Authors: Nathan Wolfe
While we work diligently to help inform these people of the risks associated with hunting, we also recognize that the real enemy is rural poverty. To solve this universal problem, we need to do more than explain risks. We need to devote ourselves to helping to find viable solutions to the nutritional needs of rural populations. We need to help them find alternatives to unsafe hunting, and we cannot blame them for trying to feed their families. As we expand our Healthy Hunters Program to more sites, we simultaneously work with development and food organizations to provide real solutions.
If we could snap our fingers and eliminate the hunting of wild game for subsistence in viral hot spots like central Africa, southeast Asia, and the Amazon Basin, we certainly would do just that. In addition to the risks of pandemics, these practices have well-known negative implications for the biological heritage of our planet and for the food security of vulnerable populations living off non-renewable animal protein sources. Yet the solution will require real energy and resources on a global scale. It will be energy well spent. In addition to the self-serving goals of wealthy populations around the world to stop plagues and preserve biodiversity, it would also help some of the poorest populations in the world to live a reasonable life. The problem of bushmeat is not a boutique issue for those wanting to save some charismatic endangered species. It affects global health, and we cannot afford to ignore it.
As GVF looks for more partners and more resources to help extend our first efforts at changing the behaviors that allow new agents to enter into our species, we recognize there is more we can do now to prevent the activities that lead to pandemics. And some of the things we can do align perfectly with other public health initiatives. As we discussed in chapter 8, immunosuppression that occurs with AIDS facilitates the entry of new microbes into human populations. We must work to guarantee efforts to extend the antiretroviral drugs that control AIDS to even the most rural populations that have contact with wild animals through hunting. We have worked with some of the pioneers in this field—scientists like Debbi Birx, who left a successful career overseeing a productive research group at WRAIR (Walter Reed Army Institute of Research) to lead the CDC’s Global AIDS Program, which focuses on the nuts and bolts of getting antiretroviral therapy to some of the neediest parts of the world. This will help us all.
There are ways that each of us can help this process. It is vital that we all put pressure on policy makers and politicians to support long-term approaches to pandemic prevention. An informed public must push governments to provide more funding aimed at generic approaches to controlling future pandemics rather than simply focusing on a single threat.
In an ideal world we might embrace changes suggested by some in the wake of recent pandemics. At the 2009 TED conference in Long Beach, Fred Goldring, an influential entertainment lawyer, suggested that we should advocate a “safe shake,” where we shake by touching elbows rather than hands. Certainly this would help to decrease the spread of some infectious agents in the same way that sneezing into an elbow rather than a hand does. To my knowledge no one has conducted detailed studies of the health impact of bowing (rather than shaking hands) in countries like Japan, but it would be expected that it should decrease the transmission of some infections. Similarly the practice of wearing surgical masks in public when ill, seen in Japan, could well dampen some bugs from spreading. Changing habits like these is incredibly difficult, but the models show that useful possibilities exist.
* * *
You may ask yourself when we will see the ideal control room that began this chapter. Though that scenario was fiction, there is no reason that we need to wait centuries or even decades for it to occur. In fact, one of our goals at GVF is to make this a reality. Our data team, headed up by Lucky Gunasekara, consists of a completely new breed of digitally minded young scientists who meld the work we do in the field with the entirely new set of data we discussed in chapter 10. Detailed data from the field and lab will soon combine with data from cell phones, social media, and other sources to create the ultimate outbreak data mash-up.
A decade ago the main structures that organized the world’s information were governmental, like the Library of Congress. Yet this was not the final answer. Today, organizations like Google have used innovative methods and incentives to build tools for accessing information that we could barely have dreamt of a few decades ago. We must be open to innovation of this sort in the area of global health. It is often said that organizations like Google have helped create a
global nervous system
. If we are ever to have the equivalent of a
global immune system
, we will need to develop new approaches that combine governmental and nongovernmental systems and use the latest approaches and technology.
In fact, this has already begun. In the coming years, whether you are a head of state wary of political and economic costs of a disease catastrophe, a CEO concerned by supply-chain and staff disruption associated with the next pandemic, or a citizen worried about your family, you will have access to better, more accurate, and rapidly available data on actual outbreaks. And not just from governments but from organizations like my own, which will combine lab results in far-flung viral listening posts with international news feeds, text messages, social networks, and search patterns to create a new form of epidemic intelligence.
* * *
We live in a world fraught with risk from new pandemics. Fortunately, we also now live in an era with the tools to build a global immune system. This huge but simple idea is that we should and can be doing a much better job to predict and prevent pandemics. But the really bold idea is that we could reach a point where we become so good at this that we mark the “last plague”—a time when we are so capable of catching and stopping pandemics that we won’t even need the word.
NOTES
INTRODUCTION
1
Throughout this book, I’ll generally refer to
microbes
rather than the more appropriate but clunky term
microorganisms
, which includes all microscopic organisms. Unless otherwise specified, the term
microbe
will be used as shorthand to refer to the full range of microscopic organisms whose groups include species that can infect and spread in humans, namely: viruses, bacteria (and their siblings, the archaea), parasites, and the enigmatic prions, all discussed in detail in chapter 1. While no doubt irritating to some of my microbiologist colleagues, who exclude parasites from the term
microbe
for
sensible taxonomic reasons, and haven’t quite decided what to do with prions, I hope they will excuse me in this attempt to increase the ease of reading for a general audience.
