weaponry. Are there techniques beyond the standard inspections that people are considering for countries that desire nuclear power but also desire to reassure the world, or that the world desires to assure itself are not developing nuclear warheads? Are there more sophisticated technological techniques being developed to ensure that?

FERGUSON: Well, there’s a more sophisticated political technique that’s developed giving inspectors greater access to a whole slew of nuclear activities. And this came about through the Gulf War in 1991 with Iraq. Frankly, we were astonished—analysts were astonished when we had pushed back Iraq from Kuwait and the strategic decision was made not to push ahead and actually topple Baghdad. But that opened the door to bring in inspectors, weapons inspectors, into Iraq and take a hard look at their activities. And what we found out is, throughout the 1980s and into the early 1990s, they were coming very close to actually developing a nuclear weapon. They were probably within months of acquiring enough fissile material to build a nuclear bomb.

So what came out of that shocking discovery was a decision on the part of the members of the International Atomic Energy Agency [IAEA] to establish what’s called the additional protocol. And what the additional protocol does—and you probably heard about it in the newspapers—after additional protocol, it’s almost obligatory to say it allows for snap inspections. Well, they’re not quite that snap or spur of the moment. But I think there are two innovations with the additional protocol. One innovation was that every aspect of the nuclear fuel cycle—from mining of uranium to producing nuclear fuel for a reactor, to using the fuel in a reactor, to possibly reprocessing spent fuel to extract plutonium, to burial of that nuclear waste—every aspect of the nuclear fuel cycle is subject to additional protocol inspections. And a nation that engages in all those activities must declare those activities and the facilities that engage in those activities to the IAEA. And so IAEA inspectors are then allowed to conduct inspections of all these facilities. And so when a state signs up to the additional protocol, they have to go through this process in order to try to get a clean bill of nuclear health.

And Iran, interestingly enough, has signed the additional protocol, but has not ratified it. But encouragingly, they said that they will adhere to the conditions of the additional protocol for the time being to try to gain this clean bill of nuclear health to allow them to proceed with what they call their civilian nuclear program, although governments like the United States find their program very suspect, and not just suspect, but you know, we have official U.S. documents saying, you know, we believe Iran has a nuclear weapons program, although we don’t see any hard evidence yet that they do have nuclear weapons, and it’s probably many years away from actually building these weapons.

So I think mainly the innovation in the last 10 years has been [of] a political nature, allowing inspectors greater access. And there are new technologies [inaudible] try to detect things that are buried, and there are smarter ways to use satellite imaging. There are old techniques that can still be refined. Trying to detect this radioactive gas called krypton-85 that can be emitted when spent fuel is reprocessed to extract plutonium. That’s a telltale sign of a possible clandestine activity.

GARRETT: You know, I should point out that with biological weapons, we’re way, way, way behind the nuclear situation. We really lack almost any capacity to speak of to verify that someone is or is not making biological weapons. The current Biological Weapons Convention, which was promulgated in 1972 in an accord between [former U.S. President Richard] Nixon and [former Soviet leader Leonid] Brezhnev, is—you know, and the United States is no longer a participant. Bush pulled us out on the eve of the 9/11 attacks, actually. And we—the real problem with it is the lack of a verification capacity because unlike nuclear, you can make bioweapons anywhere. You know, even a sophisticated high school biology lab might be a site of production of tularemia or anthrax spores, in theory. So where do you inspect? These sort of snap inspections you’re talking about, the pharmaceutical industry said you are not coming into our labs, no way. And all of a sudden you’re up against trade secrecy and on and on and on, and we really lack any capacity.

I’ll tell you an example of something going on right this minute that highlights this problem. You probably all know about GenBank in Los Alamos. It’s the largest genetic database in the world. It is where information regarding viral strains, for example, will be sent. It’s the largest repository of information, for example, about strains of HIV in the world. It is supposed to be a matter of routine that if you identify a new virus and you sequence it, you’re going to send that sequence data to GenBank.

In December, some researchers from a veterinary school in South Korea sent six sequences for six viruses they said they had extracted from pigs in South Korea. These sequences were the WSN/33 influenza virus that has not circulated Earth in 70 years—almost no one in this room would be immune to it were it to circulate—and it is a close relative to the 1918 strain. And it had been mixed with an H9N2 avian flu strain and other elements of genetic material from unidentified sources. Since the WSN/33 strain is not in nature and it’s only found in laboratories, and the H9N2 strain is also not in circulation at this time, these clearly were man-made viruses. Who made them and why? Well, they just posted it on GenBank and then it was just left in the air until a few online publications that specialize in these sorts of things started screaming about it online. And that prompted WHO, just before all the tsunami issue happened—just days before—to hold an emergency teleconference with flu experts to say, “Should we be worried? Do we think maybe North Korea is making a[n] influenza weapon? Do we think that this is a laboratory accident that might leak? What was anybody doing trying to work with WSN/33 anyway? Exactly what is going on here?” And the decision from the expert panel was, “We think it was a lab error or somebody made a mistake in the database input. We don’t think it’s cause for concern.”

