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Well?

So, while we were giving the lab tour,
I looked down at my phone

and noticed that that email had come in.

We're opening the Gates email.

Um...

No matter what, uh...

if we don't get it...

Um...

If we don't get it...
The possibilities are we don't get it

or we get it but it's different
than what we thought or...

- I think we should just open the email.
- All right, let's just do it.

Tear off the Band-Aid. Let's see.

"Grand Challenges universal vaccine
developments full proposal...

congratulate you on being selected
to move forward.

This is a very competitive process.

We're excited to work with you
more closely on your project.

Program officer and program fully funded."

I've been waiting
nine years for this.

We heard back, and...

it's yes.

Let's do a Champagne toast.

- I'll tell everybody.
- Yeah, sure.

Are you happy? Happy.

Yeah, I am happy.
I'm fucking stoked.

We've won the grant,

and that gives me the optimism

to be able to move forward
without worrying about funding.

To our piggies.

To the piggies.

Right now, I feel confident,
but a little antsy.

We need to finish the job

with the latest test of our flu vaccine
and our pigs in Guatemala.

Cheers.

Take another deep breath.

And again.

So the swab can tell us
if it's the flu.

It's pretty accurate but it can...
You know, we can miss a couple of cases.

They said that you'd been tested last week
or that you'd been sick last week.

- But it came back negative...
- Right.

As the flu season
kind of wears on,

we're busier and we're having
sicker patients.

We get tired
and we're really looking forward

to the end of flu season.

While I was working, the chills hit...

and I started feeling worse
and then the coughing hit.

And then we did the flu swab
and it was negative.

So I'm like, "I'm fine. I'll just
wear a mask." And I kept working.

That was on a Monday afternoon.

Draw labs and get an IV
and we'll run his urine...

My shift was Monday
through Thursday morning.

So I knew this was early on.
I have to just push.

He'll probably get a chest X-ray, too.

I decided...

Tuesday afternoon
that I would test myself again,

and I was positive for the flu.

It shocks me every time I get the flu
how much it hurts.

The muscle aches and joint pain

and the bad headache and just coughing
and feeling so tired,

but still feeling
too miserable to even sleep.

I get the flu shot because I want
to protect myself as much as possible,

but with the flu shot, it's not 100%.

I tell my patients that they need
good rest and they need to eat healthy.

"You need to make sure you're balancing
your life. Don't work too much."

And I think that I just don't follow
my own advice.

I don't get enough sleep,
and I'm very stressed in my position.

It does put me at a place
where I'm at risk for having more illness.

Probably, I'm putting myself at risk
for having a heart attack and stroke

and high blood pressure,

but that's the nature of the job.

There has been a rise
in swine flu cases

across India this winter season,

and Rajasthan is where the impact
has been felt the most.

Are you seeing an increase
in patients this year?

Definitely. There is a huge increase.

Authorities say
that the sharpest spike

in swine flu cases was seen last week.

The numbers are staggering.

Over 9,000 people are affected,

which means that
once it reaches that level again,

the spread will be that much faster.

So are enough measures being taken
to restrict the spread of this disease?

So shift number five.
There's an empty bed.

- Don't cough so loudly.
- What else should I do?

Cough normally.

If you cough so loudly,
it will hurt you.

I am hurting.

We have learned that every year

these two months are the most hectic.

We don't even see our own families.

No lunch or anything. There was no time.

But being a doctor is a passion.

I can work day and night.

Patients who are very,
very sick, obviously it's very difficult.

What if the patient does not make it?

You follow that patient from day one,

when you see that patient
arriving in the Emergency.

Majority of the doctors
get very attached to their patients,

and every time we lose a patient,
it really hurts.

When Rajkumar came to us,
he was very, very sick.

Take an X-ray for me now
and send it to OPD.

When Rajkumar arrived at the hospital,
he could hardly breathe.

He was completely deteriorating.

When I attended to him,
he was extremely hypoxic.

Hypoxia means
there is a lack of oxygen in your body.

His oxygen saturation was around 30-35%.

