Man vs. Microbe: We’re Not Ready for the Next Global Virus Outbreak
(Bloomberg Businessweek) -- In the evolutionary arms race between humanity and the microbes, the bugs are making a comeback. Yes, we’ve conquered diseases such as smallpox and polio, and deaths from communicable diseases have been falling worldwide. But since 1970, more than 1,500 new pathogens have been discovered, according to the World Health Organization, and “epidemics in the 21st century are spreading faster and farther than ever. Outbreaks that were previously localized can now become global very rapidly.”
In late 2002 an airborne illness, dubbed severe acute respiratory syndrome, emerged in China’s southern Guangdong province, then quickly spread across the border and killed 774 people from Asia to Canada. In 2009 a novel influenza virus, H1N1, advanced worldwide in nine weeks and may have resulted in as many as 575,000 fatalities. The new virus from central China that’s sparked global alarm, a coronavirus known as 2019-nCoV and a close cousin to SARS, reached four continents in about five weeks.
As newer threats surface, such as Middle East respiratory syndrome (MERS) in 2012, older scourges like cholera, plague, and yellow fever flare up with disturbing regularity. Even worse, the antibiotics that revolutionized health care in the last century are losing their punch as new strains of infectious diseases, especially tuberculosis, become more resistant to multidrug treatments. “We’ve created an interconnected, dynamically changing world that provides innumerable opportunities to microbes,” says Richard Hatchett, a former U.S. adviser on public health emergencies and head of the Coalition for Epidemic Preparedness Innovations in Oslo. “If there’s weakness anywhere, there’s weakness everywhere.”
The rich world has the scientific smarts to improve global biosecurity. And, in fact, there’s been real progress, with better information sharing and the introduction of improved gene-sequencing technologies. What’s missing is a long-term focus. With each new outbreak comes global panic and momentary resolve, only to give way to studied inaction once the crisis subsides. We’re nowhere near being prepared for a true pandemic, such as would occur if deadly bird flu mutated to become more transmissible between humans.
Microsoft Corp. co-founder Bill Gates, whose foundation has spent vast sums developing vaccines and drugs against emerging strains and promised up to $100 million to respond to the epidemic, warned in a 2018 speech that the “world needs to prepare for pandemics in the same serious way it prepares for war.” We certainly weren’t on war footing for the viral outbreak in China.
One obvious lesson is the need to shut down or heavily regulate food markets where live animals and freshly slaughtered, unwrapped meat commingle amid throngs of shoppers. These so-called wet markets, common in China and Southeast Asia, are unsanitary and teem with germs, making them the perfect breeding ground for deadly pathogens.
About 70% of all pathogens identified in the past 50 years are of animal origin, and the novel coronavirus causing havoc in China is closely related to strains known for infecting primarily bats, pigs, and other species. It has the ability to migrate from animals to humans—and from one human to another.
Many early cases have been linked to a market in Wuhan that sold wild animals for food. “I think they should close them all,” says Marie-Paule Kieny, director of research at Inserm, France’s national health research organization. “There’s no risk-proof world, but as much as possible, reducing the threat is the way to go.”
Another target is better livestock management in less developed parts of the world, especially India, where overuse of antibiotics by poultry producers has given rise to antibiotic-resistant bacteria, a 2016 Bloomberg News investigation showed. Some 2 billion people don’t have access to toilets; inadequate sanitation results in 432,000 deaths annually from diarrhea and is a major factor in tropical diseases.
China is a one-party state whose leader, Xi Jinping, is president for life. Yet that power means little if deployed too late in a contest against a mutating virus. In December a mysterious pneumonia started to surface among patients in Wuhan, and municipal and provincial health-care regulators were notified before the end of the month, according to people familiar with the early phase of the epidemic.
Yet a complete travel lockdown of Wuhan, a flourishing megacity of 11 million, didn’t take place until Jan. 23. By that time, cases had already surfaced in other parts of China just ahead of the Lunar New Year holidays, an epic travel period and the largest annual human migration in the world. “The coronavirus had been spreading in the city and surrounding areas for more than a month before effective measures were taken,” says Yang Gonghuan, former deputy director of the Chinese Center for Disease Control and Prevention. As a result, “the base of infection growth has been enormous.”
It takes political will to get out in front of an epidemic. Robust vaccine development matters, too, and therein lies another problem. When it comes to pandemic shots, as with treatments aimed at preventing malaria and tuberculosis, “there are essentially no incentives for big multinationals,” says Thomas Breuer, chief medical officer for the GlaxoSmithKline Plc vaccines unit. Glaxo remains focused on higher-margin products, such as cancer drugs. While the company is sharing its know-how with groups racing to develop a coronavirus vaccine, it licensed its promising TB vaccine to the Bill & Melinda Gates Medical Research Institute. “The long-term financing around this cannot rest entirely on the shoulders of companies like GSK,” Breuer says.
