Meeting report: How to get wrong things right – a... over current and future pandemic infectious diseases

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DOI 10.1002/biot.200800126
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Meeting report: How to get wrong things right – a discussion
over current and future pandemic infectious diseases
Infectious diseases have played a substantial part in shaping the history of
humanity. In a discussion at a recent EMBL-EMBO science and society symposium entitled ‘The future of our species’, several experts discussed how
infectious diseases are still influencing our world today. Here we present examples from recent and current infectious disease epidemics followed by a
discussion of the local, national and international response to these. Special
emphasis is laid on how the change of our environment can augment the
world-wide spread of infectious diseases and the role of education in limiting this spread. An urgent need for improved coordinative efforts in globally combating infectious diseases is called for and examples are highlighted.
Keywords: Pandemic · Infectious disease · Research incentives · HIV · Measles
To prioritize the allocation of complications after contracting
scarce natural and human re- measles virus, although a cheap
sources appears as one of the and safe vaccine offering comgreat challenges of today’s soci- plete protection is available and a
eties at many levels. Compara- strong international initiative
tively
little
resupports the eradsources are spent
ication of measles.
on helping people Urgent need for improved Each year around
overcome some of coordinative efforts in glo- one million chilour greatest natural bally combating infectious dren are dying
foes in spite of the diseases
from malaria, aloverwhelming evidence of the benefit to all humanity if these viruses, bacteria or
parasites were combated more
aggressively. Each year more than
300 000 children are dying from
though a combination of bed net use, insecticide
spraying and rapid treatment using currently available antimalarial drugs could prevent
many of those deaths [1]. Each
Figure 1. Past flu epidemics. (A) The Spanish Influenza. Emergency military hospital during influenza
epidemic, Camp Funston, Kansas, United States. Image: courtesy of the National Museum of Health
and Medicine, Armed Forces Institute of Pathology, Washington, D.C., United States.
(B) Graph showing the approximate numbers of human casualties of the three most devastating influenza pandemics of the 20th century and the virus subtypes involved. The Spanish Flu of 1918/1919,
the Asian Flu of 1957/1958 and the Hong Kong Flu of 1968/1969.
© 2008 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim
year two million people are dying
from tuberculosis despite the
proven effect of an existing, yet
arguably complex therapy [2].
Each year three million people
are dying from AIDS with almost
five million new infections occurring despite the availability of, arguably, expensive anti-retroviral
therapy and a clear understanding of how new infections could
be prevented.
For now, most of the above are
problems of the developing world
and thus touch the industrialized
world only superficially. According to the discussion in a session
of the EMBO/EMBL science and
society meeting in Heidelberg
(see poster) the industrialized
countries are in no safe haven.
Professor Albert Osterhaus from
the Erasmus University of Rotterdam strongly emphasized the fact
that the emergence of a new viral
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pandemic is certain to cause havoc not just in developing countries, but over the world at large.
Considering the limited precaution taken, it might well equal the
great pandemic of the Spanish flu
at the end of the First World War,
in terms of human suffering and
deaths (Figure 1). SARS, he argued, might have been on the
© Photodisc
brink of developing into such a
pandemic but was stopped at the
start [3]. This example provides a ronmental factors from forest deglimmer of hope: for once, other- struction to global transportation
wise competing laboratories and allowed it to jump over and settle
institutions cooperated closely to in the human population. As Peter Fonkwo, an inensure a rapid
characterization of For once, otherwise com- ternational public
the virus and to peting labs and institutions health consultant
Cameroon
elaborate strate- cooperated closely to […] from
stated, HIV’s curgies to stop its stop [SARS]
rent grip on our
spread. We might
species stems from
be less lucky with
the H5N1 or another influenza the fact that its spread is largely
virus, or, according to Osterhaus, (yet not exclusively) linked to the
humanity might get caught off almost unavoidable act that enguard by a completely different sures our perpetration; sexual
virus. He illustrated the unex- intercourse.To help people to dispected spread of sometimes un- tinguish between the ‘unavoidknown or locally restricted virus- able need’ and unsafe sexual
es with a recent outbreak of a bat- practices that extend the spread
borne Nipah virus, which is usu- of HIV, constant and persistent
ally constrained to Malaysia and education is the only way out.
neighboring countries, but sud- However, recent experiences
denly appeared in Bangladesh, show that seemingly straightforspreading from person to person ward education schemes about
[4]. The bats fled from the forest infectious diseases need to be
fires and destruction on Sumatra matched with a strong internaand Borneo, carrying the virus all tional effort aimed at designing
new drugs and vaccines. It was
across the Indian Ocean.
