Lessons Learned from a Summer of Outbreaks
There is no definitive reason this summer saw such a large number of outbreaks of new and emerging infectious diseases. Two separate outbreaks of Ebola in the Democratic Republic of Congo. Nipah virus in India for the first time. Rift Valley fever in Kenya.
It’s not in your imagination. Infectious disease outbreaks are becoming more frequent. According to a 2014 study published in Royal Society, we’ve seen a significant uptick in the number of disease outbreaks in recent decades, with viruses being responsible for the largest increase, particularly in the past 20 years.
This summer has done precious little to buck that trend. But there are some lessons we can glean from this summer’s outbreaks.
The Threat Is Real
“There’s a boom-and-bust mentality,” EcoHealth Alliance President Dr. Peter Daszak likes to say of outbreaks. They’re well covered when one is ongoing, but in between we are quick to forget. However, the pathogens are always out there.
Kerala, India, where 16 people died on Nipah virus in May, had never seen an outbreak of Nipah before. But the virus was out there all along and it only took one simple act, one point of contact–the nature of which we’ll probably never know–between the index patient and a fruit bat for a deadly outbreak to start.
Pathogens are all around us, all the time. We cannot afford to wait until they start making us sick to begin thinking about them.
Preparedness Is Important
The World Health Organization maintains a list of Blueprint priority diseases. These are the diseases a panel of experts has decided should be prioritized for research and study. Nipah is on the list. So is Ebola. So is Rift Valley fever and other diseases which caused people to be sick throughout the summer like Lassa fever and MERS.
Medical professionals worldwide should be trained to recognize all of these diseases, even in places where they’ve never seen before.
It was thanks to a swift quarantine response by the government of Kerala that the Nipah outbreak did not spread further. This could have been catastrophic, as the popular tourist destination of Goa is just north of Kerala, and had the disease spread there it would have been very easy for it to spread internationally.
The dual Ebola outbreaks this summer marked an important test for rVSV-ZEBOV, an experimental Ebola vaccine developed by Merck partially in response to the West African Ebola outbreak which killed more than 11,000 people. Though a two-year trial which ended in 2016 found it to be effective, the outbreak in the Democratic Republic of Congo’s Équateur province served as one of the vaccine’s first real-world tests. It was extraordinarily effective. Ring vaccination–a process in which a group of people with close ties to an infected person are all vaccinated and monitored–helped put an end to the outbreak.
The vaccine worked, but Ebola is endemic to the Democratic Republic of Congo, meaning the occasional outbreak is nearly unavoidable. Capacity must be developed to make sure these is enough vaccine to be used in future outbreaks.
Stateside, our pandemic preparedness takes the form of stockpiles of drugs, vaccinations, and medical supplies housed at undisclosed locations throughout the U.S. Those stockpiles are maintained by the Centers for Disease Control and Prevention under the Pandemic and All Hazards Preparedness Act which must be reauthorized by the end of the month. The law has passed a vote in the House of Representatives, but has not yet come to a vote in the Senate.
One Health Matters
Though the Ebola outbreak in Équateur was minimized quickly, the ongoing outbreak in the North Kivu province has been more difficult to contain. This is because of general instability in the region, with multiple armed rebels controlling different areas and violent conflict all-too-common.
This is where the multidisciplinary approach of One Health is important. Because no zoonotic disease outbreak is about just one thing. It’s about the health of the animals which spread the disease to people. It’s about the health of those who are sick and those who could become sick, of course, as well as the health of the environment which those animals and people share. It’s about the political stability of the area, as well as the food security and access to other basic human needs like clean water and shelter.
Diseases affecting humans aren’t the only outbreaks we’ve seen this summer. Last month China reported its first-ever case of African swine fever which causes high mortality rates in pigs. It has reached Western Europe as well. Our scientists recently discovered a new coronavirus which was killing pigs on farms in China as well.
These diseases are important, not only because they can cause astronomical economic losses globally. Their treatments can also often be helpful in developing therapies for human viruses. African swine fever virus contains similarities in genome structure and replication to poxviruses like monkeypox (which is currently spreading in the United Kingdom) and SADSr-CoV is closely related to another much more famous coronavirus: SARS.
Pathogens are a simple fact of nature. They have always been a part of our world and they will always be. But if we understand them and prepare for them, they don’t have to bring us to our knees. At EcoHealth Alliance, we believe that we can do that through surveillance of viruses in wild animals, as well as predictive modeling which shows where new outbreaks are most likely to begin and focusing resources in those places.
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