“The greatest threat to man’s dominance on the planet is the virus”-Joshua Lederberg, Ph.D
“This is how the world ends…not with a bang, but with a whimper”– T.S. Eliot
For many, it is hard to fathom that a life form, one-billionth the size of the average human being, can wreak such death, devastation, social upheaval, and utter fear and panic among populations afflicted with an emerging pathogen. The story unfolds daily and around the clock, as the media shares the images and recent statistics of the carnage generated by one such pathogen, the Ebola virus. Surmising that exotic and emerging pathogens are only problematic in far off lands, such as Liberia and Sierra Leone, many Westerners live their lives unconcerned and, hence, with false security, as they view the drama rise out of the thickets of rain forests and wild lands played out on our plasma high –definition televisions.
We have perceived the multi-pronged threat posed by emerging infectious diseases (E.I.Ds), as a form of entertainment conceived by Hollywood producers, either suggested by a popular novel, or a screenplay. As with other outbreaks, and even the recent quasi-pandemic of highly pathogenic influenza strain, H1N1, and Severe Acute Respiratory Syndrome (SARS) due to infection with a novel coronavirus, the uninitiated, and yet “unaffected”, masses remain complacent and certain that science will triumph over nature.
Despite extensive scientific scrutiny, and the compassionate use of an investigational new drug (IND), and amidst the promise of a far-off vaccine, approximately 2,000 individuals have perished from the ravages of the Ebola virus, within recent months, making it the deadliest outbreak of Ebola hemorrhagic fever in history. We can be hopeful due to the miraculous cure of the two health professionals brought to Atlanta, Georgia’s Emory University Hospital, however, we must also be cautious and pragmatic. There are limited quantities of the IND known as ZMapp, and antivirals, such as ribavirin, may have limited effect on viral hemorrhagic fevers (VHFs), such as Marburg and Ebola.
While leaders at prestigious institutions and organizations, such as the London School of Hygiene and Tropical Medicine, the Chatham House Centre on Global Health Security, the Wellcome Trust, the World Health Organization (WHO) and other international infectious disease and biodefense experts recognize that there are several experimental antivirals, monoclonal antibodies and vaccines in the research and development stages, it remains clear that some of the VHFs., such as Ebola, have a case fatality rate of 90%-100%;and that the mainstays of therapy are supportive in nature. Even with the most efficacious therapies and the most sophisticated biosurveillance capabilities and capacities, without fundamental enhancements and innovative thought in global health security policy-making and initiatives, such advances in biomedical countermeasures and detection would stagnate due to obstacles such as bureaucratic red tape, and political maneuvering.What may be even more perplexing to the casual observer is how E.I.D.s can create conditions that generate and exacerbate geopolitical instability, civil unrest, social upheaval, infrastructure breakdown, economic recession and collapse, and even war. The relationship of E.I.Ds and global security are not strange bedfellows, but intimate relatives.
Joint intelligence, law enforcement and epidemiological investigations have been the evolving paradigm of looking at infectious disease outbreaks, for several years, and especially with the persistent and expanding threat of “deployable diseases” in the form of bio-warfare and bioterrorism, the combined methodologies and investigative tools of the intelligence, law enforcement, public health, life sciences and medical communities are essential when addressing global health security threats involving microbial threats. Threat reduction due to emerging infectious diseases, requires strategic partnerships among several global stakeholders. Such efforts must focus on prevention-focused activities that would likely deter infectious spread, e.g., widespread public health education, scrupulous hygienic practices ,and enhancements of both indigenous and global public health and healthcare infrastructures that are capable of detection, rapid diagnosis, biocontainment, treatment, risk communication, operational continuity and community-wide resiliency and recovery.
One of the greatest challenges has been in the development of a global and integrated real-time biosurveillance system that is robust and comprehensive. Early disease surveillance systems such as ProMED, an Internet-based, public reporting system for rapid international dissemination of real-time data on infectious disease outbreaks, and the Global Public Health Intelligence Network (GPHIN), which can monitor informational sources in multiple languages, have been helpful in the detection of outbreaks, such as SARS in 2003. While the sophistication, integration and application of such early detection and data system have evolved, enhancements are still needed to address biosecurity threats. And increased public health capacity and capabilities are critical, and must be expanded especially in global areas where the health and public health infrastructure are currently poor or inadequate.
In addition, we must think outside of the proverbial box and factor in how cultural practices, such as the distribution and consumption of bush meat, and perturbations in ecosystems, play a role in the epidemiology of emerging and exotic pathogens, achieve a fundamental understanding of anthropological and anthropogenic factors and apply this knowledge base to the control of exotic, novel and emerging infectious diseases.
To thwart naturally-occurring outbreaks, the international community must partner to explore, comprehend and control human-animal interactions and interrelationships and achieve biological reservoir and vector control. The potential for weaponization of novel and emerging pathogens must be prevented by improved and comprehensive medical and geopolitical intelligence efforts, and the irresponsible spread of life sciences expertise within nefarious circles, and the control of dual-use biotechnology. An improved and robust global biomedical research and development effort, coupled with the timely and efficient availability and distribution of medical countermeasures are essential, as in responding to outbreaks of exotic and emerging pathogens, cutting edge and rapid diagnostics and treatment are crucial to the containment of disease and optimal outcomes in decreasing morbidity and mortality.
The on-going biological emergency involving Ebola hemorrhagic fever is a stark and grim reminder of the impact that the microbial world has on international health, global security and safety, and the need for a broader and more aggressive stance by the international community when faced with lethal pathogens.