All right, now, are all of you breathing easy? [Laughter] Have you all decided that’s the end of the process? The problem is at this moment that’s what we’ve got for a process, total chaos. And indeed, the chatter on the Internet, far from dying down because WHO decided that there was nothing to worry about, has moved forward, full steam ahead. And footnote, South Korea, despite promising to do so, has yet to turn over the samples. So we don’t have mechanisms in place that resolve these problems. [Laughter] If we lack it for nuclear, which is much more verifiable, you just begin, by orders of magnitude, imagine what we’re dealing with in biological.

And by the way, I should add that, you know, one scenario for explaining what happened with the South Korea WSN/33 is that some malevolent individual deliberately put into GenBank misinformation to shame North Korea. How would we know that? How would we refute that? Suddenly, if you think in foreign-policy terms, you realize there’s tremendous vulnerability there. Pakistan could deliberately post a sequence, say they got it from pigs from India, and all of a sudden the world’s wondering if India is making biological weapons. So this sort of chaotic situation we’re in is highly unsatisfactory.

QUESTIONER: Julian Josephson. I’m a freelance writer here in town, also from Bootstrap Press in Bethesda, Maryland. May I be the devil’s advocate?

GARRETT: Please.

QUESTIONER: Is it not the better part of wisdom to apply Occam’s razor in this sense and assume the worst? Because that way you’d need the least amount of other assumptions. Assume the worst and proceed accordingly?

GARRETT: Well, let me counter. We have somebody here from the New York City Department of Health. They are currently under fire for taking that stance, assume the worst: “This new HIV found in this one individual may, in fact, have spread, and it may be a super-virulent HIV that’s highly drug resistant. We should send out an alarm.” Look at how many groups, agencies, and individuals are now attacking the city for taking that position? It’s not an easy position to take. And if you go into the global arena and start talking about bioterrorism or nuclear, you know—is [Secretary of State] Condi Rice taking the appropriate stance with Iran? It is a stance that said, “We assume you are making nuclear weapons, we assume you are lying, we assume we can’t negotiate with you.” And we’re actually telling the Europeans, “If you want to go putter around and negotiate, go ahead and waste your time.” Am I right? And then you had [Vice President] Dick Cheney say on—was it “Meet the Press”—you know, if Europeans don’t get their act together, Israel will take care of the problem, implying that we’re sanctioning Israel taking out nuclear production facilities in Iran. Bob?

QUESTIONER: Bob Roehr, freelance, Washington, DC. Getting back to stem cells, there are two questions. I guess the first one, the easy one, is why are stem cells not going to be the new gene therapy, where for decades people have hyped it and it really hasn’t moved into clinical practice?

MCMURRY: Did you have a second question as well?

QUESTIONER: After this.

GARRETT: Let him keep the mike. [Laughter] I know this guy. [Laughter]

MCMURRY: I think there’s a real risk that it will turn into gene therapy, and that’s what I meant when I said it may not turn out to be the panacea, especially since we’re deciding the funding levels based on public outrage rather than scientific promise, which has been our tradition. So it’s definitely possible. I think at this point we just don’t know.

QUESTIONER: The other question is, then, do we know whether—assuming the best about gene—assuming the best about stem cells and they do work, will it be on a model which is the current paradigm for the pharmaceutical industry, which is based on blockbusters, or is it going to have to be individualized? Are we going to have to take tissue-typing type concerns into account, in which case it’s a very different market paradigm?

MCMURRY: I think it’s wise to assume at this point that it’s going to be much like the transplant, that—you know, that is very individualized, very expensive to apply, and used in worst-case scenarios. That being said, I’ve been attending the California meetings, and they are right now in the midst of trying to debate different versions of intellectual property. The legislation stipulates that the state must benefit in some way, but nobody knows exactly how to make that happen and it’s not clear. And when it comes to international innovation on this front, what we’re going to do when there’s an international proof of principle but you need domestic scientists to apply it to an individual patient in the States and that scientist may be NIH-funded, how that is going to work will be very, very complicated.