2
There is some debate about whether viruses themselves should be considered living, while there is no debate about the other microbes: bacteria, archaea, or parasites, all of which are clearly living organisms. The debate, in my opinion, is a semantic and largely unimportant one. Viruses are completely dependent on other organisms for elements of their life cycle, but that is no different than the rest of known life forms, none of which, to my knowledge could live in a world devoid of other life. Either way, it is clear that viruses are part of the living systems of our planet, and for those intent on engaging in this debate, my reference to viruses as living can be interpreted in that way. I will use the same inclusive convention with prions, despite the existence of similar debates on them.
3
In fact, the death rate for the 1918 H1N1 infection itself may be even lower than 2.5 percent, as many deaths were probably caused by secondary bacterial infections—deaths that could at least partially be prevented today due to antibiotic use. Deaths from H5N1, on the other hand, are largely due directly to viral disease.
4
In the case of rabies, vaccine delivered in short order after infection can successfully prevent death, but without it death is largely inevitable.
5
Like H5N1, the “swine flu” that began in 2009 suffers from terminology problems. Called H1N1/09 virus by the WHO and 2009 H1N1 influenza among other things by the CDC, here I will refer to it simply as H1N1, which is the commonly used shorthand among the scientists who study it. As with H5N1 and all influenza viruses, H1N1 has its ultimate origins in bird populations.
1. THE VIRAL PLANET
1
There are some who consider Dmitri Ivanovski the “father of virology” because he did similar research with tobacco mosaic virus six years earlier. But perhaps because he wasn’t the first to name the new entities (i.e., viruses) or did not as widely disseminate his findings as Beijerinck, he is not generally credited with their discovery.
2
In addition to his pivotal work as the first virus hunter, creating the foundations of what would later become the field of virology, Beijerinck remains an unsung hero for those studying the relationships between plants and bacteria. Among other notable findings, he discovered nitrogen fixation, whereby bacteria living in the roots of legumes make nitrogen available to plants through a set of biochemical reactions critical for the fertility of agricultural soil systems.
3
Among the most intriguing possibilities is that non-DNA/non-RNA forms of life, which originated completely independently of our own RNA/DNA-based life, might persist undetected on Earth. These life forms, referred to as shadow life, would almost certainly be microscopic. If discovered, they might best be described as aliens, and some believe that if we are to discover aliens within our lifetimes, looking on Earth will be our best shot.
2. THE HUNTING APE
1
Sadly, using actual fossil evidence, such as tooth wear and carbon typing methods, to address these questions remains imperfect. They indicate that just as for chimpanzees and bonobos, the majority of food for our ancestors prior to around 1.8 million years ago was of plant origin. But meat was almost certainly a part of the diet—tool-scarred bones have been found that are over three million years old, and tooth wear patterns indicate heavy meat eating by around two million years ago.
2
The same virologist duo—Martine Peeters and Beatrice Hahn—who along with their colleagues showed that SIV was a recombinant of two monkey viruses also showed through long-term monitoring of SIV-infected chimpanzees that, like humans, they also eventually become sick.
3. THE GREAT PATHOGEN BOTTLENECK
1
The genetic similarity that dogs and wolves share is virtually identical to the genetic similarity between humans and chimpanzees. For many, this is shocking since we perceive ourselves as so different from chimpanzees yet view dogs and wolves as essentially the same. Such perceptions are more telling of our sensitivity to differences among beings similar to ourselves than they are of the actual genetic relationships between species.
2
Sadly, we do not have equivalent information about the microbial repertoires of all of our ape cousins. For example, because bonobos have smaller numbers and live exclusively in the Democratic Republic of Congo, their territory was often inaccessible during the wars of the last twenty years, so we understand much less about their microbial repertoires than we do for those of chimpanzees. As studies of these fascinating apes increase, they will certainly provide additional vital clues to the origins of our own infectious diseases.
3
In fact, humans are actually infected with multiple malaria parasites, each with its own evolutionary history. Here, when I refer to
malaria
, I’ll use it to mean
Plasmodium falciparum
, the malaria parasite that accounts for the vast majority of human illness.
4. CHURN, CHURN, CHURN
1
Unlike our ancestors forty thousand years ago who lived with no animals for protection or to assist with labor, all current hunter-gatherer populations have dogs.
2
One notable exception was populations supported by marine habitats. People living off of the ocean through fishing and the hunting of marine mammals were often able to achieve relatively large population sizes and maintain a sedentary lifestyle without domestication. While likely not sustainable in the long-term, the vast quantities of animal protein present in certain marine systems mimicked the concentrated caloric resources that subsequent domestication would provide.
3
Ant societies, like bees, consist of large colonies of female workers, all descended from a single mother (the queen) and father. The workers’ fathers (and all males) result from the development of unfertilized eggs, which means they lack half of the genetic information of fertilized offspring, or are haploid, in scientific terms. The haploid father contributes identical genetic information to each of his daughters. For this reason, the worker ants in a colony share 75 percent of their genetic information, rather than the 50 percent shared by sisters in species like our own. Because of their close genetic relationship with each other, female workers lie squarely in the middle of the continuum between sisters and cells. Ants in a colony are more accurately thought of as physically distinct cells in a large and single organism (i.e., the colony/hive) rather than as collectives of cooperating unrelated individuals.
4
There is ongoing debate among scientists as to the importance of sylvatic dengue for the human outbreaks. Unfortunately, the intense difficulties associated with isolation of dengue virus from forest settings makes ideal comparisons a challenge.
5
Recent work in Bangladesh by researchers at the International Center for Diarrheal Disease Research has shown that Nipah can enter into humans without pigs. One of the delicacies in parts of the country is sap from date palm trees, which is tapped overnight and consumed fresh in the morning. During the night, bats feed on the sap that flows into collecting pots, on occasion contaminating the sap with Nipah virus.