Since the outbreaks of SARS and the often fatal Ebola virus, U.S. federal money for developing drugs and vaccines for emerging diseases has increased, and drugs that may combat coronaviruses are ready for trials. One is remdesivir, a treatment from Gilead Sciences Inc. that failed tests in people with Ebola. The first U.S. coronavirus patient, in Washington state, received the drug after his condition worsened. He improved the day after he was infused, according to results reported in the New England Journal of Medicine.
Gilead says it’s shipped enough of the drug to China to treat 500 patients and is working to produce more if the trials starting imminently in China are promising. “We have an army of people working 24/7 now opening up manufacturing lines and doing whatever we can to get as much available as quickly as possible,” says Chief Medical Officer Merdad Parsey. Yet the drug may already be the focus of an intellectual-property dispute: China’s Wuhan Institute of Virology has applied for a patent on its use against the coronavirus.
Smaller companies might be more likely to enter the field, but that would require government financial incentives, not unlike the kind the U.S. Department of Defense offers to arms makers for critical national security needs. “No one goes out and buys missiles in the free market,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “There’s no capitalism, it’s all procurement. Creating a business model is one of the challenges.”
More can also be done to identify pathogens before they unleash their furies. “We are reactive rather than proactive,” says Amesh Adalja, senior scholar at the Johns Hopkins University Center for Health Security. Diagnostic tests able to identify the precise species that cause a patient’s illness aren’t used that widely. If more testing were done on patients with suspicious symptoms, we might have a better sense of the pathogens lurking out there, he says.
Encouragingly, information sharing has improved since SARS. Early in the current crisis, after Chinese scientists had isolated the new coronavirus, its genetic sequence was promptly submitted to several online data-sharing portals where public-health specialists swap information.
That helped researchers get a better read on the virus’s behavior and gather information to work on medicines, according to Arnaud Fontanet, an epidemiologist and director of Institut Pasteur’s center for global health research in Paris. He’s confident there soon will be antibody tests that will allow doctors to know whether someone had the virus in the previous three months, even if they showed no symptoms. Disease chasers, Fontanet says, have also been able to model the spread by following airline connection data. In the Ebola crisis, mobile phone usage helped track transmissions.
British scientists are helping China track the spread of the new coronavirus from its origin in Wuhan to countries around the world. Viruses such as 2019-nCoV constantly incur small mutations in their genetic material. While the alterations make little difference to the organism’s structure or function, they’re almost like the rings of a tree in that they can tell scientists how long the virus has been around and how it got there, as well as how quickly it’s spreading.
Spotting copies of the same version of the virus helps disease trackers identify chains of transmission that may have been hidden. “Often when you have a new flare-up of disease in an area that hasn’t seen cases, you need to find out if it was transmitting all along and we didn’t know about it, or is it an introduction from somewhere else,” says Andrew Rambaut, a professor of molecular evolution at the University of Edinburgh. “If you can find the contacts, you can break those chains of transmission.”
Rambaut and his colleague Nick Loman, a professor of microbial genomics and bioinformatics at the University of Birmingham, train health workers to use a low-cost, portable “lab in a suitcase” to decode genomes in places such as West Africa, where the Ebola virus killed more than 11,000 people in an outbreak that lasted from late 2013 to 2016. By tracking individual strains of the virus, identified by certain mutations, they were able to show that some transmission occurred from people crossing borders and establish that in some cases the disease was passed from mother to child.
The lab includes a sequencer, called MinION, made by Oxford Nanopore Technologies Ltd. in Oxford, England, that’s about the size of a mobile phone and allows researchers to identify differences among viral strains. “You can sequence 12 to 24 samples in a day, and you get a good estimate of the whole genome,” Rambaut says. Those sequences can be compared with other existing strands of DNA to track the virus’s movement and evolution, he says.
Despite such gains, huge weaknesses remain in disease fighting worldwide. Although Ebola had been around for decades before the West Africa epidemic, the virus spread undetected for three months in Guinea, allowing it to gain a foothold in cities. The U.S. eventually spent $5.4 billion in emergency aid to try to get it under control.
Building a global health-care fortress against dangerous pathogens won’t happen overnight—and will never be fool-proof. Yet whatever the ultimate cost, it will be far less than the economic hit from a prolonged global pandemic that kills millions. “The foundation for better preparedness is investing in stronger primary health-care systems which provide surge capacities that can be mobilized for effective response to contain outbreaks,” Muhammad Ali Pate, global director for health, nutrition, and population at the World Bank, wrote in an email.
At some point, the outbreak will subside, and the world will move on. And that’s precisely the problem. “It’s a battle you never win,” says Peter Doherty, a researcher in Melbourne who won a Nobel Prize in 1996 for discovering how the immune system recognizes virus-infected cells. “Organisms mutate, apart from anything else, so it requires constant vigilance and constant research.” —With Jason Gale, Dandan Li, Thomas Mulier, John Lauerman, Marthe Fourcade, and Yinka Ibukun
Read more: How the Coronavirus Could Impact Global Business
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