We had to intubate him
immediately and put him on a ventilator.

He was kept unconscious through sedation.

There is a lot of stress,
whether he'll make it or not.

Although deep inside,
they're very worried,

the family has full trust in us.

His children are getting
married on the 9th and 10th of March.

But his health is more important now.

If he gets well, it's fine, or else
we will try to postpone the wedding.

Let's see.

Get his X-ray sent to me in OPD.

We have to prone him at two o'clock, okay?

Proning is a way of placing the patient.

If the patient is not getting
sufficient oxygen from the ventilator

when lying on his back,
then we place him on his stomach,

so that even his lower lung
will open up with the pressure.

If after proning,
his saturation is not improved,

then it means his mortality
is almost confirmed.

Being a Muslim,
it shapes my daily life.

With our busy schedule these days,

it's hard to attend various programs,
events or prayers,

but I always try to make the time to go.

- Thank you.
- You're welcome.

Will everyone
please come in close?

You can move in very close.
People are gonna be joining us.

I try to go to Jumu'ah
or Friday prayers

at the NYU Islamic Center
as much as I can.

Do you want to have the heart
that feels and is awakened

with what they are going through...

My faith drives me
to do the work I do.

And my desire is to not just help
this community, this city, this nation,

but the whole world.

But we're only as strong
as our weakest link.

And that's why I'm starting
a global health center.

To help the health care sector
around the world to keep us all safer.

Attention please,

this is a boarding call for Amtrak
Crescent...

We have no idea
where the next patient zero will present.

So, for this global health center to work,
I need to recruit professionals

from throughout the health care sector.

The best and the brightest
for my leadership board,

and I'm starting that process
in Washington, DC.

Let's do this.

We're gonna finally learn the results
from the third pig study.

Let's take a seat.

Worst-case scenario,
which is still a possibility,

is that nothing worked,

and so we're stuck
in the second experiment.

So I'm hoping that we see
a real improvement with the Centivax.

So I have data to present
from the vaccine study in Guatemala.

This is just showing you
that there were 35 pigs in the study.

Five pigs in each category.

This shows that if there is signal,

if there is binding,
you see a curvature that goes upwards.

- You're killing me. What's the result?
- Tell us.

This is the table that summarizes
all of the results.

They're categorized by the groups.

So, as you see, group one was the...

So I look at the screen.

I'm seeing some green,
and here green is good,

because green is the amount of response
that we're seeing from the pigs.

Seven had MPLA and so forth.

These results are huge for us,

because we have a vaccine formulation

that takes less shots
and gives a stronger response.

So this is very successful.

The pigs are producing antibodies
against different strains of flu virus.

All right. Thanks, Christina.

All right, so good news.

The primary goal
of the experiment succeeded.

Obviously, we need some tinkering still
because this required three shots,

and we want only one shot if possible.

We're excited about those results.
We have new questions.

Scientists look at success and ask,
"What's on the other side?"

And additional questions.

From an outsider, it's not always obvious
that we've achieved a victory.

As for scientists,
that's not how we see it.

We see, "Okay, one less thing
to worry about

and there's new things
we're gonna fight towards next,"

but it's exactly those victories

and even more so,
the new questions that really drive us.

The foundation of all good science

is that the work should work
in other people's hands,

and so this gives us
some winning groups to move forward

and we've already gotten better
than where we were before

so the study was successful.

- Cool. Thank you very much, Christina.
- Sweet. All right, magic.

Our success
with our vaccine technology

on top of the Gates Foundation money

means we can begin
a pilot study in the UK,

where we're gonna further optimize,

and then the next step is it creates
a flu shot so that people don't get sick.

Our goal here is to create a flu shot

so that within a decade,

we're looking back and we think
of flu as a disease of the past.

I remember each pig
and each group that they were in.

I'm like...

You need to get rid
of that information.

I know.

- Just burned into your brain.
- Yeah. I want to learn new cool stuff.

Yeah, there's other things
to put in there.

Sweet. Done.

