go
hey everybody i'm eric paraxels the
chief science and digital officer at
dcri and a professor of population
health sciences at duke college of
medicine i'm here today to talk about
truth trust and biodefense
so what does an 80 movies 80s movie has
to do with biodefense well i was
thinking about what i was going to talk
about and i was thinking about you know
what movie reminded me of the pandemic
and the movie that came to la
mind this pandemic was sex lives and
videotape and the more i thought about
it the more it made sense and there's a
couple of reasons for that right i mean
from wikipedia the plot tells a story of
a troubled man who videotapes women
discussing their sexuality and fantasies
and his impacts on the relationship of a
troubled married couple and the wife's
younger sister so kind of uncomfortable
right talking about sex and whatnot well
a lot of what's going on in this
pandemic with covet has to do with what
people are comfortable talking about
what they're not comfortable talking
about what they feel vulnerable
about what they're willing to share what
they're not willing to share and when
why and how those reasons might be their
own so i think i think there's some
wisdom in this but i also think there
might be a little fun in this
so for folks uh that aren't familiar
with the concept of biodefense the
history of biodefense has really been
about
um pathogen defense um and in particular
it's been really dominated by like the
terrorist use of pathogen defense like
biological weapons or something like
that and and the time that you know most
of us can remember maybe of that was was
back after 9 11 when some anthrax uh
laced mail was sent and actually you
know killed five people and 17 were or
sickened and this really really startled
the biodefense kind of industry just
like 911 startled everybody especially
the airline industry travel industry etc
this really
startled the biodefense industry but we
have to kind of be careful about that
right because it's it's there's a couple
things to it one
over responses uh are always something
you have to think about but when you're
talking about defense and strategy you
also have to really think about the
nature of an adversary and what they're
doing you know maybe they did something
to deceive you into looking at that
because they want you looking the other
way so you know maybe a a slightly
implied way to think about that is
imagine what you're the airline security
on your annual trip to disney world
would have been like if the shoe bomber
had put the bomb in his rectum instead
of his shoes nobody wants that
inspection at an airport right but yet
we take off everybody's shoes including
100 year old you know poor person a
wheelchair has got to take their shoes
off and you know we've got to be careful
about when we're being told to do things
when we're being told to look a certain
way by an adversary
so i want to start with a case of
redefining biodefense you're right so
again after 911 really got about
pathogens how to detect passages in the
mail how to detect pathogens
and you know in airports and things like
that but if you actually look at the
math here for a second you find out that
you know in 11 years from 1995 to 2016
you know there were roughly 3 220 plus
um american deaths uh due to terrorism
which of course is a horrible horrible
number the biohacking village and defcon
and myself in my own research were
really focused on medical device
security truth is as much as we know
there's a risk there aren't that many
documented cases yet
of where
you know there's actually been a death
or serious injury although we did have
one this year where ransomware attack in
germany was linked to
actually directly causing a death and we
know that the the rise of cyber attacks
and data breaches and hospitals has been
linked to things like higher incidents
heart attacks and things like that yet
at the same time we also know that 600
000 people died in this pandemic which
is way more than died in all of world
war ii so if we're going to think about
how we're defining biodefense and maybe
how we should redefine biodefense i
think we have to actually put
pandemics caused by whatever nature or
somebody else as one of the main things
that we're looking out for
so going back to the movie here i'm
going to talk about trust truth and
biodefense and so you know looking in
this movie there were just some really
really great co quotes that meant a lot
so in this case anne is mad when she
finds out her husband's cheating says
nothing's what i thought it was john's a
bastard let's make a videotape some
pretty important stuff in this first of
all um someone's mad and they want to
talk about it yeah well welcome to
facebook and welcome to online chat
groups and stuff like that when somebody
thinks that they've been deceived or
duped they're much more likely to talk
about it and they still may be wrong
about what really went on but the idea
here is that angry people take to the
internet many people can convince
non-angry people to do things so we have
to think about you know what we mean by
trust and when we're violating trust and
this especially includes
when medicine's violating trust i mean
right now we're in this latest wave of
covet and truly truly looking like a
