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[narrator] Let's imagine, for a second,
all the ways the world could end.
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It could be something from above.
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Or something from below.
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Or it could be something
we did to ourselves.
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But there's one thing
that consistently ranks
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as one of the most likely things
to end the world...
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Well, if you think of anything
that could come along
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that would kill millions of people,
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the pandemic is our greatest risk.
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[narrator] A pandemic is a disease
that escapes our control,
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sweeping across the world,
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killing millions
and changing civilizations.
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We know this
because we've seen it before...
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a few times.
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In the 6th century, a pandemic killed
half the world's population.
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In the 14th,
another wiped out half of Europe.
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And in the 20th, a pandemic killed
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almost five percent of
the world's population in just two years.
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But that was a hundred years ago.
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We've learned from these past pandemics
and made incredible advances.
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Improved response, improved training,
improved workforce...
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We have improved surveillance systems,
improve communications.
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We have organizations
like the World Health Organization, CDC...
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We have improved diagnostics,
improved drugs, therapeutics, vaccines.
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[narrator] And yet the risk of it
happening again has never been higher.
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[man] We've done the math on this.
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We estimate there are about five new
emerging diseases happening
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somewhere on the planet every year,
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and that rate is accelerating.
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So it is inevitable that they
will become pandemics.
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Mother Nature
is the ultimate bioterrorist.
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[narrator] We're in a race,
and the stakes couldn't be higher.
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This simulation estimates that a pandemic
today could kill 33 million people
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in just six months.
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In terms of a death toll, a pandemic would
rival even the gigantic wars of the past.
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The economy will shut down.
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The cost to humanity will be unbelievable,
and no country will be immune
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from the problem this will create.
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[narrator] So the question is not,
is the next pandemic coming...?
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There are only three things
that are inevitable in this world.
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Death, taxes, and flu pandemics.
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[narrator]
Or... when is the next pandemic coming?
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We estimate there are around
one and a half million viruses in wildlife
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that we don't yet know about.
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Any one of those could be spilling over
into the human population right now.
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[narrator] The question is...
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will we be ready for it?
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Influenza pandemics
must be taken seriously.
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The world is fighting
the worst Ebola epidemic in history.
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The stakes couldn't be any higher.
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[man] A virus can be just as destructive
as a bomb or a missile.
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[man 2] Pathogenic organisms recognize
no boundaries lines.
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[woman] Residents believe their town
is ground zero for the swine flu epidemic.
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[man 3] All sorts of animals
may be the culprits.
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[man 4] A sick person can be healed,
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but in the meantime,
he spreads the disease.
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[man 5] The campaign
against infectious disease can succeed
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only if the public cooperates.
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[man 6] We just don't know
what the future is going to hold.
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[narrator] Pandemics begin
in a world invisible to the naked eye.
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Microbes were likely
the first living things on earth.
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Many can't replicate on their own,
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so they hijack other living cells.
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And today they're all around us.
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And on us.
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And in us.
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Many arrive in peace, but others damage
or kill our body's cells.
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Fever, coughing, sneezing, diarrhea...
that's our body fighting back.
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But some are so strong,
they can overwhelm our immune system...
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and kill us.
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Pandemics are mainly caused
by two types of microbes:
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bacteria and viruses.
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The interesting thing about viruses
is they are supremely adapted to jump
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from one species to another.
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They're the most likely microbes
to become the next pandemic.
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[narrator] As you can probably guess,
viruses that cause bird flu
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come from birds.
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Swine flu comes from pigs.
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HIV came from chimpanzees.
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Ebola likely comes from bats.
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And several diseases
come from mosquitoes.
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When these spill over to humans,
the new virus is called a zoonotic virus
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and they're extremely dangerous.
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These are viruses which mutate rapidly
and therefore change the surface
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and evade immune responses quickly.
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They can transform into a new virus
once they get into the human population.
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Now those don't happen all the time.
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They're quite rare events.
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[narrator] But when they do,
the effects can be devastating...
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which brings us to a farm
in Kansas a century ago.
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Experts aren't certain, but they believe
the 1918 flu pandemic could have started
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when an infected bird
and an infected human
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met the same pig.
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The bird had bird flu,
a type of influenza virus that have been
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infecting chickens, geese and ducks
for at least a hundred years.
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While the person had a different
influenza strain, the seasonal flu
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that had made humans feel stuffed up
and feverish for centuries.
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The two viruses couldn't infect
each other's species,
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but they could both infect pigs.
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And in one pig cell,
those two viruses combined,
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creating a new zoonotic virus: H1N1.
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These parts from the human virus
gave it the ability to infect humans,
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but these parts from the bird virus
prevented immune systems
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from recognizing it
and effectively fighting back.
