Public Health Engagement Aff Notes

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Disease EXT

SQ Insufficient

Despite efforts, countries aren’t prepared enough to combat the next pandemic

Economist '13 (Economist, world news and issues, "Pandemic Preparedness: Coming, ready or not", The Economist, April 20,, CL)

Despite progress, the world is still unprepared for a new pandemic disease. THE threat of a global pandemic is rising again. In China an influenza virus never before seen in people had, as The Economist went to press, infected at least 82 and killed 17. Meanwhile a new type of coronavirus, the family that brought severe acute respiratory syndrome (SARS), is festering in the Middle East. The risk of such an outbreak turning into a pandemic is low, but the danger, if it does, is huge: in 1918 50m-100m people were killed by Spanish flu, compared with 16m in the first world war and 30m so far from AIDS. Fortunately, the world is better prepared for an outbreak than ever before (see article). SARS in 2003, the H5N1 bird flu of 2005 and the H1N1 swine flu of 2009 have prompted action. By 2011, 158 countries had pandemic-preparedness plans. America has poured money into the development of new vaccines and antiviral drugs. Researchers have a better understanding of influenza and other risky pathogens. Rapid amplification of DNA segments helps scientists identify viruses quickly. Full genomic sequencing allows them to explore worrying strains. Mathematical models predict where a new disease might emerge and how it might spread. Going viral: Yet all this may not be enough. No one has yet managed to predict an influenza outbreak. H1N1 exposed many problems, from the slow deployment of vaccines to simple breakdowns in communication. Thankfully that virus was not especially deadly. But an independent commission, charged with reviewing the response of the World Health Organisation (WHO), issued a bleak assessment: “The unavoidable reality is that tens of millions of people would be at risk of dying in a severe pandemic. Reducing that risk means, among other things, more government spending—an unwelcome prescription at a time of austerity, but a necessary one, for protection against pandemics is a valuable public good. First, governments and companies should continue to expand the availability of vaccines. America’s Biomedical Advanced Research and Development Authority deserves praise for working with Novartis, GlaxoSmithKline and other drug firms to create new vaccines and faster ways of making them. Such contracts often guarantee the American government a share of production. Some vaccines are donated to other countries. But poor countries, in particular, need reliable access to vaccines. GlaxoSmithKline has signed a deal with the WHO to donate 7.5% of its vaccine production to poor countries, in the event of a pandemic. More firms should follow suit. Second, governments should encourage more basic research on dangerous pathogens. In 2011 studies of mutations that might make H5N1 more contagious inspired global controversy—critics feared the papers would provide a cookbook for a biological attack. America suspended funding of such projects, a moratorium that dragged on foolishly. Now officials are implementing new ways to oversee research of dangerous viruses. Concern over security must not slow urgent work. Studying a deadly virus is risky. Not studying it is riskier. Third, patent laws for viruses need reform. Last year a scientist in Saudi Arabia sent a sample of the coronavirus to Ron Fouchier, a prominent academic in the Netherlands. Dr Fouchier then patented his sequencing of the virus’s genome. Saudi officials, who did not authorise the shipment, were furious. America’s Supreme Court is currently hearing a case involving genome patents (see article). A good starting-point would be that natural DNA cannot be patented, but therapies exploiting the discovery of specific genes can be. Faced with a distant but deadly threat, the world is not doing badly. But it needs to be better prepared still, because viruses move a lot faster than governments do.

Pandemic Coming

Pandemics are inevitable—our ignorance fuels its deadliness

Quammen '13 (David Quammen, writer, analyst and science researcher, "The Next Pandemic: Not if, but When", New York Times, May 10,, CL)

