Viral Cataloging ≠ Pandemic Preparedness

When my Johns Hopkins Center for Health Security colleagues and I were working on our pandemic pathogens project, the report of which has been released, one of the more contentious issues we had to face was separating the task of pandemic preparedness from viral discovery and cataloging. One of the participants in our round table meeting on the topic colorfully referred to viral cataloging as "stamp collecting"! 

On its face, it might seem very reasonable to believe that knowing all the viruses "out there" will by design lead us to new pathogens that have the capacity to cause pandemics, but that is not a foregone conclusion for two main reasons:

1. Most viruses on the planet are innocuous to humans and do not have the capacity to cause damage 
2. While it is most likely that pandemics in the modern age are exclusively the province of viruses, it is possible a non-viral agent could, under certain circumstances and in certain contexts, be the cause of a pandemic

For pandemic preparedness purposes, we proposed focusing on ensuring specific diagnosis and enhanced surveillance of infectious syndromes such as respiratory infections, sepsis, and central nervous system infections in all parts of the world. By focusing on what has unequivocally demonstrated the ability to infect humans -- what would be level 2 and 3 pathogens according to an insightful paper by Woolhouse, the yield of uncovering a potential pandemic pathogen will be much higher. Such activities will have salutary effects on other activities such as antibiotic and antiviral stewardship as well as improving the epidemiology around well-characterized pathogens.

It is undeniable that viral discovery will enormously advance our understanding of virology and is very valuable but it is not synonymous with pandemic preparedness -- it is distinct. 

A new commentary published in Nature by three eminent researchers in the field, Eddie Holmes, Andrew Rambaut, and Kristian Anderson, provides some additional validation for the above conclusion we drew. The piece, entitled "Pandemics: spend on surveillance, not prediction," makes the point that:

“Broad genomic surveys of animal viruses will almost certainly advance our understanding of virus diversity and evolution. In our view, they will be of little practical value when it comes to understanding and mitigating the emergence of disease.”

Pandemic preparedness is a daunting task with many facets and varied approaches. It is only in the modern era with the sharp tools of biology coupled to advances in information and communication technology that we are even able to truly prepare for pandemics. It is essential that these powerful tools be directed at the right task.

Nipah: A Dangerous Virus That Deserves A Lot of Respect

While infectious disease headlines are rightly focusing attention on the current Ebola outbreak in the DRC, those with an eye to how pandemics unfold are watching a less prominent one unfold in India. A Nipah virus outbreak, centered in the Indian state of Kerala, was first reported last month and has killed 17 of the 18 people it has infected -- a horrific fatality rate that hovers around 75%.

Nipah is not an unknown virus as it has been responsible for sporadic deadly outbreaks since the 1990s in countries such as Singapore, Malaysia and Bangladesh. It has also appeared in India before. It is actually a priority virus when it comes to vaccine development. The virus is zoonotic and spills from fruit bats (the natural host) to pigs and humans. Humans can be infected by direct contact with bats, by consuming date palm sap contaminated with bat urine, by pigs, and by other humans. The virus causes flu like symptoms that can progress to a fulminant infection of the brain (encephalitis). There are no standard treatments for it though the antiviral ribavirin may have some positive impact.

When it comes to pandemic pathogens, as my colleagues and I argued in our recently released report, RNA viruses (because of their mutability) and respiratory-borne microbes rise to the top of the list. Nipah is a paramyxovirus and, as such, has an RNA genome. Though early outbreaks of the disease did not revolve around respiratory transmission between humans, subsequent outbreaks have been augmented by human-to-human transmission, especially to those caring for patients who were likely exposed to oral and respiratory secretions known to harbor the virus. It appears that the current Indian outbreak has been enhanced by human-to-human transmission after originating from exposure to bats. 

The major fear is that Nipah might become more efficient at transmitting from human-to-human and cause a large outbreak that spreads to multiple countries (the fictional virus in the movie Contagion was a Nipah-like agent). Such a scenario would rapidly become difficult to contain as there is no vaccine and no standard antiviral regimen. Currently, Nipah transmits only inefficiently between humans (about 1 in 12 pass it on to another human). 

While the not-so-contagious Ebola may grab headlines like no other infectious disease, and this NIpah outbreak has not been deemed a global threat, ultimately, it is viruses with the potential for respiratory spread that merit the most attention. While this outbreak will likely be contained, it underscores the danger of this class of microorganisms, the need to understand their evolution, track their transmission, and to be prepared for their appearance with robust countermeasures.

Condoms as a Instrument of Crime ?!? Law Enforcement Becomes an Instrument of Disease Transmission

When a condom is labeled an "instrument of crime" by law enforcement, law enforcement becomes an instrument of disease transmission. The recent news that police in Allegheny County, in which the city of Pittsburgh is located, are adding charges to the arrests of commercial sex workers if they are found to possess condoms is almost incredible. It illustrates just how backward and misguided the Puritanical war on prostitution is. Such actions compound the injustice that occurs each time consenting adults are arrested for a crime in which there are no victims and no violations of individual rights -- except for the ones violated by the arresting officers. 

To penalize a commercial sex worker for possessing condoms -- a sign of mindfulness regarding risks inherent in the profession -- does nothing except discourage the use of condoms and facilitate the spread of sexually transmitted infections -- an incontrovertible fact. When sexually transmitted infections increase further in the area it will be important to see how much such insane policies as this one contributed.