Vol. 192 May 1, 2018 Infections Going Viral

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“World conditions are ripe for a pandemic like the 1918 influenza epidemic, but we, the U.S. and the world, are not prepared to fight it.” – Bill Gates, April 27, 2018

Ten experts (three of them had British accents, so they were particularly believable) agreed with Bill Gates when he presented this warning in the 2018 Shattuck Lecture at the Massachusetts Medical Society Annual Meeting in Boston last week.

The 1918 influenza virus first appeared in the U.S. in New York City and within just 5 weeks it had spread across the country to California resulting in 670,000 U.S. deaths. As you know, the flu virus changes every year and we can’t start making a vaccine until we recognize and identify “this year’s mutation”. It then takes months to produce, distribute, and administer a vaccine, so consequently our flu vaccine is always playing catch up. Since 1918 we have developed anti-viral medicines and a number of different antibiotics to combat influenza complications, so a repeat of such a lethal flu epidemic is today considered unlikely.

But it is the other viruses, the “novel viruses”, that concern the experts at this conference. For instance, 1000 “novel” viruses from different species which could potentially cross over to humans and cause significant disease have been identified over the past 8 years . Of these 1000 “novel” viruses, 891 are brand new, never before identified. Advances in genomic sequencing allow the specific identification of potentially pathogenic mutations, but as one speaker noted it has taken the U.S. Weather Service over 50 years to build a data base that allows “reasonably good” weather forecasts, so our ability to forecast the effects of new virus diseases is considered to be woefully rudimentary. (1)

We will probably receive the earliest warning signs of any new epidemic from mining the “digital exhaust” of our social networks, “flu near you” apps, crowd sourcing of symptom reporting, net-connected thermometers. upticks in certain prescriptions, volunteered Alexa conversations, Google search statistics, bot-driven AI, and locations of Uber-delivered medicines. (2)

The reasons the world is ripe for an infectious pandemic are: increasing population, increasing urbanization in developing countries, continued poverty that promotes inter-species living, routine rapid travel between countries, increasing frequency of natural disasters due to climate change, plus potential bioterrorism. Several speakers used a military preparedness metaphor, consciously using the verb “fight” and the noun “war”. For example, “If we knew our enemy was developing a new military weapon we would be throwing all sorts of resources at analyzing what the threat is, how to detect it at the earliest possible moment, how to defend against it, and how to deal with its effects if deployed. We should be doing the same for future infectious disease epidemics, and we are not.” (3)

Bill Gates was most impressive with his command of diverse, seemingly obscure facts like the per cent change of Uganda’s GDP, the identifying numbers of a new unnamed TB antibiotic, the three viruses that could mimic Ebola, and that in a recent study 4 almost random doses per year of the antibiotic zithromax reduced childhood mortality in developing countries by 50% in 2 years! He remains a man of vision as well , made it clear that the Bill & Melinda Gates Foundation would continue its support of innovative health and education efforts, and describes himself as an optimist. He nonchalantly reported that his foundation had just granted $12 million seed money to a group working with Glaxo (stock-pickers take notice) to develop a universal flu vaccine, one that would be effective against all flu virus mutations. (Such a universal flu vaccine was the #1 fervent wish of the Deputy Director of the CDC when asked for her hopes for the next ten years.(4))

 Our pandemic preparedness is not just a task for the medical/clinical sciences nor just for “new” technology.  The “old” technologies of anthropology and the fine art of negotiation were vital to a successful defense against Ebola. It was not until we recognized the cultural traditions of burial rituals of some African tribes, and persuaded them to change them, that we were able to contain the Ebola epidemic. (5)

Pandemic preparedness is not only a multi-disciplinary effort. It must also be political. Even as science advances, there must be the political will to deploy the resources before a pandemic attack . Of course, “urgent” often trumps even important “long term” needs in politics, but a pandemic is the equivalent of a war. By the time the battle is raging it can be too late to effectively marshal all the troops and equipment necessary to win. (3)

The consensus of the conference was: “The U.S. should continue to be the leader in global health security.”

References:
1. Joanna Mazet, DVM, MPVM, PhD, Professor of Medicine, University of California, Davis
2. John Brownstein, PhD, Chief Innovation Officer, Professor of Medicine, Boston Children’s Hospital
3. Jeremy Farrar, OBE, FRCP, FRS, Director, Wellcome Trust
4. Anne Schuchat, MD, Principal Deputy director, CDC
5. Mark Gordon, Esq. Co-Founder Vantage Partners

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