pandemic of the unvaccinated that this
virus is just circulating and hopefully
not mutating and evolving and
unvaccinated populations you know we
know from vaccine sentiment and studies
like that that most of these people
uh that vac that aren't vaccinated ha
were influenced by by different types of
information campaigns and politics and
in the last election cycle and whatnot
like that there are some people that
have always been vaccine hesitant right
so that has to be out there too but we
know that it's a very different thing
now and we have to understand that
information media things like that are
directly contributing to life and death
choices that people are making
and i've been saying this for a while if
you saw my last deft on defcon talk i
think if we look at rebuilding trust and
medicine i think that's where we are you
know we can talk about the
disinformation and whatnot and we could
talk about the lady who you know was
went viral saying that you know a
vaccine made key stick to her head or
something like that we might even
snicker at that but the fact is there's
got to be a reason why these people
don't trust doctors and don't trust
scientists and don't trust the
government and you know here's just a
few few
facts but if you think about it if you
look at the last one if just one third
of americans trusted the government to
do the right thing in 2019 what do you
think that number is now
so this is from my last defcon talk and
in general the way i've talked about it
is that misinformation and
disinformation should be viewed as a
medical problem with the media dimension
and that the only way to address it long
term is to address why people don't
trust doctors in science and here's a
few of the facts medical errors still
the 14th leading cause of disease board
and across the w.h.o
we have significant unmet uh grievances
of cost and inequity in medicine today
people are cynical and isolated by
what's gone on there really isn't a
great way for patients to express
grievances with medicine today other
than taking it online you know how many
how many hospitals are really open or
hold open public forums and town halls
to hear about how patients felt that
week and probably not in a smart way to
do the cure but if you think about it
there really aren't forms for it how to
bend better enable gender faith and
ideologies based specificity people have
different beliefs and you know we can't
we can't discard that they're meaning
them you know
aren't all large industries corrupt if
people are making money and then what
about radicalization based on bad luck i
mean the fact is that you know we have
seen for example breakthrough
covet deaths because of a vaccinated
people it's extremely rare and the math
is extremely complex but you know what
it it happens and then it gets amplified
and then it gets blown out of proportion
so we really have to deal with this
medical problem with the media dimension
but can we get our message i mean you
know one of the things that that shocks
me is i continue to see what i think are
kind of self-inflicted wounds
by science and medicine you know
it's very easy to say you know pandemic
response hinges on trust i'm going to go
into that in a lot of detail from this
and other pandemics of course that's
true but how do you get to trust if you
can't stay on message
you know this one alone in the last few
weeks just startled me you know fisa
putting out an announcement or you know
basically communicating they thought
somebody might need a booster shot and
then immediately the medical
establishment cdc others says people
probably don't need a booster shot i'm
just kind of want to pull my hair out
and say really i mean really like like
fizzy you couldn't have like
talked to the cdc before you put the
message out and see if you guys could
have gotten on the same page instead of
doing something like this that's going
to actually allow you know
disinformation people to just go
hog wild we can't feed them
data like this we can't give them
reasons to do this stuff this to me a
hundred percent
preventable and naturally if you really
read it neither of these two are saying
anything that that really contradicts
the other but it can be sure be made to
sound like that that way in clickbait
let's talk about privacy in the movie
for a second so we're talking about
these interviews of people on their
their habits
and so these are interviews huh yes can
we watch one no why not well i promised
each of the subjects that no one would
see the videotapes except for me one
woman used up three minutes the other
one used up two two three hour three two
hour tapes
so this is a lot like conversations i
have when i've talked to people about
things like contact tracing and when i
talk to things about um
security or privacy and why this
enterprise thinks they should have data
but this one can't in particular in
trying to set up cova testing earlier
this year there was data that the cdc
wanted that was actually being blinded
by the counties to the states so how
does that data go through the answer is
it doesn't
you know and so we we've got to get on
page and what privacy is we've got to
get on page on in something like a
pandemic response with a simple case
report form about what's going to be
public what's going to be private and