I don't feel like I can sit down
and just rest,

because I have these things
that are kind of pending.

I have too many balls
in the air right now.

Makes me a little anxious.

As a physician, we pour out,
and pour out, and pour out,

and because we work long hours,

and because we lose sleep,

fatigue is really, really right there
in front of us all the time.

I have a 72-hour shift,

and the toll that it takes on my body,

and on my emotions, and even on my spirit,
is not something that I factored in.

Honestly, as a physician,
you begin to sacrifice little things

like dinners and church services
and baseball games.

- Come in, baby.
- Hi.

- Are you ready to eat?
- Yeah. If you've got it ready.

One little sacrifice at a time,

and if we're not careful, we sacrifice
our family over it or our marriage.

She did. I heard her say that.

I wish you'd got some sour cream.

Right there, on the table.

- In a little package.
- Okay. I didn't see it.

My husband and I
have a very strong relationship,

but the last probably six months,
I haven't been very nice.

- I'm sorry. I'm in your way.
- No problem.

So our relationship
has been suffering.

More arguments.
Not really listening to each other.

I know that what I do is important to me
and, of course, my patients,

but what am I doing to myself
and my family?

Is this really right?

I don't leave home
without praying first.

Even if I spend just a few minutes
in my temple, I am content.

Sometimes, I make a request to God,

"God, please help me with my patients."

Sometimes you put in 1,000%
and still nothing happens.

Then I sit in my temple and ask
for God's help.

I tell God, "I have made every effort.
Nothing is happening.

God, please do something. Give me ideas."

And then I see that the patient is
gradually improving.

I realized that when I ask God for help,
he gives it to me.

This is the patient,
Rajkumar.

It seemed like he would pass
away in one to two-and-a-half hours.

When we intubate
and put on a ventilator,

it was the maximum ventilation.

Then we proned the patient.

Three cycles of proning
for 16 hours.

It is day ten for him, isn't it?

Please call his companions.

- How are you related to him?
- Brother-in-law.

- Mr. Rajkumar, look at him.
- You okay?

You recognize him?

I am telling Mr. Rajkumar, if he can be
brave and is willing to cooperate,

then all these machines will be removed.

Cooperate with the doctors.
Don't be tense.

Now, your arms are weak because
you were on a ventilator for ten days.

You don't have strength in your limbs
like normal people do.

You have to bring that strength back,

and you have to show me how much
power is in your breathing muscles.

Now, you grasp my finger with your fist.

Tightly. Grasp it. Bravo!

Use more force.

He has the strength.

Now, listen to me.

I want to try taking him
off the ventilator.

We reduced it from 100% to 30%.

But now the question is,
can he live without the ventilator?

We are trying that out today
for the first time.

This will stay outside.

Outside.

Easy.

Breathe calmly.

Breathe calmly.

You have to breathe on your own now.

We have turned the ventilator off.
It is not connected now.

Now, we can see your power
by the saturation over there,

which shows how well you are breathing.

Pull his bed up at an angle of 90 degree.
We'll see for two, four, six, eight hours.

How long he can remain like this?

If I see that there's no problem
for 12 to 13 hours,

then starting tomorrow,
he will stay off the ventilator.

What is the saturation?

92, 93.

Wow, that is great!

Do like this.

You have to use
your strength continuously.

Bravo.

Okay?

I will send you home walking.

You will walk out of here.

Okay?

Show us your courage
for six hours like this.

Okay?

Don't you want to go home?
There's a wedding to attend.

Now, you have to dance
in the wedding, okay?

When I say things like,
"You have to dance in the wedding,"

then the patient feels it's not
a doctor who's treating him,

but someone dear to him.

And his confidence in me increases.

We were very scared for ten days
when he was unconscious.

We felt a bit relieved
when he became conscious.

We finally had some hope.

But until he is shifted
from the ICU to the regular ward,

we can't say anything yet.

We have to go
to the Dirksen entrance,

so we're gonna have to maybe walk around.

We're in DC to meet with some high-profile
individuals in the field of public health.

We have a meeting at APAJ.

