0995_200800126_Meeting_report.qxd 08.08.2008 Biotechnol. J. 2008, 3, 995–998 11:50 Uhr Seite 995 DOI 10.1002/biot.200800126 www.biotechnology-journal.com BTJ-FORUM 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 995 0995_200800126_Meeting_report.qxd 08.08.2008 11:50 Uhr Seite 996 BTJ-FORUM Biotechnology Journal 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- 996 © 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 0995_200800126_Meeting_report.qxd 08.08.2008 11:50 Uhr Seite 997 Biotechnol. J. 2008, 3, 995–998 © 2008 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim 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 997 BTJ-FORUM 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 www.biotechnology-journal.com 0995_200800126_Meeting_report.qxd 08.08.2008 11:50 Uhr Seite 998 BTJ-FORUM Biotechnology Journal 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 998 © 2008 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim Biotechnol. J. 2008, 3, 995–998 Taiwanese SARS hospital, © NIOSH References [1] Curtis, C. F., Maxwell, C. A., Magesa, S. M., Rwegoshora, R. T., Wilkes, T. J., Insecticide-treated bed-nets for malaria mosquito control. J. Am. Mosq. Control Assoc. 2006, 22, 501–506. [2] Mukherjee, J. S., Rich, M. L., Socci, A. R., Joseph, J. K., et al., Programmes and principles in treatment of multidrug-resistant tuberculosis. Lancet 2004, 363, 474–481. [3] Kuiken, T., Fouchier, R., Rimmelzwaan, G., Osterhaus, A., Emerging viral infections in a rapidly changing world. Curr. Opin. Biotechnol. 2003, 14, 641–646. [4] Epstein, J. H., Field, H. E., Luby, S., Pulliam, J. 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Received 13 June 2008 Revised 13 June 2008 Accepted 16 June 2008