In an era of increased globalization, public health and surveillance are playing an increased role in biosecurity. Whether novel pathogens are intentionally created bioweapons or naturally occurring emerging infectious diseases, recognizing the threat is a necessary prerequisite to countering it. This panel brings together representatives from Federal public health agencies, industry researchers, and representatives of NGO’s.
Director Global Disease Detection Operations Center
Centers for Disease Control and Prevention
The CDC Global disease detection program helps with prompt identification of emerging infections internationally. Experience has shown that outbreaks occur in unexpected locations, and that the surveillance capacity is only as strong as its weakest link. CDC has centers around the world in collaboration with local public health authorities. A total of 18 regional surveillance centers are planned.
Where possible, CDC programs make multi-use facilities that can recognize unknown pathogens. Facilities that could test for 69 pathogens in 2008 were ready to recognize 152 pathogens by 2009. This versatility assists with the recognition of completely new pathogens.
Another rapidly growing trend in public health surveillance is the use of communication tools and networks. Health Canada pioneered the use of Internet media scanning and text mining in 1997, and found it to be a valuable tool for public health. In the US today, a similar program known as the Argus Watchboard, has 33 analysts, monitoring 1.5 million pages per day, written in 40 languages and over 228 countries. To verify information coming off of the press, the US developed the Biosurveillance Indications and Warning Analytic Community. This group of 12 agencies evaluates information on human, animal, and plant diseases. The agencies use each others’ networks for subject matter expertise, and to verify information.
Director, Avian Influenza/Emerging Pandemic Threats Unit
U.S. Agency for International Development
Dr. Carroll discussed risk-based surveillance approaches. Though three quarters of new emerging diseases are zoonotic infections (transmitted to humans from animals), it is not feasible to monitor all possible threats around the entire world.
Instead, USAID focuses on so-called “hot spots” – geographic areas where humans are potentially in closest contact with animals, along with animals that pose the highest risk of transmitting diseases to humans and pathogens that are most likely to be transmissible between humans. This focus on areas with the highest risk can greatly improve cost-effective strategic uses of public health resources. The current target areas where the risk of disease emergence is believed to be the greatest are in the Amazon, the Ganges River, the Congo Basin, and Southeast Asia.
Head, Viral Vaccine Research and Diagnostics
Novartis Vaccine Research
Dormitzer presented the industry experience responding to the H1N1 pandemic as an example of the challenges faced in preparing epidemic countermeasures. Certain types of responses require simultaneous response by the government and the private sector. The H1N1 pandemic showed the importance of having infrastructure in place in advance. Though the system is tried and true, it was slow to respond with vaccine arriving after the worst of the outbreak had passed.
The response at Novartis to H1N1 started a month after the outbreak started in Mexico, when the first cases hit the US and BARDA contacted the company to ask for their help. Novartis spent a week to develop a reverse genetic protocol, which was not used for treatment but did prepare to allow them to scale production of the official candidate vaccine strain from the WHO with a day of receiving the strain. The race to produce a new vaccine is tempered by the need for more streamlined infrastructure for producing vaccines.
The other scientific vignette Dormitzer offered focused on a quirk of the H1N1 demographics. H1N1 was 5 times more lethal than expected amongst young people, and much less lethal than expected against older cohorts. The dynamics suggested that the evolution of influenza moves in response to the human immune response. The 2009 H1N1 vaccine crossprotects against the famous 1918 pandemic strain, which seemed counterintuitive given that flu vaccines often cannot protect against strains from a year or two later. The implication is that it might be helpful to vaccinate high-risk individuals, such as people who are in contact with animals, with historic pathogens to prevent those pathogens reemergence in the future.
Director for Global Health Threats
Skoll Global Threats Fund
Smolinski closed the session with some practical examples of improvements in public health that were possible with relatively low tech improvements in cooperation. With diseases crossing borders, nations need to cooperate with neighboring countries to truly know the local disease trends. As an example, a regional collaboration between Israel, Jordan, and Palestinian health authorities has greatly improved the local response to disease.
In another example, public health authorities in southeast Asia developed a new system to communicate outbreak information via text messaging (which the local telecommunications companies provided for free in the interest of public health). This system improved the response time from the 9 weeks it took for authorities to receive and catalog the old paper forms to overnight receipt of reports from doctors around the region.
Finally, Smolinski noted Google’s famous flu project. By analyzing web search trend data that the company already had, they were able to build a model that predicted flu outbreaks faster than the CDC’s reporting system and predictions had previously allowed. This type of advance will be crucial to improving public health responses with limited budgets.