that means to everybody
how about contact tracing what are those
phone calls like and did you touch did
he touch you no did you touch him no did
anybody touch anybody well yes
this is what contact tracing
conversations can sound like in case
you've never sat in and want to heard
one or anything like that to be very
personal you're out on a date you did
this you went to the dentist this day
um you know we have to think about what
we should have learned in the 80s from
hiv
when we had a an epidemic a deadly
non-treatable disease and the social
stigma was so bad that people were
scared to share their testing status
which was the most dangerous thing they
could do but they're worried about their
jobs and they're worried about their
lives and we're not we're not we've got
to be thinking clearly about this stuff
and we've got to remember that the
lessons are there
you know this is a great piece on
community trust in the ebola end game it
talked about what it was like in in the
west african ebola outbreak in 2014 2015
when i was there and it talks about how
um you know people would come in and
talk to people in villages and people
would run out screaming saying you know
they're going to take your baby and
they're going to cut your baby into
little pieces you know in 2014 15 that
sounded absurd have you seen some of the
us headlines in 2020 2021 they're no
less absurd than that and you know this
is uh myself and and a postdoc in a
village in kona sierra leone and you can
tell from the looks we're getting as
we're talking to people that you know
not exactly all that much trust and love
going on there but they did talk to us
and they they did point us to what we
needed to see but they did it because
we're standing there
nothing in our hands uh no soldiers with
us in the village being we were more
vulnerable than they were and they built
trust
we've got to learn from these lessons we
can't make mistakes and i i think we've
got to turn around and say even if we're
seeing what appear to be really severe
responses to things it can't be that we
go ahead and start tweeting about how
silly people are it has to be that we
start addressing why people feel that
way
you know and so very very similar you
know this was all over the place i was
interviewed i think it was on political
and a few other things about that but
the whole contact tracing thing most
people would just say probably hasn't
worked i mean there's a lot of reasons
for that one is the disease moved too
fast and we're too populated another
reason would be people simply didn't
trust it people didn't answer the phone
when an 800 number calls your cell phone
do you answer it if you don't know who
it is
people don't the other thing is that
some of these things are really just
surveillance you know some of these
these high-tech things that were really
just like proximity alerts of uh oh
you're you ha you're we can see you on a
gps and your your little red dot is next
to a red dot of somebody that might have
tested positive i mean it's brownian
motion of humans you don't know what
they were wearing you don't know if they
had masks on you don't know what happens
in lows on a checkout line and so i mean
contract tracing is something that's
been around for hundreds of years and
the truth has always been it's been
about
about trust and this this menace to
public health um article i suggest to
everybody it's a great it's uh article
on 1800's 1900's past 1700's past
epidemics and how people got people to
talk to them paying them usually worked
but it's a pretty fascinating piece to
see what we're what we're living with
living through again
and the bottom line is simply here you
don't need invasive tech for successful
contract tracing what you need are
community-based engagement and you need
trust and you need to ask ask
questions that respect privacy and you
need to provide assurances that you're
going to protect privacy it's a little
bit late now with the level of community
spread we have and stuff like that but
you know one of the things that
people like me think about people where
this isn't their first rodeo when it
comes to infectious diseases is that i
really hope the next one isn't more
deadly than this you know with a disease
like this as horrible as it is all the
people we've lost
roughly you know 1.8 death rate or
something like that overall right pretty
low what if it was 20 or 30
you know what we've shown is how badly
we can handle it we need to show how
well we can handle it
what about truth
graham i'm reading somewhere that men
learn to love the person they're
attracted to and women become more
attracted to the person that they love
and ann
i've just got all this time in my hands
i sit around and i start inventing these
like intricate scenarios and then i
don't want all that wasted time i want
to believe in them let's talk about
misinformation versus disinformation
you know because i i actually have
worked with a family that had a child
that had cancer um and the child did
very very well with cancer um but the
child recently was taken out of
follow-up care because that one of the
parents became very vaccine hesitant and
very suspicious of the medical
establishment that had saved their
child's life
and now not only did that child get
