Posts Tagged ‘pandemic’
By: Teegan A. Dellibovi-Ragheb, PhD
The increasing frequency and scope of infectious disease outbreaks in recent years (such as SARS, MERS, Ebola and Zika) highlight the need for effective disease monitoring and response capabilities. The question is, can we implement programs to detect and prevent outbreaks before they occur, or will we always be reacting to existing outbreaks, trying to control the spread of disease and mitigate the harm to people and animals?
In some cases, the science suggests that we can predict the nature of the public health threat. For instance, scientists at the University of North Carolina at Chapel Hill identified a SARS-like virus, SHC014-CoV, that is currently circulating in Chinese horseshoe bat populations. This virus is highly pathogenic, does not respond to SARS-based therapies, and can infect human cells without the need for adaptive mutations. Furthermore, there are thought to be thousands of related coronaviruses in bat populations, some of which could emerge as human pathogens. These findings suggest that circulating SARS-like viruses have the potential to cause another global pandemic, and resources need to be dedicated to surveillance and the development of more effective therapeutics.
What is biosurveillance?
In 2012 President Obama released the first-ever National Strategy for Biosurveillance, whose purpose is to better integrate the many disparate governmental programs and non-governmental organizations that collect and monitor public health data. The Strategy defines biosurveillance as “the process of gathering, integrating, interpreting, and communicating essential information related to ‘all-hazards’ threats or disease activity affecting human, animal, or plant health to achieve early detection and warning, contribute to overall situational awareness of the health aspects of an incident, and to enable better decision making at all levels”. The “threats” described by the Strategy include emerging infectious diseases, pandemics, agricultural and food-borne illnesses, as well as the deliberate use of chemical, biological, radiological and nuclear (CBRN) weapons.
The overall goal of the Strategy is “to achieve a well-integrated national biosurveillance enterprise that saves lives by providing essential information for better decision making at all levels”. This goal is broken down into four core functions: (1) scan and discern the environment; (2) identify and integrate essential information; (3) inform and alert decision makers; and (4) forecast and advise potential impacts.
How are these programs implemented?
A number of programs were launched in response to President Obama’s Strategy. For instance, USAID’s Emerging Pandemic Threats (EPT) program created four complementary projects (Predict, Prevent, Identify, and Respond) which together aim to combat zoonotic outbreaks in 20 developing countries in Africa, Asia and Latin America that are hotspots of viral evolution and spread. Predict focuses on monitoring the wildlife-human interface to discover new and reemerging zoonotic diseases. The Prevent project aims to mitigate risk behavior associated with animal-to-human disease transmission. Identify works to strengthen laboratory diagnostic capabilities, and Respond focuses on preparing the public health workforce for an effective outbreak response.
There are many other agencies besides USAID and the State Department that participate in biosurveillance and biosecurity, including the Department of Health and Human Services (through the Biomedical Advanced Research and Development Authority). The Department of Defense and the Department of Homeland Security both have biosecurity programs as well (the Defense Threat Reduction Agency and the National Biodefense Analysis And Countermeasures Center, respectively). These focus more on protecting the health of armed forces and combatting deliberate acts of terror, however there is still a lot of overlap with emerging infectious diseases and global health. A comprehensive disaster preparedness strategy requires coordination between agencies that may not be used to working together, and who have very different structures and missions.
What are the challenges?
Global disease surveillance is a critical aspect of our biosecurity, due to accelerated population growth and migration, and worldwide movement of goods and food supplies. Political instability, cultural differences and lack of infrastructure in developing countries all present obstacles to effective global biosurveillance. These are complex issues, but are critically important to address, as rural populations in low- and middle-income countries can become hotspots of infectious disease outbreaks. This is in part due to the lack of sanitation and clean water, and the close contact with both domestic and wild animals.
Another challenge is determining the most effective metrics with which to monitor public health data. Often by the time a new pathogen has been positively identified and robust diagnostic measures implemented, a disease outbreak is well under way. In some cases, the actions of health workers can make the situation worse, such as in the tragic mishandling of the 2010 cholera outbreak in Haiti by the United Nations. One approach that has been shown to be effective for early detection is the use of syndromic surveillance systems, such as aggregating data from emergency room visits or the sale of over-the-counter medication. When combined with advanced computing techniques and adaptive machine learning methods this provides a powerful tool for the collection and integration of real-time data. This method can alert public health officials much earlier to the existence of a possible outbreak.