GARRETT: I mean, do you think we can be down the road 15, 20 years from now and there are, you know, spa-like centers in Mexico where wealthy Americans go down, have their own cells cloned in order to deal with Parkinson’s or whatever, and it’s all illegal in the United States?

MCMURRY: That’s actually happening. Last year there was a row with the FDA because there were some scientists using cord stem cells to treat ALS [amyotrophic lateral sclerosis, also known as “Lou Gehrig’s disease”]. And there were patients with very advanced ALS who really wanted this therapy, and the FDA actually raided a clinic in Atlanta, which ended up moving to Mexico to try to continue to research. Because they were a private-sector lab, they didn’t have the infrastructure to meet all of FDA’s demands to do a large clinical trial. So we’re already seeing that kind of thing in a much—and that’s a much easier case because those cells supposedly are OK to work with in general. So I don’t think that’s a far-fetched conclusion at all.

GARRETT: Over here.

QUESTIONER: I’d like to—

GARRETT: Wait. Mike, mike.

QUESTIONER: Oh. I’d like to change the topic just a bit to prion diseases. And there’s been quite a bit of resistance in this administration for certain—against sort of mass testing, and also accusations against [University of California, San Francisco, Professor] Stanley Prusiner for making money off tests he’s developing, which are less than clear-cut if they’re effective. But what are your thoughts on the testing of U.S. beef and other beef? I think it’s very low now; it’s less than 12 percent or something like that.

MCMURRY: It’s [laughter]—it’s a difficult question. Part of the problem is, as a nation, we’ve never dealt well with public health screening. We’ve never dealt well with explaining false negatives, false positives, and assessing risk accordingly, and I think we’re seeing that same problem here. And it was very interesting to me that when Bush made his trip to Canada, he suddenly announced that it was OK to import Canadian beef and they suddenly announced that they would prohibit any re-importation of Canadian drugs to the U.S. So you’ve got to worry about the trade quid pro quos that are going on in this case and whether or not we’re really talking about human safety or we’re talking about the beef economic sector, which is what the USDA [U.S. Department of Agriculture] is charged with protecting.

GARRETT: I also took note of—the Bush administration’s budget proposal for 2006 actually greatly reduces food and meat inspections by the FDA.

MCMURRY: [Inaudible] I think you’re—well, I don’t know what you’re imagining for backlash, but one thing is sure when you get to talking about the U.S. budget: the American people are very slow to respond to information about budgets. It’s overwhelming. And what you see are individual interest groups responding to that niche of a budget that affects the thing their interest group is targeting. So a given foreign-policy group might respond to certain segments of the State Department budget; you know, a food-safety watchdog group might be, in fact, right now formulating a response to the FDA reductions in the Bush administration proposal. And frankly, all of this is only, you know, the first hat tossed in the ring. Now it goes to the Congress, and that’s where the real fight’s going to happen. And it’s going to be interesting to see which elements of the Bush budget the Democrats basically feel they are overwhelmed by and roll over and just let happened, and which elements they stage an all-out battle and try to find bipartisan support to block. And I don’t think we know the answer yet. This is a very fluid political situation on the Hill right now.

GARRETT: Joe, in the back there.

QUESTIONER: Thanks. Joe Neel from NPR [National Public Radio]. I want to—Laurie, I want to go back to the New York City case for just a minute and ask—just sort of gauge, get your reading on this situation. Do you think that the Health Department jumped the gun in making this announcement? That’s my first question. And the second question is whether or not you think it’s a serious threat. How do you think it will play out in developing countries where treatment is just getting started?

GARRETT: I have an op-ed in tomorrow’s L.A. Times [laughter] on exactly that. So hit the www.lat.com.

QUESTIONER: Maybe you can describe it? [Laughter]

GARRETT: I think the city did the right thing, and I’ll tell you why. First of all, all disease trends start small. You know, if we had discounted, as most did, a report of six gay men with pneumonia from a Los Angeles physician in 1981, you know, we were caught by surprise, and here we are with millions and millions of dead from HIV and, you know, an absolutely out-of-control global pandemic. We know that this virus is highly labile, that it’s constantly mutating, constantly changing. It is folly in the extreme, given the history of antibiotics and the history of other antivirals, to not assume that widespread use of drugs would fail to create selection pressure on, you know, a whole host of viral species.