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A deadly combination.
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It killed somewhere between 50 and 100
million people around the world.
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It was unlike anything else in history.
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[narrator] You can think of a disease
on two scales:
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how contagious it is
and how deadly it is.
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Here is the seasonal human flu
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while this is the bird flu.
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And this is the 1918 combination.
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It was so contagious
because it was airborne,
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meaning the virus could hang in the air,
infecting anyone who inhaled it.
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And a 1918, it infected one
in every three people on Earth.
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Then it killed almost 5%
of the world's population.
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The final ingredient was human technology.
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This flu emerged in the middle
of the first World War.
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We were sending people
across from the U.S. into Europe for war
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and then we were bringing them back.
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So this virus exploited
those travel patterns
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and spread around the world
very quickly and very effectively.
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[narrator] In fact,
in every past pandemic,
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human technology is responsible
for taking diseases around the world.
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The Black Death arrived in Europe
on ships in the 14th century.
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It was two distinct diseases:
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Bubonic plague, which killed
as many as 60% of the people who got it.
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And pneumonic plague,
which killed almost everyone who got it.
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Then there was smallpox.
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It was less deadly than the Black Death,
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killing 30% of the people who got it,
but it was more contagious.
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Humans spread it around the world.
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In the 20th century alone,
it killed around 400 million people.
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These other diseases
have also become pandemics.
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But eventually, we developed technology
that could defend us.
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The practice of isolating travelers
for a time to see if they were infected,
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now known as quarantine,
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was first developed
during the Black Death.
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Then we invented microscopes,
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allowing us to see the enemy
for the first time.
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Next, we developed antibiotics.
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These made these diseases
spread by bacteria far less deadly.
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And smallpox led to the development
of the first ever vaccine
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which defends us against some viruses.
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The way a vaccine works is we get
injected with proteins from the virus
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and we create our own antibodies.
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These are little molecules that attach
to those proteins and neutralize the virus
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and allow it to be swept out of the body.
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So when we get infected by a real virus,
we can rapidly create an immune response,
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send out these antibodies,
and get rid of the virus.
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[narrator] If enough people
in a population get vaccinated,
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it's almost impossible
for the disease to spread.
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So smallpox was declared eradicated
in 1980.
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And these diseases don't cause
nearly the amount of deaths they used to.
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And antiretroviral drugs have made viruses
like HIV far less deadly and contagious.
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Finally, the internet is helping us detect
and contain diseases earlier.
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This is why studies show that fewer people
are contracting infectious diseases today.
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But at the same time,
the number of outbreaks is increasing,
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and that is largely
because of emerging zoonotic viruses.
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Out of an estimated 1.6 million
unknown viruses in wildlife,
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we currently know of about 3000.
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So it's really less than 0.1%.
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[narrator] That means the next pandemic
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could be a virus
that we're not prepared for.
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[Daszak] We know some pretty lethal ones,
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but we expect that there are
others out there that are more lethal,
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that are better at being transmitted,
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where we've got no drugs and no vaccines.
They're the big risk.
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[narrator] This is called Disease X.
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And we know we're unprepared
because we've seen them before.
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[indistinct chatter]
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This is a wet market
in the Lianghua, China.
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Unlike markets in much of the West where
animals are already dead when they arrive,
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this wet market sells meat
that's very fresh.
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It's killed on sight.
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That's what makes it a Disease X factory.
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Many different animal species
are stacked on top of each other,
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their blood and meat mixed,
before being passed from human to human.
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All the while,
their viruses are mixing and mutating,
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increasing the odds that one
finds its way into humans...
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which is likely what happened at a market
here in southern China in 2002.
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Back then, some wet markets in China
sold wild animals
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like snakes, civet cats, and bats.
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And demand for them was high.
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On November 16th,
a man in Foshan, China got sick
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after preparing a meal
of chicken, cat, and snake.
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He had the symptoms of pneumonia.
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Fever, cough, and trouble breathing.
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When treatments for pneumonia didn't work,
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Chinese officials reported it
simply as "atypical pneumonia."
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But then it started spreading.
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And people started dying.
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There were reports of clusters
of respiratory infections
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in hospitals in China.
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[man] But we're used to that.
There were strains of influenza virus
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that caused flu in Asia many times over.
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Um... and we always noted them
and there was always concern,
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but they were not
particularly scary to us.
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But people like the CDC
and the World Health Organization
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start to take notice
of these rumors of illness
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and went to the Chinese government
and asked, "What is going on?"
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And the way that the world found out
about it is that someone
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from one of those towns
decided to go to Hong Kong.
