Closing the door on potential pandemics

VIEWPOINT William Karesh

Geographic and environmental boundaries that once protected us from widespread disease outbreaks are no more, says William Karesh. In this week's Green Room, he calls for the West to adopt a "prevention is better than cure" approach to human and animal health.

Animal health is tightly linked to the conditions of its surrounding environment, and humans are increasingly changing or affecting those conditions

During the 1918 Spanish Flu pandemic that killed up to 100 million people worldwide, children sang a nursery rhyme: "I had a little bird, Its name was Enza, I opened the window, and in-flu-enza."

Today, the expanding human population and activity has opened the pandemic "window" even wider.

A major component of any strategy to protect ourselves must involve treating disease before it gets to us.

We are reminded by the recent World Health Organization designation of a H1N1 pandemic that infectious diseases have little regard for the Darwinian divide.

Humans share more than 60% of "known" infectious organisms with animals, and the majority of new or emerging diseases are linked in some way to wild animals; ebola, HIV/Aids, Sars, and Avian influenza are just a few examples.

But don't blame the animals; these diseases in humans stem from how we move about the planet, interact with animals and the environment, educate our citizens, provide or don't provide health services, and deal with poverty and hunger.

Going global

Animal health is tightly linked to the conditions of its surrounding environment, and humans are increasingly changing or affecting those conditions.

Boundaries that limited the spread of diseases are being broken down

The trade in wildlife for food, traditional medicine, or pets, for example, has increased in response to human demand.

This flourishing trade - both legal and illegal - of domesticated animals, wildlife and wild animal parts is often marked by unsanitary conditions that can give rise to zoonotic diseases (those transmitted from animals to people).

As modern transportation is made available to more of the world, geographic boundaries that once protected us from remote disease outbreaks are nearly obsolete.

Viruses and bacteria long confined to living in a single species, or in one part of the world, can now quickly be moved to new areas and thrive in environments, animals or people unprepared for their arrival.

Other human-induced environmental conditions can have an effect as well, and are not predicated on human physical presence in a specific place.

Disturbances, such as fluctuating precipitation levels and increasing temperatures brought about by climate change, can have far reaching consequences on ecosystems and animal health, and thus, ultimately drive changes in disease proliferation and redistribution.

Human well-being is dependent upon healthy ecosystems

Not surprisingly, predicting outbreaks of zoonotic diseases is an increasingly complex, but critically important, undertaking.

It is a mistake to believe that stockpiling vaccines or drugs will be enough to ensure that we are protected from future pandemic threats.

The next pandemic may not come in the form of an influenza virus. There is no guarantee that in response to a viral threat, we will have time to modify a vaccine or that current drugs will remain effective.

Many of us have been actively promoting the concept of One World, One Health - a philosophy that dictates a comprehensive approach to pandemic preparedness that starts "upstream", and attacks disease at its origins.

That means working with people in the poorest areas of the world who have little access to health care for themselves or their livestock, or to proper hygienic provisions for raising and handling animals.

In many of these places, the order of the day is simply survival.

To really protect those of us "downstream", in places like the US and Europe, from emerging pandemic diseases, we must focus a portion of our efforts on collaborating with those upstream populations to create a safer and healthier future.

This means building capacity in the developing world to monitor wildlife, domestic animals and people for disease.

Potential pandemics needs to be tackled at source, not on our doorsteps

It also means giving those living at the frontlines of an outbreak the ability to respond.

This may sound like an ominous task, but in the long run, preventing or solving a potential pandemic disease crisis at its source will prove far more cost effective than paying for the effects after its devastating impacts.

The nascent beginnings of such a comprehensive, global approach to pandemic disease have been initiated by the US government and a number of UN agencies.

Formal and informal networks of public health agencies, infectious disease scientists, veterinarians, conservation organisations and technology firms are sharing resources and enabling access to disease distribution data, sample analyses and outbreak information.

This is vital to predicting, identifying and responding to new emerging diseases in countries most in need of help and at the highest risk.

As with climate change, we are learning that what we do locally affects our global community, and that all nations both developed and developing, will play an important role in the future condition of our shared planet.

Working as partners within a One World, One Health philosophy is a critical approach to answering our environmental challenges - including minimising the impacts of a future pandemic.

Just as we share the planet's atmosphere, we share all of its infectious organisms.

Dr William B Karesh is vice president of the Wildlife Conservation Society and director of its Global Health Program

The Green Room is a series of opinion articles on environmental topics running weekly on the BBC News website

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Do you agree with Dr Karesh? Do we need to tackle potential pandemics at source, rather than waiting until they arrive on our doorsteps? Is modern society breaking down geographic and environmental boundaries that protected us in the past? Or is there little that can be done to halt the spread of determined diseases?