Devastation of our natural the consensus of the invited panworld has often advanced the elists and speakers, that it is only
emergence of new pathogens. by combining such approaches
Malaria, one of the most patho- that we might be able to stop more
genic human parasites, probably suffering. Fonkwo gave some exdeveloped and spread with the amples of the difficulties conadvent of agriculture, which stantly faced in health education
brought man into intimate con- efforts against HIV/AIDS. Trying
tact with its natural habitat. to put a consensual sexual educaMeasles virus might have evolved tion forward, he had to propose
from a common ancestor with the the compromise between the advirus causing Rinderpest follow- vocates of abstinence (the most
ing domestication of cattle. HIV effective prevention method) as
evolved from a similar virus in- the way to salvation and those in
fecting our closest relatives, the favor of the systematic introducchimpanzees.Then, a mix of envi- tion of condoms (the most accept-
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© 2008 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim
Biotechnol. J. 2008, 3, 995–998
able and realistic prevention
method). Depending on the target
population we need to first stress
on abstinence (for the youth and
sexually inactive), then fidelity
for the sexually active, then the
use of condoms for all if any of the
above is not acceptable or not
practical. It was evident that lack
of information is not the only
problem. It is often an issue of
wrong information. From experiences by Fonkwo, in small villages
simple and free vaccination campaigns could not be implemented,
because the local population believed that the doctors came not to
help but to harm. This might well
be more problematic when medics from a different ethnic group
or foreign countries are involved.
In spite of all these drawbacks,
education is the most important
weapon in the fight against these
diseases. This is made evident by
the fact that with most disease related health indicators the educated population is more performant than the less educated or
uneducated. A subtle but effective
way to raise disease awareness,
recommended for by Fonkwo, was
the use of language classes to introduce diseases-related messages. The promotion of English
language textbooks that talk
about diseases was the case in
point presented by Fonkwo.
The developed world also
faces obstacles related to education – as noted by Osterhaus and
chairman Hans-Georg Kräusslich, a virologist at Heidelberg
University. Osterhaus lamented
that the press was too eager to parade pictures of children showing
side effects of vaccinations when
these were not even real, thus
causing undue scare among parents, who consequently fear to
vaccinate their children. Unfortunately there were no reports
showing those parents the suffering and sometimes even dying
from measles and other vaccine
preventable diseases, in what he
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Award for good governance by the
Mo Ibrahim foundation.
Many Western countries are
similarly complacent when it
comes to another epidemic: the
spread of antibiotic resistance.
According to Julian Davis from
the University of British Columbia this was already discussed in a
publication in 1953 [8] but is still
not realized by the broad public.
The availability and usage of antibiotics varies highly within the
European Union, according to Osterhaus and Krause. Osterhaus
reported on the yearly holiday
home-comers from Southern European countries, who fill Dutch
hospitals with bacterial diseases
that would have been properly
treated in the Netherlands. The
abuse of antibiotics can clearly be
linked to the level of antibiotic resistance. Krause mentioned that
the industry sometimes fosters
the problem, by promoting children drugs to parents, who then
expect the doctors to prescribe
these antibiotics, even if they are
unnecessary. This undue pressure on the back of the prescriber
sometimes leads to doctors giving
out drugs simply because they
think that patients are expecting
them to do so. Davis however cautioned that one should not just
blame physicians. The use of antibiotics in agriculture takes its
fair share in promoting such resistance, as is for example the
case with vancomycine. According to Davis, it has been clearly
shown that the rise of resistance
can be reversed upon termination
of preventive treatment or the
suspension of the use of the drug
for a given period. This equally
counts for antivirals. Osterhaus
therefore pleaded to forbid their
use in animals.
The discussion ended with a
more positive note when in reply
to a question from the audience
on whether the vicious circle of
more population leading to more
disease and other disasters could
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called the Dutch Bible Belt. Simi- spective of the state of scientistlarly, a former pressure group press relations, all speakers and
member has recently discussed panelists agreed that there is no
publications identifying the dan- alternative to informing the pubgers of the current ‘organic’ wave lic about all matters of public
[5]. Kräusslich also referred to a health.