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[McKenna] Hong Kong was
a uniquely bad place for this to happen.
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[narrator] In 2003, Hong Kong was home
to about seven million people.
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Over 16 million tourists
visited each year,
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and over 500 international flights
took off and landed there every day.
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On February 21st, one man arrived.
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He was already feeling sick.
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He checked into the Metropole hotel
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and headed up to his room
on the 9th floor.
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There, he threw up or coughed,
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spewing droplets
all over the elevator and hallway.
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That's how he infected 16 people
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who would spread the disease
around the world.
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The man in this room
boarded a flight the following day,
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arrived in Hanoi, Vietnam,
and checked himself into the hospital,
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where he infected doctors and nurses.
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One of those doctors
then took the disease to Bangkok.
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That's when the World Health Organization
declared an international emergency
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and officially named the disease.
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Severe acute respiratory syndrome.
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Or SARS for short.
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[narrator] A few days later,
scientists found the cause:
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a virus they had never seen before.
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Back at the Metropole,
a woman in this room
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flew home to Toronto and died.
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Her son checked himself into the hospital.
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I remember sitting there,
my kids were there,
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and I was watching the news
and all of a sudden I saw
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a picture of my hospital,
Mount Sinai Hospital, on the news.
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That was the first time it hit home
that this was going to be a problem.
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It was about a week later
when we identified
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that there were a substantial number
of staff at the hospital
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who were also ill with SARS.
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Who's going to be on call on Tuesday?
We have to get somebody else.
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What was their job?
Who's going to fill in for them?
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Sometimes just losing one
senior resident in our department
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throws the whole department into chaos.
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I was feeling fine when I got home,
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but I woke up in the middle of the night
not feeling well with a fever and...
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then I knew that was probably what I had.
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[narrator] By late March,
47 hospital staff were sick in Toronto
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and hundreds more were in quarantine,
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including Allison.
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This was one of the scariest things
about SARS.
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It's early symptoms were subtle
and hard to identify,
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causing outbreaks
even in advanced hospitals.
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Back in Hong Kong,
a nightmare was taking place.
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SARS was spreading faster than ever.
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A man with SARS was in this unit
of an apartment complex.
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He had diarrhea
and when he used his toilet,
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the SARS virus was carried
through the pipes to the unit below
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where a fan blew the virus
back up into the building's ventilation
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and into the apartments above.
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Then the wind was likely blowing the virus
to nearby buildings,
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making it much more difficult to contain.
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[man] That's truly a nightmare scenario.
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You're not physically in contact
with a known infected person.
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So it's much harder to track
because we don't necessarily know
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the source of the contamination
or the infection.
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[narrator] In total, 329 people were
infected in this apartment complex
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and hundreds were quarantined.
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By now the world was panicking.
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[woman] The fear that dogs and cats
can carry SARS
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has led some residents in Beijing
to abandon their cherished animals.
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[woman 2] Taxi authorities
have set up points
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to test cab drivers for high temperatures,
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one of the symptoms of SARS.
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In part, it's all down to how much
we, the public,
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trust what we're told by officials.
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Is it absolutely out of the question
that this could have been something
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inflicted upon people
by a terrorist agent of some sort?
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I think in March of the year 2003,
we exclude nothing.
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[narrator] 1755 people were infected
in Hong Kong and 300 died.
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In Toronto,
251 were infected and 41 died.
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With cases
in at least 26 other countries...
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ultimately, SARS killed 774 people,
about 10% of those it infected.
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But then SARS did something
totally unexpected...
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The funny thing about SARS is that
after a while it just kind of goes away.
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SARS just wasn't that hardy a virus.
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We didn't know that when it started,
but that's how it turned out.
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But I don't think that's a success story.
284
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I think a lot of that is just luck.
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[narrator]
Because a lot of mistakes were made.
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Chinese health officials only admitted
there was an outbreak
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after 18 people had already died,
and hundreds of others were sick.
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[in Mandarin] We will try all means to
reverse and improve upon the weaknesses
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and faulty aspects of our work.
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[narrator] After the SARS epidemic,
the World Health Organization
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brought together 196 countries,
and they all committed to improving
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their ability to "detect, assess, notify,
and report public health events,"
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including outbreaks.
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In 2014, only a third of them
were in compliance.
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The big problem with the pandemic
is we don't know when it will come.
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And so it's very easy to put off
to another day.
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It really takes an extraordinary act
of political will to say,
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"Yes, right now things
don't look that bad,
299
00:16:11,680 --> 00:16:13,932
but we're going to send funding
to public health anyway
300
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because we know that someday
it will be bad."
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[narrator] SARS showed how far and fast
a virus can travel in our modern world.
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SARS went around the world in weeks.