TERRIBLE new forms of infectious disease make headlines, but not at the start. Every pandemic begins small. Early indicators can be subtle and ambiguous. When the Next Big One arrives, spreading across oceans and continents like the sweep of nightfall, causing illness and fear, killing thousands or maybe millions of people, it will be signaled first by quiet, puzzling reports from faraway places — reports to which disease scientists and public health officials, but few of the rest of us, pay close attention. Such reports have been coming in recent months from two countries, China and Saudi Arabia. You may have seen the news about H7N9, a new strain of avian flu claiming victims in Shanghai and other Chinese locales. Influenzas always draw notice, and always deserve it, because of their great potential to catch hold, spread fast, circle the world and kill lots of people. But even if you’ve been tracking that bird-flu story, you may not have noticed the little items about a “novel coronavirus on the Arabian Peninsula. This came into view last September, when the Saudi Ministry of Health announced that such a virus — new to science and medicine — had been detected in three patients, two of whom had already died. By the end of the year, a total of nine cases had been confirmed, with five fatalities. As of Thursday, there have been 18 deaths, 33 cases total, including one patient now hospitalized in France after a trip to the United Arab Emirates. Those numbers are tiny by the standards of global pandemics, but here’s one that’s huge: the case fatality rate is 55 percent. The thing seems to be almost as lethal as Ebola. Coronaviruses are a genus of bugs that cause respiratory and gastrointestinal infections, sometimes mild and sometimes fierce, in humans, other mammals and birds. They became infamous by association in 2003 because the agent for severe acute respiratory syndrome, or SARS, is a coronavirus. That one emerged suddenly in southern China, passed from person to person and from Guangzhou to Hong Kong, then went swiftly onward by airplane to Toronto, Singapore and elsewhere. Eventually it sickened about 8,000 people, of whom nearly 10 percent died. If not for fast scientific work to identify the virus and rigorous public health measures to contain it, the total case count and death toll could have been much higher. One authority at the Centers for Disease Control and Prevention, an expert on nasty viruses, told me that the SARS outbreak was the scariest such episode he’d ever seen. That cautionary experience is one reason this novel coronavirus in the Middle East has attracted such concern. Another reason is that coronaviruses as a group are very changeable, very protean, because of their high rates of mutation and their proclivity for recombination: when the viruses replicate, their genetic material is continually being inaccurately copied — and when two virus strains infect a single host cell, it is often intermixed. Such rich genetic variation gives them what one expert has called an “intrinsic evolvability,” a capacity to adapt quickly to new circumstances within new hosts. But hold on. I said that the SARS virus “emerged” in southern China, and that raises the question: emerged from where? Every new disease outbreak starts as a mystery, and among the first things to be solved is the question of source.

In most cases, the answer is wildlife. Sixty percent of our infectious diseases fall within this category, caused by viruses or other microbes known as zoonoses. A zoonosis is an animal infection transmissible to humans. Another bit of special lingo: reservoir host. That’s the animal species in which the zoonotic bug resides endemically, inconspicuously, over time. Some unsuspecting person comes in contact with an infected monkey, ape, rodent or wild goose — or maybe just with a domestic duck that has fed around the same pond as the wild goose — and a virus achieves transcendence, passing from one species of host into another. The disease experts call that event a spillover. Researchers have established that the SARS virus emerged from a bat. The virus may have passed through an intermediate species — another animal, perhaps infected by cage-to-cage contact in one of the crowded live-animal markets of the region — before getting into a person. And while SARS hasn’t recurred, we can assume that the virus still abides in southern China within its reservoir hosts: one or more kinds of bat. Bats, though wondrous and necessary animals, do seem to be disproportionately implicated as reservoir hosts of new zoonotic viruses: Marburg, Hendra, Nipah, Menangle and others. Bats gather in huge, sociable aggregations and have long life spans, circumstances that may be especially hospitable to viruses. And they fly. Traveling nightly to feed, shifting occasionally from one communal roost to another, they carry their infections widely and spread them to one another. As for the novel coronavirus in Saudi Arabia, its reservoir host is still undiscovered. But you can be confident that scientific sleuths are on the case and that they will look closely at Arabian bats, including those that visit the productive date-palm groves at the oases of Al Ahsa, near the Persian Gulf. What can we do? The first obligation is informed awareness. Early reports arrive from afar, seeming exotic and peripheral, but don’t be fooled. One emergent virus, sooner or later, will be the Next Big One. It may show up first in China, in Congo or Bangladesh, or maybe on the Arabian Peninsula; but it will globalize. Most people on earth nowadays live within 24 hours’ travel time of Saudi Arabia. And in October, when millions of people journey to Mecca for the hajj, the Muslim pilgrimage, the lines of connections among humans everywhere will be that much shorter. We can’t detach ourselves from emerging pathogens either by distance or lack of interest. The planet is too small. We’re like the light heavyweight boxer Billy Conn, stepping into the ring with Joe Louis in 1946: we can run, but we can’t hide.

Our relationship with disease depends on our response now

NPR '16 (NPR, top reporter on world news, "'Pandemic' Asks: Is A Disease That Will Kill Tens Of Millions Coming?", NPR, February 22,, CL)

As public health officials struggle to contain the Zika virus, science writer Sonia Shah tells Fresh Air's Dave Davies that epidemiologists are bracing themselves for what has been called the next "Big One" — a disease that could kill tens of millions of people in the coming years. Citing a 2006 survey, Shah says, "the majority of ... pandemic experts of all kinds, felt that a pandemic that would sicken a billion people, kill 165 million people and cost the global economy about $3 trillion would occur sometime in the next two generations." In her new book, Pandemic: Tracking Contagions from Cholera to Ebola and Beyond, Shah discusses the history and science of contagious diseases. She notes that humans put themselves at risk by encroaching on wildlife habitats. "About 60 percent of our new pathogens come from the bodies of animals," she says. Shah adds that international travel is also a factor in the spread of disease. "Air travel shapes our epidemics in such a powerful way that scientists can actually predict where and when an epidemic will strike next just by measuring the number of direct flights between infected and uninfected cities," she says. Looking toward the future, Shah says that epidemiologists can do more to identify potential outbreaks before they happen. But eliminating them altogether is another matter. "Our relationship to disease and pandemics is really ... part of our relationship to the natural world," she says. "It's a risk we have to live with."