The way to tackle any pandemic is simple. Basic hand hygiene! According to the United States Centers of Disease Control and Prevention, "Handwashing is the single most important means of preventing the spread of infection." a fact that has been known since the late In the late 1840's, Dr. Ignaz Semmelweis was an assistant in the maternity wards of a Vienna hospital. There he observed that the mortality rate in a delivery room staffed by medical students was up to three times higher than in a second delivery room staffed by midwives. In fact, women were terrified of the room staffed by the medical students. Semmelweis observed that the students were coming straight from their lessons in the autopsy room to the delivery room. He postulated that the students might be carrying the infection from their dissections to birthing mothers. He ordered doctors and medical students to wash their hands with a chlorinated solution before examining women in labor. The mortality rate in his !

maternity wards eventually dropped to less than one percent!

Surely we should be looking to prevent rather than cure? Soap and water are readily available and more so than ever are Hygiene Wipes and Hand Gels. Education is the key to good hygiene, perhaps money would be better spent to convey the importance of this basic practice!!
michael hill, ramsden heath, england

William Karesh neatly sums up the risk humankind has, unwittingly, created for itself.

Quite rightly he states that the next pandemic may come in any number of forms and influenza is but one of many possibilities.

Factory farming, wherein animals are kept in completely unnatural and unhealthy environments - pumped with antibiotics because that's the only way to stop them dying very young due to the poor conditions they are being kept in (i.e. crammed into very small spaces, with no natural light, no space to exercise, etc) - is creating a time bomb waiting to explode. At some stage one or several animal viruses will develop immunity to antibiotics and when they do its not only the animals that are at risk, but the humans that interact with them - and thus the human race as a whole.

Essentially by keeping factory farmed animals is such poor conditions we are incubating the next pandemic - as they say you reap what you sew. Team this with the conditions in which humans now transport themselves and the the speed with which humans travel around the globe - i.e. people crammed in their hundreds into tube and train carriages, traveling far greater distances in far shorter time frames than ever before and the scene is set - it's not if, it's when.

Karesh is perfectly right to point out that the increased trade in exotic pets and bush meat creates a higher risk - a far higher level of poaching is going on (due to poverty in Developing World nations and increased demand for bush meat/animals parts for Chinese medicine and exotic pets) and this puts greater numbers of people in contact with tropical diseases and viruses. Further more it creates risk to the species that live in virgin habitats - as many, such as primate species, have no immunity to human diseases - just as humans have no or low immunity to many animal diseases/viruses, animals often have low or no immunity to ours.

I agree with Karesh that viruses tend to go upstream - though its odds on that we face as much risk from the mutation of a virus strain such as HIV, as we face from a new, as yet unknown tropical virus strain.

The Black Death killed up to 50% of the population of several cities in Europe in the 1300's - a time when people travelled at a fraction of the speed we do today and travelled over far shorter distances.

However, to get things into perspective, Malaria is still the world's No.1 killer and it's on the increase because global warming is extending the regions mosquitoes are able to inhabit. Climate change is also creating food scarcity issues - indeed some scientists predict that by 2050 agricultural yields will have dropped to such an extent due to flooding, drought and other direct impacts of climate change that annual harvests will only feed a population of 2 billion people. Thus, yet again, prevention really is better than cure.

Unless we acknowledge the sheer magnitude of the challenges we face we cannot comprehend the magnitude of the changes we must make at a societal level to tackle those challenges.
Melissa Sterry, Oxford

While great challenges in health exist it seems ridiculous to believe things are worse now. Both life expectancy and quality of life are on the increase. Tradional scourges of humanity , such as malaria, have seen improved situations in countries were intervention has been greatest over the past decade. More and better resourses will only improve that situation.

Along with the shrinking world and denser populations has come better medical facilities and research, communication, surveillance, drug distribution, education and general health all of which put ourselves in a better position to fight new diseases.

The recent experience of SARS, Avian flu and H1N1 seems to show that it is fear-mongering of pandemics that is the greater risk than the diseases themselves.