coveted and did okay
great shape but also now you know is not
not doing follow-up care or adult care
for her very serious childhood cancer
and you know people do have a lot of
time on their hands during lockdowns and
people will read all kinds of stuff and
they will invent scenarios and then they
will talk about them this is really
human behavior but that type of
misinformation we have to make sure
we're we're separated from
disinformation which which unfortunately
is what i feel is going on in parts of
the media right now where they're
intentionally
giving up false information to try to
drive certain behaviors
um you know so this is a great couple of
piece something that i've you know
people ask me about sometimes is you
know are we living in a post-truth world
and i didn't really know what that meant
but um this particular npr interview is
really really good on it
and what this what lee mcintyre says in
my book i define
post-truth as the political
subordination of reality
so i think of post-truth as a tactic
that's used by our authoritarians
in their wannabes to control the flow of
information so they control the populous
is any of this sounding familiar to you
all because it really really should
shouldn't it
you know so on the left hand side we've
got a a a picture
from the american media in spring of
2020 and on the right-hand side is a
large banner i took in a traffic jam in
sierra leone during the ebola and people
were believing ebola was real
people weren't believing it was real
right it's very alone in the us people
were saying it was politicized there was
no epidemic this isn't going to get you
it's all it's all being made up
um to drive behavior
i mean i mean come on right so what do
you do in this situation what i did was
i ran the experiment
how did i run the experiment well i was
asked um to comp comment on
some privacy issues on fox news and i
had a lot of suspicions and i'm i'm a
empathetic left-leaning person and i'll
put that out there but at the same time
you know i try to be objective and i
said let's let's let's figure this out
and so i i i met the person good people
trying to do good work and they
interviewed me and this is what that
interview ended up looking like on tv
you know eric how's the weather the
weather's really nice today it's sunny
it's bright everything's going good and
like well well you live in new england
right so so what's the weather like in
new england on the worst day well on the
worst day we can have blizzards we can
have ice storms things can be shut down
um you know you'd be saving water in
your bathtub like it's a hurricane that
could be the worst day what did the
interview look like on tv hey eric
what's the weather like what's the worst
possible weather because it's blah blah
blah i mean a hundred percent without a
doubt i actually taped my own interview
without them knowing it and they've been
they scrambled answers and questions and
it wasn't cool and i haven't gone on
again because of that but i think i
think when you see that
um you've got to recognize it now people
will tell me well but don't all medias
do that and i'll say actually my
experience this year no i was on here
and now twice this year on npr
both times that not only was that not
done but in one of the interviews on
kova testing i actually corrected
the host because she said something had
been fda approved and i said it had an
emergency youth authorization they went
back and retaped it to make sure that
she said the correct thing and i'm not
so i'm not going to say always good
always bad what i'm going to say is the
media is 100 being manipulative and
people have to be smart and be watching
out for that and at some point we have
to decide what's legal and what's not
legal if people are being harmed and
killed
so on social responsibility graham
you're right i've got a lot of problems
but those problems belong to me and you
think they're yours but you're not
everybody that walks in that door
becomes a part of your problem anybody
that comes in contact with you i didn't
want to be part of your problem but i am
so what if that problem was a virus
right i mean
let's be let's be clear we have to be
thoughtful about this
you know if i'm a supermarket delivery
driver
hourly rent um hourly wage
month to month rent a baby at home
and i think i might have covet and if i
tell my boss i'm getting fired i might
put on gloves mask up and not want to be
tested too and i and i and in this and
as irresponsible as that seems i think
we've got to understand that for people
food clothing shelter matters
right at the same time when people do
have
the ability um to take care of
themselves and to quan to quarantine and
stuff like that we have to be able to do
it and i think that's one of the reasons
why some of our research programs
haven't been effective it was about the
wraparound services you know people can
only do what they can do take the belief
out of it for a second if i've got to be
to work i'm going to be at work you know
and i'll i hope i don't get anybody else
sick but you know what
it is what it is social responsibility
and morality they're really different
when something's going on but attacking
these things intentionally that's
something else
you know telling people you know
vaccinated people telling unvaccinated