On our first response to new pathogens: A lot of times when we talk about being more prepared in preventing pathogens from spreading or preventing pandemics, what we're really talking about is first response, stepping up our first response, so that when we have outbreaks of disease that our hospitals are prepared and we have vaccines stockpiled and we are able to fly our experts around really quickly to get to the scene of the outbreak, and things like that. But that's not actually preventing these pathogens from emerging and from causing outbreaks. That's kind of after the fire has started, then we rush in with our fire extinguishers. But to really prevent them would mean stepping it way farther back, and that is possible now, because ... we know there's certain places that have higher risk of pathogens emerging, and we can do kind of active surveillance in those places by mapping the microbes that are there, by surveilling people or animals who are more likely to spread or to have spill-overs of microbes into their bodies. ... We have more advanced detection capacity now with genetic analysis and other kinds of ways that we can see where these invisible microbes are spreading and changing. On how most of our pathogens come from animals: From bats, we got Ebola; from monkeys we got HIV, malaria, most likely Zika, as well; from birds we got avian influenzas, all other influenzas as well, West Nile virus, etc. So it's when we invade wildlife habitat or when we disrupt it in ways that brings people and animals into close contact, that their microbes start to spill over and adapt to our bodies.

On the evolution of antibiotic-resistant bacteria: We've known since antibiotics were first developed that if we use them in ways that were not medically necessary that it would lead to the evolution of resistant bacteria. And yet, in this country, 80 percent of our antibiotic consumption is not medically necessary, it's done for commercial reasons. When we have livestock farmers giving antibiotics in low doses to their animals because it fattens them, it helps them gain weight faster and that gets them to market faster, so this is a commercial use. And that's the vast majority of the antibiotics that are consumed in this country are for that reason. We've known this for years and we do have an increasing problem with antibiotic-resistant pathogens, which is a very serious problem where we're running out of these drugs to treat these runaway infections, and we're on the cusp of entering an era when we have no more antibiotics that work for some of these bugs. We need to use antibiotics more rationally. We don't do that now. That's sort of the hardest part of it that we need to do. But the other part of it is we also need to develop new antibiotics to keep up — these pathogens are always going to evolve resistance eventually, so we always need to come up with new weapons to fight them.

On why incidents of Lyme disease are increasing: Lyme disease is caused by a bacteria that lives in rodents and is spread by ticks. Now in the intact northeastern forest where Lyme disease first emerged, there used to be a diversity of different woodland animals there, like chipmunks and opossums as well as deer and mice and other things, but as we spread our suburbs into the northeastern forest and we kind of broke up that forest into little patchworks, we got rid of a lot of that diversity. We lost chipmunks, we lost opossums, and it turns out that those animals actually control tick populations. The typical opossum destroys about 6,000 ticks a week through grooming, but the typical white-footed mouse, which is what we do have left in those patchwork forests, a typical mouse destroys maybe 50 ticks a week. So the fewer opossums you have and the more mice you have, the more ticks you have and the more likely it becomes that this tick-borne pathogen will spill over into humans. And that's exactly what happened with Lyme disease and now with many other tick-borne illnesses as well. On what scares virologists most: Novel forms of influenza are what really keeps most virologists up at night, because we are so good at spreading those around quickly, and it happens every year. We have a flu pandemic every year, and now we're hatching all kinds of new kinds of flu viruses, mostly in Asia, and then they're spreading across the globe, and we don't have immunity to some of those. Right now, a typical flu virus, the seasonal flu, will still kill a lot of people every year and it's a real drain on our global economy. But we kind of put up with that, so if you had a new flu virus that even had a slightly higher mortality rate, you could see a lot more death and destruction because so many people get the flu. Think about the 1918 flu, which killed maybe 100 million people, maybe more, estimates vary, but certainly huge numbers of people died from that flu. The mortality rate was like 1 percent, which isn't huge. It sounds like a small number, but when you think about how many people get the flu, that adds up to a huge number of deaths. So these new kinds of influenza, I think, are what virologists are most fearful of.

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