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It's entirely possible that the next
will go around the world in days.
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That's far faster
than we could ever catch up.
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[narrator] Which means,
if we want to stop the next pandemic,
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our best bet is catching it at the source.
307
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SARS began as a virus living silently
in a wild animal.
308
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Experts believe it was bats
here in southern China.
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These scientists have been coming
to these caves since the outbreak,
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catching bats and scanning them
for viruses similar to SARS.
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And they're finding a lot,
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which is allowing them
to create an early warning system.
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And when we find them we raise the alert,
and the government of China comes in
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and tries to reduce the exposure
of those populations to viruses.
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[narrator] China is not the only place
these viruses are being found.
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This map shows where a new virus
is most likely to emerge.
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The front line for disease emergence
are places like the end of the road
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in a tropical forest
where someone's just built
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00:17:28,256 --> 00:17:31,093
a new mining concession.
People have moved in.
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There's no food supplies so they go out
and hunt wildlife.
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00:17:34,179 --> 00:17:38,433
Or it's a farm in Southeast Asia
that's been expanding and intensifying
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that has bats nearby that spread viruses
into the pigs in the farm.
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This is a revolutionary way to defend
ourselves against future pandemics,
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but it won't catch every new disease.
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For that, we need to improve our vaccines.
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If a disease comes along
that we haven't seen before,
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typically it would take four or five years
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00:18:00,288 --> 00:18:02,707
to come up with a vaccine
against that disease.
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00:18:02,791 --> 00:18:06,586
And new technologies
might shorten those times.
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[narrator] That's why an organization
called CEPI was founded.
331
00:18:10,173 --> 00:18:13,301
And they're developing a vaccine
for Disease X.
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00:18:13,385 --> 00:18:16,847
Traditional vaccines inject
protein molecules from a virus,
333
00:18:16,930 --> 00:18:20,600
and manufacturing these proteins
is a long and expensive process.
334
00:18:20,684 --> 00:18:23,353
But this new vaccine doesn't use proteins.
335
00:18:23,436 --> 00:18:28,733
It injects genetic material that tells
the body to produce those proteins itself.
336
00:18:28,817 --> 00:18:33,363
Your body becomes the manufacturer,
creating the protein molecules
337
00:18:33,446 --> 00:18:35,323
and then the antibodies for them.
338
00:18:35,407 --> 00:18:38,743
Scientists can customize
the genetic material to get the body
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00:18:38,827 --> 00:18:42,038
to produce the protein molecules
of almost any virus.
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00:18:42,122 --> 00:18:44,666
Once they figure out
how to deliver this into the body,
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00:18:44,749 --> 00:18:48,003
it could reduce the time
it takes to develop a new vaccine
342
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from several years... to just 16 weeks.
343
00:18:52,299 --> 00:18:57,262
Meanwhile, scientists are trying
to develop a universal influenza vaccine,
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00:18:57,345 --> 00:19:02,309
one shot that could immunize us
from every possible flu strain for life.
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00:19:02,392 --> 00:19:06,396
None of those universal flu vaccines,
as they're called,
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00:19:06,479 --> 00:19:09,149
are anywhere near
to being deployed in the population yet,
347
00:19:09,232 --> 00:19:12,235
but the U.S. federal government
and governments in Europe
348
00:19:12,319 --> 00:19:16,114
have been supporting that research
in a way that they didn't
349
00:19:16,198 --> 00:19:19,242
a couple of decades before,
because they understand
350
00:19:19,326 --> 00:19:23,663
that flu really is an eternal
and very serious threat.
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[narrator] The truth is human technology
has made the next pandemic inevitable.
352
00:19:29,336 --> 00:19:30,795
Deforestation is bringing
353
00:19:30,879 --> 00:19:34,299
more wild animals
into contact with more people.
354
00:19:34,382 --> 00:19:38,261
And factory farming
is pushing animals closer together,
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00:19:38,345 --> 00:19:42,682
giving their viruses more opportunities
to combine into one that could infect us.
356
00:19:43,225 --> 00:19:45,810
Then we give them
more ways than ever to spread.
357
00:19:45,894 --> 00:19:48,939
But human technology
has stopped pandemics before,
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00:19:49,022 --> 00:19:51,191
and it's our only chance
against the next one.
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00:19:51,274 --> 00:19:56,238
We know that, because we've been
in this race since life on Earth began.
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00:19:56,321 --> 00:19:59,366
When a pandemic comes along, of any size,
361
00:19:59,449 --> 00:20:02,535
we always look back and wish
we'd invested more.
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00:20:06,206 --> 00:20:09,125
We are far short
of what needs to be done.
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[theme song playing]