people they shouldn't get the vaccine
that's something else
so a little bit about this you know rand
paul vows to introduce
to um legislation to repeal mass
mandates and stuff like that
you know what
you know what i mean this type of
politicization it's just hurting people
and you know what i i know it's politics
i know that stuff goes on but for me
there's there's just been lines that
have been crossed when it comes down to
doing things and saying things that are
going to get people hurt you know if
you're norwegian cruise lines you know
you're going to lose millions and
millions of dollars because you can't
put your ship into florida you know
you're being you're being penalized for
trying to do the right thing which is
saying look
the public sentiment now is a lot of
people people like me may never get on a
cruise ship again it doesn't matter if
it's covered or not they just may never
do it right and so these are industries
that are trying to survive at least
they're trying to be responsible and we
shouldn't have a political system that's
that's trying to punish them for that
we had this interesting thing a few
weeks ago you probably saw it um biden
said facebook
platforms like facebook are killing
people with coveted misinformation and
then facebook isn't killing people biden
softens his attack you know my view on
these platforms frankly is that they can
be weaponized and it's it's you can say
it's whether it's their fault they can
be weaponized or they can't be
weaponized but are arms dealers and
bullish dealers responsible for wars not
for starting them right they might make
it easier but i think but i think things
can be weaponized i mean a car can be
weaponized by a drunk driver
right i mean these these things can
happen i think we do have to think about
these these social media platforms and
the harm they can cause and the fact
that by the way they are cleaning up
right because they're taking out money
from everybody they're taking it from
both sides which in an election is 100
fine in a public health emergency i
think that's getting to be something
else so while i would probably agree
that
facebook's like saying that platforms
like facebook are killing people might
be a step over the line it's just a
toenail over the line as far as i'm
concerned on where to go from here so
john mulaney things are getting too
complicated and cynthia no they're
getting real simple and i got to tell
you at this point i think things are
getting real simple i think that
with what we've seen you know two years
ago i stood in front of this audience in
this form and talked about the threat of
men of misinformation it was
600 000 lives of an epidemic
earlier we had no idea we had no idea
what would be right now and so i you
know i'm going to say some of those same
things but i'm going to say them with a
lot more um force and and a lot more uh
intensity because i think they're
essential
i think first of all as i as i wrote in
march of 2020 and then my colleagues at
harvard wrote again
in april 2021.
you know one of the most important and
most successful tools in all pandemics
have been community health workers i was
recently on a panel um
with the african-american dakova task
force down down at duke in north
carolina and one of the community
leaders um that was was there was a
community health worker he was a barber
and you know how you talked about how
you know how many people and how many
conversations go through a barbershop in
a day of people that have questions
whether they should get vaccinated or
not not only that but you know what if
amazon drivers were
community health workers what if they
had a community health worker in the
truck with them when they went into air
on to every street
in this country every single day what if
they brought food what if they could
vaccinate what if they could do covet
testing we we have to enable community
health workers and
my closing thoughts here again about how
we enable hackers as community health
workers to save lives
so one of the best things in government
is when they can do something bipartisan
it does happen i know sometimes you
don't think it does in the bipartisan
commission on biodefense is something i
studied but i was i was reintroduced to
recently by by the amazing nina ali the
executive director of this forum and you
know here's a little bit of what's going
on i'm going to talk about some of the
recommendations if i didn't mention it
um i know this will be on youtube but
the actual deck most of these graphics
are hot linked so you can go to the
article and stuff like that i couldn't
hot link to the whole movie though
you're going to have to go rent it or
find that yourself
so the recommendation's adequate
at a glance so here's a whole list of
them let's talk about two recommendation
six improve the management
of the biological intelligence center
enterprise so this is better
surveillance surveillance and monitoring
online activity are things that hackers
know how to do they know how to measure
reach they know how to measure breadth
and how to do these things so this is
this is a great application recommend
prioritizing orion investments in
medical counter meshes
among federal stakeholders what about
cyber countermeasures right what about
