90% of salmonella cases never get reported

Well, thank you very much. especially thank you for what you're doing for the community. I think the selfless intention of trying to support and help the community is very, very good. So thank you.

Right. Well, thank you for the introduction. So yeah, my career has been in the field of public health. Actually started my career working at State Health Department in Oklahoma in the laboratory and then moved up to to manage and organize a division of integrated surveillance and got my PhD there in Oklahoma in microbiology and immunology and then joined what's called the Epidemic Intelligence Service of the CDC. It's a two year Training program at the US CDC. We moved to New Orleans. We loved New Orleans. I learned to Cajun dance, and my wife and I loved you know, Orleans coffee and you know, it was very interesting culture in New Orleans. then we moved to Atlanta, where I, as you indicated, spent 20 years working at CDC. Most of my efforts have been in international settings. So I worked in the former Soviet Union after the dissolution and Caucasus and traveled all through the Caucasus and came to work in Armenia, which was a country that was at war with Azerbaijan. So I worked quite extensively in Armenia helping them to struggle with how do they establish public health in Armenia. There was an outbreak of measles happening at that time because of the dissolution of the former Soviet Union. and also spent quite a bit of time working with the Brand new Africa CDC. We established what I what we call the Institute of Workforce Development. We have developed what I believe are the best practices for multi-communication online e-learning. We believe that's a very important area. I just finished two courses at Columbia University in New York teaching them online, and a course at the University of Georgia teaching the online Master's in public health program. So we're in a Period of shaking, which means that the corporate infrastructure, the way that we have seen public health and healthcare services evolve over the last 80 years is being shaken. And, you know, that's shocking to many people. My students, my students tell me, maybe we should not be in public health. Is there a better, a better field for us to go into? And I say, no, no, no, take a deep breath, step back. And let's think about a better way to move forward. How can we improve public health performance? You know, this is an opportunity. And you know, I retired from CDC 2010. it had, and as you probably know, CDC celebrated its like 80th anniversary last June. So it's been in existence for 80 years. And any company or large institution that grows for that long develops into i inefficient what I'm calling call silos. And the way it is in public health is if you're in the medical school and you want to become a doctor, you decide, well I'd like to be an infectious disease. So I go and become an infectious disease physician. And then you decide, you know, I really like TB. So I'm going to become a T B expert. So at CDC institutions, silos were developed with each disease. TB division, HIV AIDS division, hepatitis division, each one of those Division directors then went to Congress, US Congress, and to receive money, and then they distributed the money to the states through what is called a cooperative agreement. In the United States, we live in a federated form of architecture. So according to our constitution, health care and public health reside the res responsibility resides with the state. So every state has a different system, so to speak. But they work together because they have to report to the national level at CDC. but but over you know these 80 years inefficiency has developed and basically inappropriate ways of going about things. So the shaking provides us an opportunity to put forward a better way. And we have we have done that. We believe we have a better way forward. We call it public modernizing the public health ecosystem and intelligence. You know, the word surveillance. has a sort of a negative meaning, as you might imagine. And public health surveillance is capturing public health information to be able to use it to try to protect the community. But the word surveillance is has such a negative connotation. We're thinking about the use of intelligence, public health intelligence, but but intelligence has a sort of a crazy meaning too. But we believe that using ethical, generative AI, we can talk more about that, and using modernization approaches We've been talking with Google and Microsoft about how do we provide, I call it the ductwork, to provide the infrastructure to be able to support and stand up a very effective public health system is really our goal. That's that's sort of I'm sorry that I went so long about that, and we can talk about the details. but you can look at what's happening in Africa. There's a large outbreak in the Democratic Republic of Congo. the, you know, as I mentioned, we did hosted four courses. across the continent using using modern tools for training, but there really needs to be something like Starlink to be placed into the the continent so that public health and healthcare can have easy access to internet. As you know, Starlink is being used in Ukraine right now for the war. So there's a lot of things that we believe we can do to make things better. And so my students and my team are poised to do pilot projects that would showcase that this is a better way forward.

Yeah. That's a very important question and one that's being asked at the our national level and at the global level. I'm sure it'll be discussed at WHO and at all of the global meetings. And it's a very important question. And you've probably heard some of the CEOs of various companies describe what they think should be done. And I think in general, there should be always we all should always have the trigger. Meaning we all should we should always have the ability to turn it off. and this when I say ethical generative AI, I'm meaning that when we collect health information, either healthcare information or public health information, it should be protected. It should not be available to any other company or resource be to be used. So ethical for our point of view means that pu personal health information should always be protected. when I talk about generative AI, we believe we can create, well, let me just describe one use of it, for example. when I was at CDC, I work with a team in Boston to develop an approach where we could abstract, let's say, let's say your daughter is sick and you have to take your daughter into the doctor, right? So you take your daughter into the doctor's office and he or she is examining your doctor, trying to develop what would be called a differential diagnosis. And he or she enters information into an electronic medical record, right? And there are many electronic medical records. I think in the United States are over 120 proprietary ones. That doctor in the United States is also required by law to report measles to the health department. So it either has to be done in a separate data entry. We were trying to work with the team in Boston to abstract the reportable condition. From the electronic medical record and then let it go electronically to public health. But it over 20 years that that just really has not worked. And the fact is that it's not what's called one health, because we have to include veterinarians and veterinary labs into this data entry s stream because many of our diseases now, dinghy fever, West Nile virus and Atlanta, other other forms of health conditions that impact the public are coming now from from the veterinarians and the veterinary labs. So the the modernizing of the ecosystem means including all data entry providers, veterinarians, veterinary labs, pharmacists. Because if you get sick, like you have a stomach ache and diarrhea, you may just go to the pharmacy to pull something from the shelf rather than going to a doctor. And we know that in the United States fewer than 10% of salmonella cases end up being reported. So we have to include pharmacies and the public. So a new modernized approach for public health service is being proposed and we have we believe the the best way forward and we would love to do pilot programs which demonstrate this benefit to public health officials because public health has a different workflow process than healthcare.