The dramatic effects of lacking
recent outbreak in Germany that
saw over 2500 children sick from information can be seen in many
measles. All these cases would historical contexts, e.g. the spread
have been easily prevented if the of the Plague in medieval Europe,
misinformed parents had not the accidental import of smallpox
questioned the benefits of vacci- and measles into the Americas,
the deliberate release of infecnation.
It is evident from all of the tious agents or the recent spread
above that scientists have to ask of HIV in much of Africa [6, 7].
themselves how to better interact Fonkwo illustrated the latter in
with the press in order to proper- more detail. In his view, the fact
ly inform the public about biolog- that for a long and critical period
ical risks. Osterhaus stated that he politicians all over the continent
thought of AIDS as
very carefully approblem
that
proaches the
Education is the most im- a
press as he feels
portant weapon in the fight would scare away
investors
made
that it usually
against diseases
them avoid any
portrays scientists
open declaration of
as ”crying wolfs“,
which leads to an oblivious pub- the problem.This made it difficult
lic. However, Gerard Krause, an – if not impossible – to correctly
epidemiologist at the Robert Koch and openly teach the population
Institute in Berlin, commented about the AIDS problem from inthat he saw the relationship be- ception. It was their general hope
tween scientists and the press in a that the problem would solve itmore positive light. He is observ- self.They suppressed information
ing an improvement of the press related to the disease, thus missin explaining the risks and bene- ing a golden opportunity to nib it
fits of health measures. However, from the bud. This obviously led
having just witnessed how sever- to the current tragedy that now
al local and national newspapers affects practically every family in
simply copy-pasted a press re- Cameroon and many more elselease from one of our recent sci- where. Presently, efforts by the
entific articles, we would rather politicians in conjunction with
state that the institutional press support from foreign investors
officers might be the cause for and the local population in
such improved reporting. Irre- Cameroon have led to the availability of retroviral therapy for a
good number of AIDS patients at
a minimal and symbolic cost. Unfortunately not every country can
claim these standards.
Some politicians still do not
accept foreign aid aimed at combating disease directly or indirectly for myopically more important issues, such as national security. One can only hope that the
recent introduction of the AchiMeasles in African child, © Mike Blyth
evement in African Leadership
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eventually be broken. Osterhaus
replied that our brain is part of
evolution, which is evidenced by
our ability to produce and use
vaccines and drugs. Similarly, he
hoped, to the approving nods
from the other panelists, we might
finally be able to control population growth and focus on combating disease.
Knowing that the announcement of the 10 million US $ Ansari
X prize for the first commercial maybe surprising fact that even
space flight mobilized over 10- large pharmaceutical companies
fold more money in pursuit of the might save more money by postprize, we are not the only people ing a challenge than by asking
to wonder whether a similar com- their own employees to go after a
certain problem.
petition could not
Whatever the
trigger a race for
“Our brain is part of evoluunderlying reawhat we need
tion”, Albert Osterhaus
sons for this apmuch more urgently: affordable drugs, vaccines parent conundrum, handing out
and delivery strategies. Indeed prizes appears a real step forward
recent discussion included a two- in problem solving not just for
day workshop in Maastricht, The space travelers.
Netherlands, at the end of January, where speakers discussed By Friedrich Frischknecht,
whether prize incentives could Simone Lepper and Marek
stimulate the generation of new Cyrklaff, University of Heidelberg
drugs, with James Lowe from the Medical School, Germany
Knowledge Ecology International E-mail: freddy.frischknecht
think tank in Washington D.C. @med.uni-heidelberg.de
highlighting the similar incentives prizes and patents offered
[9]. Remarkable examples were The authors thank Peter Fonkwo
also recently reported from a for corrections on the manuscript
company, InnoCentive, which and the panelists for their insightmakes money on its website by ful discussions.
posting and managing challenges
for other companies and thus recruiting experts from all over the The authors have declared no conglobe [10]. This revealed the flict of interest.
The measles initiative:
http://www.measlesinitiative.org
EMBO/EMBL Science and Society conferences:
http://www.embl.de/aboutus/sciencesociety/conferences/index.html
The Mo Ibrahim foundation:
http://www.moibrahimfoundation.org
InnoCentive:
http://www.innocentive.com
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© 2008 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim
Biotechnol. J. 2008, 3, 995–998
Taiwanese SARS
hospital, © NIOSH
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Received 13 June 2008
Revised 13 June 2008
Accepted 16 June 2008