being being able to take down
destructive sites what about ensuring
that positive energy positive
information and important sites stay up
if they're protected and they can't be
hacked so let's let's talk about
recommendation eight for cyber
countermeasures
recommendation 12 is to involve others
beyond um just the federal government so
what about we heart hackers which
already works with the fda already works
with industry rds and why why do we not
have weak heart hackers biodefense that
works with federal
entities on biosurveillance
provide emergency service providers with
the resources they need to keep
themselves and their families safe we've
seen this right i talked about we needed
a medical troll army in my last talk
what about simply keeping these people
safe
from being attacked what about making
sure their families are okay what about
making sure their internet stays up what
about making sure that their phones work
right can't can't we form a protective
circle around people that are on the
front lines
and they're and you know and can we be
smarter i mean you know there's redouble
efforts to share information with state
local tribal partners you know there's
something called a a certified social
engineering prevention specialist there
are specialties now all across
information science and communications
and library science and people that
really know how to measure things how to
say things how to determine impact and
you know shouldn't we have more people
certified like this shouldn't there be a
biodefense certification specialty for
something like this
um develop and implement medical
countermeasure response framework
topic of my talk two years ago a jam
article that rob calef and i did about
having cyber um techniques as part of a
countermeasure response framework so
link to that paper there definitely
think we should do it
and then harden pathogen and advanced
biotechnology information from cyber
attacks well this is exactly what the
biohacking village and and partners have
done so well for the medical device
industry and why medical device makers
bring bring their new newest highest
potential devices to defcon hoping to
have them tested by the best security
specialist right
isn't this a great expansion of the
mission for biohacking village or
something similar
implement military civilian
collaboration for biodefense one of the
things that i think is
tough about government is that it kind
of has always been somewhat siloed and
if you say the word defense
as in biodefense it immediately means
you're you're in the defense industry
you're talking to defense contractors
well what about biodefensive health so i
so i think the idea is you know should
we have we heart hackers collaborations
specifically for medicine with the dod
in a similar way that they have on with
fda and there of course there are
hacker collaborations with the dod but
i'm talking specifically about
biodefense
prioritize innovation over
incrementalism in medical countermeasure
development um
you know as somebody who's been a
federal cio i i can tell you that the
the procurement process from the federal
government it makes it very hard to
implement uh to innovate
it makes it hard to innovate and
implement and that you've got this this
you know these large beltway bandits and
these huge contracting rules and you
know i don't like that google cloud
didn't get picked for this i'm going to
sue and all that type of stuff
i think they should come to defcon i
think they should work with individuals
i think they should work with cottage
industries and small businesses and i
think that's where they'll find the
innovation and the progress that they
need
i recommend lead the way towards
establishing a functional agile
global public
health response apparatus we need one
that's secure we need one that's safe
and we need one that's trusted again
something that the experts in this room
know something about
so
and bottom line we really can no longer
afford a public health system that's
ultimately a silly movie about people
behaving badly uh we just didn't get it
this time and a lot of people died
because of it but we can learn from it
and we have to
so in closing you know we need to apply
we heart hackers to pandemic
preparedness and biodefense including
public-private partnerships formally and
informally hardening our defenses of
biotechnology and pandemic information
systems
collaborating with the medical and the
scientific military
we must find a way to coordinate
messaging and amplify messaging on the
internet popular that aren't
self-inflicted wounds like we should
have boosters we don't need boosters we
have to stop that we must improve
surveillance and be willing to deploy
cyber counter measures when we know
there's something wrong you know with
this thing with the biden you know by
talking about misinformation everybody
kept talking about these eight channels
of these 11 channels and all i got to
say is if you can prove it why are they
still up
and then lastly we need the equivalent
of certified social engineering uh
prevention specialists and such frequent
for disinformation for making this work
thanks for having me today i enjoyed
giving this talk hope you enjoyed
hearing it now i look forward to taking
your questions thank you very much peace