Our purpose of meeting
with these individuals

is to tell them that we've launched
this new global health center.

Thanks.

- Welcome. Glad you're here.
- Thank you.

And then also to have them
as board members,

to really help leverage some
of their network and connections.

- How are you? It's great seeing you.
- How are you? Nice to see you.

And also get their advice
and recommendations

as we are looking to develop
our strategic plan moving forward.

We want to talk to you
about some of the things that we're doing

in terms of bio-defense,
our new global health center.

There's infectious disease outbreaks
every second, every day.

So it's constantly all around us

and we just need to make sure
that we have the structure in place

to manage these types of cases.

Our focus really is on the front line

whether it is an H7N9, or seasonal flu,
or Ebola.

And in a pandemic situation,
in a health care delivery system,

we don't have the luxury
of having a week or two months

to come out with the clinical guidance
or some sort of program.

And so based on some of our findings,

we actually have launched
a global health center.

It is geared towards preparedness
to special pathogens and pandemics.

We are looking to assist, you know,

health care delivery systems
outside the United States

in terms of preparing
for special pathogens

based on a lot of tools, resources
and experience that we have here.

To turn back to you with a question,

as you are sharing your learnings
and your recommendations,

what is your, um... way forward?

Have you got to a point
where you have a game plan?

For example, the flu on call,

when we talked to CDC,
that's something we are very interested in

and partnering and piloting,
given our significant impacts.

Other tools that we can also come up with
are, like, flu forecasts

and knowing when flu season's gonna peak

or knowing when there'll be
a more severe flu season,

so we can get the three S's,

more staffing,
making sure we have more space,

making sure we have adequate supplies.

So tools that can come
from a health care delivery standpoint.

Probably the biggest scare is
that if funding does not continue,

that the system that we've built in place
may not exist next year.

You're on point,

because our history with this
as a country is

we have one of these incidents,

we invest very heavily
in this sort of stuff,

and then we slack it.

We spend, you know, the equivalent
of a half of an aircraft carrier

on bio-defense when issues involving
bio-defense have been responsible

for far more deaths than all the wars
put together in the last century.

And we are looking at putting
an advisory group together

on this global center, and we would love
to have you be a part of it,

if you are interested.

I would love to be.
I'd be honored to be a part of it.

Obviously, I'd be happy to help
in whatever way you think I can.

This is an issue I care deeply about.

- It's an urgent need.
- Yeah.

And we obviously saw
how close to the edge we have been.

- One time we're not gonna be that lucky.
- Absolutely.

Right. To the future!

- To Centivax!
- To Centivax!

The victories that you get,
they're important to celebrate.

That's what fuels us.

I had a career in the first world
in the pharmaceutical industry,

where there's a focus on markets
that have a lot of money.

But if we really are serious
about creating cures,

and vaccines can be cures,
unlike many other types of medicine,

then we need to finish the job,

and the way to do that
is to subsidize its release globally.

I always wanted to be a scientist.

I like the idea of science,

but I think I never really knew
what that could mean.

I feel like I'm really able
to make a difference

and maybe surmount a problem
that was previously insurmountable.

Our success has been because
I've a lot of brilliant people like Sarah,

who are willing to go tackle
these new classes of problems

and not be afraid of the past.

There are many scientists who said,

"Hey, you're never gonna get to the Moon.
No one's done it before."

And, luckily, there
are always voices in humanity

who ignore voices from the past because,

ultimately, those voices
will always be wrong

because humans are moving towards
a greater future.

That's it.

In order to maintain my health,

in order to find a lifestyle
that I can balance,

I have to leave Jefferson County.

- No? All right.
- I don't think so.

I know that someone will come up behind me

and continue the work.
I just decided it can't be me.

Nothing spectacular here,
but you may work a little bit. Um...

Miss Reynolds is in 2C.
She's a hip fracture. She is...

The bottom line is
I can't continue to work

24, 36, 72-hour shifts and be healthy.

I think their plans
are to bring in two doctors

to do what I was doing,

'cause the model's not working.