That's a very good question. We need to have you on our team as a part of the strategy. Cause at a you've already got a job. But I've been I've been I've been on the front lines in Oklahoma, as I mentioned, watching my screen and saying, there's a case of measles there. there's another case of measles. I need to do an investigation, you know. The information about the patient and the family is kept.

confidential, private, but for a public health official, they have to investigate is there an outbreak going on? What do I need to do to make recommendations, to try to prevent future cases? So ethical AI can capture the information that's being presented by the electronic medical record system and indicate that, yes, this is a case of measles. And then it can establish an analytic capacity. We can establish the analytic capacity to put the Put the information in front of the epidemiologist in a line list or an epicurve, some sort of a tool that the epidemiologist would need. So AI can serve a function for us to provide the information we need when we need it, where we need it, which is one of the key components. So the two components are data entry once, meaning we minimize the drama and the trauma to healthcare services. They don't have to enter a second time. And also we have the information needed when it's needed, where it's needed, by the public health official, which needs to happen immediately. They need to know immediately that there's measles from this jurisdiction, this location, and so forth, so they can perform their work. Now they have a list of 70 or 80 reportable conditions that they're concerned about.

Well, you know, I first of all we're we are very supportive, even though the United States government has withdrawn support from WHO, we're very supportive of them. And one of my friends and colleagues, Dr. Hanan Balkey, we hope will be the next WHO executive director to replace the current director next May. She's running right now the WHO regional office in Cairo. She's a great leader. And I think she would be a fantastic director after the current director. and she knows public health very well. We've worked with her in Saudi Arabia when she was working there. I've spent quite a bit of time working in Saudi Arabia. I had two five-year multi-entry visas, so I came to know Riyadh, in fact, better than Atlanta in many ways. And the kingdom has great potential. I know that they're undergoing really challenges right now, attacks and so forth. So the Middle East is really under a lot of controversy and challenge right now. But there is a need. We work also with the Eastern Mediterranean Public Health Network, which is headquartered in Amman, Jordan. They provide support to all the Middle Eastern countries in this area, training, also implementation of different tools and activities. So we would work with ImpANET, Eastern Mediterranean Public Health Network, and we have a specific team in Pakistan that we would want to work with. So We want to work with global leaders everywhere to try to develop this new model. And you know, we developed what's called integrated disease surveillance and response around the year 2000 in Nigeria and West Africa. And so it's become the standard. Integrated surveillance can become the standard for WHO. This is the next step using information technology to improve.

Yeah, that's a great question too. And you've probably seen that there's a enormous rise in Africans identifying the issues and finding the solutions. One of the issues that we faced earlier on, I worked when I was at Emory to help support Liberia and Sierra Leone when they when they they had an outbreak of Ebola. You probably remember that. but we have we had at CDC some individuals who had the money. And the power, and they would come into the country and sometimes they like spend fifteen thousand dollars to transport a dog so the dog could live with them in the country. So there was a colonialization happen happening there, or or an attempt to say, We've got the money, you do what we want you to do. That's not right. And so we had this challenge. That's one of the elements of global health that we have to correct. We're not into the business of colonializing. different countries or saying here we have the money, you do what we want you to do. It's supporting from the community up the in the implementation of appropriate responses. And that's what Africa CDC is doing right now. Let me also say that I lived in North Carolina when the we had a large hurricane come through and our county was impacted in North Carolina. So we our internet was completely wiped out. So I bought I bought Ska Starlink. And it worked great. I think Starlink is the future. So I'm I'm hoping that I can get a hold of Elon Musk and encouraging him to donate, you know, a certain proportion of Starlink services to public health and healthcare services. It would be a great effort to help the community. So that's one of the issues. If we were to establish Starlink throughout Africa, meaning that public health officials could have a phone, Starlink phone, wherever they go. have un unlimited access to the internet and the communication stream would be wide, then we can implement in a very broad way without the challenges that exist now, the sort of training and the, you know, the communication that's necessary. So that's one of the issues we're facing.

Well, I would say hope. We want to do the right thing for the right people for the right reason. And that means working on we we have, we believe we have a right thing, so to speak, a new modernization approach. We're scientists, so we would propose to do applied research studies, have graduate students like yourself come work with us to implement and test with an appropriate monitoring evaluation plan and indicators that everybody would agree to. to see if this way is better than the last way. You know, so we we want to scientifically test our approaches, but we believe we have a better way forward and that this would provide the information needed for public health officials to take the right action. So we believe we have a way forward.

Thank you. Well, you can post this too. It's our website is Public Health Practice LLC. And my internet link is there available too. We can connect by inter by LinkedIn or by our website, whichever your audience prefers. And you can post my email address if anybody's interested. I use WhatsApp and other other tools too. It's it's an interesting world right now because we have tools that are d have been developed by different organizations. So there's a sense of competition, but there's also a need to work together, especially around AI.

Thank you very much.