Now, the counterargument all along, as we have seen this mounting toll in the United States of primary infection being due to drug-resistance viruses, now well over 22 percent of new infections in the United States due to drug-resistant HIVs, the counterargument all along has been, “Well, you know, drug-resistant viruses are wimpy viruses and once they’re in the host in the absence of the pressure from the presence of drug will revert to [inaudible] type and be a more—a tougher virus, but not a resistant virus.” Conversely, it’s often argued, or similarly argued, that viruses give up so much to be highly drug resistant that they’re not going to be highly transmissible; that they’ll lose that capacity.

We saw [Institute of Human Virology and Division of Basic Science Director] Bob Gallo step forward and decry the city of New York and call the commissioner, Tom Frieden, irresponsible and outrageous for holding this press conference. And I think they’re wrong. Look, look at the facts of the case. It’s true that we don’t know yet if this is a highly virulent virus. Although this fellow appears to have gone from infection to full-blown AIDS in an incredibly short time, perhaps as little as 10 months, which, you know, eclipses anything we’ve previously seen, we don’t know if it’s because of host factors. There may be something in him that makes him especially vulnerable, all right, we can’t rule that out. But we also can’t rule out at this time that the virus is indeed a more virulent, more pathogenic virus. We don’t know that.

So a prior questioner said why not err on the side of the assumption of risk? If this had been an individual who had a relatively finite sex life, knew who his partners were, then the prudent approach would have been to not issue a statement and to immediately conduct aggressive contact tracing, find all those sex partners, sequence their viruses, check their clinical status, and see what kind of a situation you’re up against. But that was not the case. This is a fellow who says he’s had almost 200 sex partners in two years, under the influence of methamphetamines, and doesn’t know who any of them are. So what options did the city have? You can’t contact trace, you know, an invisible list of 200 people. I think they did the right thing.

Now, some of the media coverage has not been right. And if you really look at the press statement put out by the city, they never said this is a super bug, they never said this is a super strain, they said the facts of the case. But a lot of the media and the headlines just lept all the way to: “There is now a new HIV in the world that is a super killer.” We don’t know that yet. But we do—I think it is prudent to be cautious right now, to have a heightened state of alert. And frankly, probably long overdue for certain individuals in the gay community to remember that we have a terminal disease that is contagious out there, and safe sex is the right sex.

QUESTIONER: To follow up is the effect on treatment in Africa.

GARRETT: Right. Well, you know, we have very good reason, and we always have had good reason, to be worried about how we’re going to disburse antiretrovirals in poor countries without promoting resistant strains. The counterargument for a long time has been—I had one scientist put it to me this way: “Why doesn’t Africa have as much a right to have resistant virus as America does?” You know, the counterargument is access counterweighs the concerns about resistance.

And I, frankly, have tended to fall in that camp myself. I can’t, you know, look at babies, whose parents will die before they’re five years old but who might be alive to see them graduate from high school if they had antiretrovirals, and not think we have to get in there and aggressively treat. But throwing the drugs out helter-skelter without any kind of infrastructure to appropriately distribute, follow the patients, and do the right thing, is irresponsible anywhere in the world. We wouldn’t want a clinic in Washington, DC, where people could just walk up and anonymously get antiretrovirals. Why would we want that in the poor world? Is it because they’re poor that they deserve no better?

Well, it looks like we’re winding down, and I bet everybody would like to have another glass of wine. [Laughter] Let me—let me—I want to introduce one person in case any of you have not met her. Lisa, stand up, please. Lisa Shields handles communications for the Council based in New York. And if you get anybody’s card on the way out, you should get Lisa’s so you know how to not only reach us, but the vast reservoir of foreign policy expertise that is the Council on Foreign Relations.

And I think, you know, if there’s any take-home message from tonight I’d like to leave with all of you, and I hope you’ll share with, you know, your friends this week at the NASW meeting, it is that when I started out as a science reporter, most science reporters thought the job boiled down to you got advance copies of all the journals and you were specialized in physics or you were specialized in chemistry or medicine, and those were the journals you really jumped on, and you found some cool article, some study that looked great, and you made a bunch of calls and you wrote a story, and that was science reporting. And that’s how we all started out.

The world has changed. That is not adequate anymore. If we continue to think, as science writers, that science is an American enterprise and that calls made in American area codes satisfy your needs as a journalist, and that the global ramifications of research, whether it be in America or it be in Britain or wherever it may be, are not part of your story, you don’t have time to think about that, then you’re missing the story entirely. And that will be only more the case as we go forward.

This world is globalizing and it’s time for science writing to do the same thing. And if nothing else happens as a result of this evening’s dinner and our discussion, it is that the Council