- Love ya.
- Love you, too.

But truly,
this is a great hospital.

It's a beacon for the community.

So that was really
a difficult decision to make,

to leave Jefferson County Hospital.

My husband and I are going to work
really hard on our relationship

and reconnecting with each other.

Place is so pretty. She's beautiful.

I wanted to be "the guy."

I had the attitude
that I could do it all,

and I enjoyed doing it all for a while.

Now, that's come to an end for me.

Can you give that to him?

And I fear that
if other physicians in rural areas

are experiencing
the same sorts of stresses

and the same sorts of fatigue,

that rural medicine as a whole
is going to be depleted.

It's gonna take a plan to be in place

and, now,
I don't think we have that plan.

Good morning, everybody.
We'll go ahead and get started.

The CDC estimates that flu has caused
as many as 29.3 million illnesses,

394,000 hospitalizations,
and over 35,000 deaths just this season.

It has been a mild season,
luckily for us, this year,

and from a city, state,
and national perspective,

with flu activity
decreasing generally all around,

we've opted to deactivate
our system seasonal flu activation calls.

So, with that, I would like
to first express my thanks to everybody

that has been with us on a weekly basis

for this protracted
and long seasonal flu activation.

Thank you all for your time,

and we will see you next year
in the next activation meeting.

Take care, everybody.

Open your mouth. Ah. Good job.
Just like that. Exactly.

- Go pick out his book.
- Mommy, turn the lights off.

No, Omar's using his toothbrush right now.

Why are you sitting
in the sink like that?

When I think about my two boys

and my little girl that's now on the way,

and the future that they'll have
10 to 15 years from now,

I want my children to grow up in a world

where they don't have to think
about this as constantly as I do.

Failure to take this as a global crisis
will have dire consequences.

We're all in it together,

and the greater our complacency,
the greater the crisis will be.

How are you,
Mr. Rajkumar?

Okay, he's not getting a fever, right?

- He had fever yesterday.
- About 99.

99 is...

It never went above 99.

Rajkumar,
it was a very gradual journey.

It was a very challenging case,
very challenging case,

because he had come in a very bad state.

Our patient is much better
after coming here.

I think he needs
a little family support.

He's been alone for so long...

I'll move him into the ward today.
He will be with you all in the ward.

Keep pen and paper handy,
so he can say what's on his mind.

He can write it out.

Because, look...

- He escaped from the jaws of death.
- Yes.

Then, what's the problem?

If it's not destined,

even if you keep him within the ICU walls,
you can't do anything.

If it wasn't his destiny,
then would he come this far?

So he'll stay in the ward
for a couple of days.

- Okay.
- Okay?

On Sunday,
I didn't come to the hospital,

but I tend to follow patients,
so I called him...

I called the resident on duty,
and he told me that he's gone home

and he was very happy.

So it was very, very satisfying.

He was so happy that he'll be
able to attend his daughter's wedding.

Rajkumar basically
stayed in the hospital for 22 days.

In my opinion, they should go all out.

He has a new lease of life.

Dr. Vijay is a true doctor.
He's excellent.

Dr. Vijay is more than a doctor.
He is God's incarnation.

For us, he is that.

Yes.

I try to save
every case of swine flu.

But when you step into the battlefield,

you cannot win every battle.

There is still
a lot to be done

regarding the swine flu.

The government is trying,
the doctors are trying,

but considering
the doctor-to-population ratio,

we still have a lot of things to be done.

- Peter, hey.
- Oh, hi, Dennis.

I thought maybe we could talk
a few minutes about our visit to China.

And in particular, the graphic that...

At some point in time,
there will be an event

where an emergent virus,
like the 1918 virus,

will emerge
and will spread around the world.

And we're talking about the wellbeing
of seven-plus billion people.

Policy makers and planners,
global health leaders,

they should be thinking about this
in serious terms.

We have to be prepared.

We have to be vigilant.

So a little bit about core structure
and what to expect, so this morning...

I am not one
to back down.

Flu will be back again next year.

We will fight against it again.

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