Scientific research on high-consequence pathogens is a key aspect of an effective biosecurity program. This is how we develop new diagnostic and therapeutic capabilities, as well as understand how pathogens spread and evolve. However, laboratories can also be the initial source of an infection, such as the laboratory-acquired tularemia outbreak, and research with the most dangerous pathogens (Select Agent Research) must be carefully monitored and regulated. It has been an ongoing challenge to balance the regulation of Select Agents with the critical need to enhance our scientific understanding of these pathogens. Of particular concern are gain-of-function studies, or Dual Use Research of Concern (DURC). From a scientific standpoint, these studies are vital to understanding pathogen evolution, which in turn helps us to predict the course of an outbreak and develop broad-spectrum therapeutics. However this also poses a security risk, since it means scientists are deliberately increasing the virulence of a given pathogen, such as the experimental adaptation of H5N1 avian influenza to mammalian transmission, which could pose a significant public health threat if deliberately misused.
How well are we doing?
The International Security Advisory Board, a committee established to provide independent analysis to the State Department on matters related to national and international security, published a report in May of 2016 on overseas disease outbreaks. They make a number of recommendations, including: (1) better integration of public health measures with foreign policy operations; (2) working with non-governmental organizations and international partners to increase preparedness planning and exercises; (3) increase financial support and reform structural issues at the World Health Organization to ensure effective communication during crises; (4) bolster lines of communication and data sharing across the federal government, in part through the establishment of interagency working groups; and (5) strengthening public health programs at the State Department and integrating public health experts into regional offices, foreign embassies and Washington for effective decision making at all levels.
The RAND Corporation, an independent think tank, conducted a review of the Department of Defense biosurveillance programs. They found that “more near-real-time analysis and better internal and external integration could enhance its performance and value”. They also found funding to be insufficient, and lacking a unified funding system. Improvements were needed in prioritizing the most critical programs, streamlining organization and governance, and increasing staff and facility resources.
RAND researchers also published an article assessing the nation’s health security research. They found that federal support is “heavily weighted toward preparing for bioterrorism and other biological threats, providing significantly less funding for challenges such as monster storms or attacks with conventional bombs”. In a study spanning seven non-defense agencies, including the National Institutes of Health (NIH) and the Centers for Disease Control (CDC), they found that fewer than 10% of federally funded projects address natural disasters. This could have broad consequences, especially considering that natural disasters such as earthquakes, hurricanes or tornadoes can create an environment for infectious diseases to take hold in a population. More work needs to be done to integrate biosurveillance and biosecurity programs across different agencies and allocate resources in a way that reflects the priorities laid out by the administration.
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By: Aminul Islam, Ph.D.
It is amazing to think that the pandemics of HIV, and more recently Ebola, all originated with just one infected person, otherwise known as ‘Patient Zero’. It is a testament to the globalized era that we all live in that an infectious disease can originate in a single individual and span across the globe within a single decade. CDC (Centers for Disease Control and Prevention) estimates that about 40 million people in the world are currently infected with HIV with approximately 2 million new cases reported every year. Fortunately for us, Ebola has not had quite the same devastating reach as seen with HIV, but like HIV, Ebola too originated in West Africa, and this has led to some debate as to why we are seeing such viruses emerge and spread rapidly from this region across continents and what we can do to tackle them.
Both HIV and Ebola are thought to have originated in species other than humans, namely chimpanzees (HIV) and fruit bats (Ebola), therefore zoonosis playing a large part in their transmission. Whether it involves local practices of eating bushmeat, illegal exotic animal trading, development of rural areas thorough deforestation, or exploration and mining of remote regions for precious materials and resources; it is evident that humans are more frequently coming into closer contact with isolated wild animals who are judged to be the natural reservoir hosts for these viruses. This can lead to an increased likelihood for zoonotic transmissions to take place. Should we now accept the burden of dealing with these viral pandemics as a likely price we have to pay for the cost of developing low-income nations and promoting globalization? If indeed we do, then as a global community we need to prioritize certain policies and back them up with appropriate resources. The recent failure of the WHO (World Health Organization) to adequately respond to the Ebola outbreak, both in a timely fashion and with sufficient resources, reminds us that such global infrastructures are weak and lack the correct tools in the fight against viral pandemics from West Africa.
I would suggest that a more balanced approach to dealing with this situation is to spend some time developing long-term science and global health policy countermeasures which focus on setting global strategies aimed at dealing with the ecological, geopolitical and socioeconomic changes. More precisely, let us truly develop and support a respected global infrastructure charged with unrestricted and even worldwide public health surveillance; which also has the right figurehead, capability, and capacity to effectively predict, monitor and respond to global health situations and challenges of the future, such as viral pandemics. This may mean setting up a permanent global fund to provide the best catalyst of them all, money, in an efficient, fair and sustained manner to facilitate the prediction, prevention, mitigation and countermeasures for pandemics. As has been the case of late, relying just on a single global superpower to make unilateral decisions and take action may not be the most wise, stable and long-lasting way to tackle such issues going forward. In addition, U2 front man Bono will not be around forever to campaign for the plights of Africa.
Yes, it is true that these viral pandemics do start with one individual but in the end, it is up to us all to act as a global community which engages with one another and resolves the challenges we all face from viral pandemics, particularly during the fine balancing act of promoting economic development in the midst of long term public health.