We should not be teaching our children to lock the windows in fear of pandemics. Train the next generation of medical researchers to develop better drugs, vaccines and strategies for tools in the fight against disease and give them the belief they can fight anything that nature throws at them.
Pete Williamson, Melbourne, Australia

I agree with Dr. Karesh, that we need to tackle the problem at its source. However I still believe that tackling the disease at its source is still not enough to diminish or limit the determined disease. We are in the 21st century of course geographical boundaries are going to be broken we can't stop that no matter what we do. What human beings in the 21st century should realize is that the more knowledge we gain, and the more technology provided for us in the world only should make us more aware about the environment and our health most importantly. What Dr. Karesh said is right, but in order to stop the disease we need to tackle the source and in this particular case the source is us human beings. We basically have to come upon an agreement that "its not all about us anymore" its all about the human race, and if we don't realize that the source is us human beings then there will be no further change!
Samuel Housh, Bangkok, Thailand

And what about industrial agriculture? These animals live in their own filth and are fed massive amounts of immune system suppressing drugs. Now we find out viruses like H1N1 spread easily between humans and pigs. We can't keep thousands of animals in small enclosed spaces without consequence.
Krissy, Austin, TX

A modest proposal: If disease is allowed to spread it will reduce the population. At some point it will reach equilibrium. Thus we can stop spending resources on trying to stop disease and share them among the remaining population and raise the standard of living.
Pat Nelson, Potsdam, NY, US

I do agree with the comments above, but the world needs to wake up to the fact that the human population cannot continue to expand and grow at its current rate. If population growth is tackle would start to help some of the issues mentioned above.

The developed world needs to change from being profit and possession lead to maintenance and then a reduction in resources needed, the undeveloped countries cannot use the argument we need to catch up so can use the all the resources we want. (I am taking about government not substance farmers or populations) They need to have learned by our mistakes if the world is to continue a flourish.

I do not think that the world as the will to do this yet and by the time it does it may be too late.

A really bad pandemic may be all that in the end saves the world? However I doubt the world will do anything until it has happen.

If swine flu was really a bad virus it would all ready is too late.

There is no one answer
Ian Martin, Colchester

He's absolutely right, flights, ships and borders should have been cancelled and closed with Mexico as soon as the outbreak first happened instead of hand wringing about the spread... as though we couldn't have stopped it(!) The problem is economic activity taking priority over human lives.
Richard Payne, UK

Dr. Karesh' s arguement that diseases always originate in 'upstream' ( unhygeinic and unhealthy poor) countries and spread to 'downstream' ones like US and Europe may not always be true. Where has H1N1 originated??? It is countries like ours that are practically importing the disease from west. US, Australia and Europe have more number of cases then the third world. Hygiene and good healthcare systems have not been able to contain the disease. With climate change and globalisation it may not be always right draw such biased conclusions on disease origin and proliferation
manjula, Hyderabad, India

This article is ridiculous. Nowhere does it cover the fact that our farming practises are a major contributor to these diseases. If we changed the way we use animals and either encouraged a meat-free diet or at least more organic free-range farming practises, instead of intensive factory farming, many of these diseases would never have the chance to develop or 'incubate' in the first place. To blame trade in bush meat and illegal pets and animals is laughable...what idiot wrote this?
Jinx, Basingstoke

During a conversation one guy says "Why did you do this particular thing which makes me so angry"? Here, one thing is certain that second person has to explore all other paths except those where first person gets angry. That means we keep some of our things in fixed basket and the remaining things have to make adjustments accordingly. Similarly, the growth of human population has been kept in a fixed mode and rests of the infinite things have to make adjustments according to growing human population. The best strategy is to focus more on the population growth and simultaneously assure appropriate efforts at other infinite places, regardless of peoples worry.

William Karesh has drawn our attention towards a very important phenomenon. He is correct that though world is divided in different lands and thoughts but we share its atmosphere and its infectious organisms. We can not assure good health to all the creatures unless we do not prefer to side with the nature friendly life styles.

Mexico is the place where H1N1 pandemic started. It is the same place, where in 1986 world cup 'Mexican wave' originated. As we share the atmosphere, can we start 'Eco Friendly Mexican Wave' to make our planet healthy?
Sanjay Singh Thakur, Indore,India

Totally agree, and as a vegan I would encourage the world to go vegan before it is too late. Mother Earth must be treated as a loved one, with respect and love for everything, for everything is alive in one form or another. Peace to all...
Steven Henderson, Perris california, usa

The problem with the ONE WORLD theory is Europe and the U S is expected to pay for it. It is time for the Mid-East oil barons,Russia,China and India to belly up to the bar and pay their fair shares also. 3rd worlders can form $$ Co-op's and pool their money to put where their mouth is also. The U N is useless for distributing $$ It never gets to where it is supposed to go, because of corruption. The U S and Europe are just about tapped out people, what part of this is so hard to understand ?
Michael Gudat, Dallas, Texas

Maybe the only way the human race can more forward and survive is to take steps backwards to a time when we were more in tune with our environment and less in tune with our greed and modern convenient lifestyles. This would not agree with modern life, people wouldn't change unless forced, and the powers thatbe wont let it happen coz they like their modern life too. We can not protect our kind from our kind.
Mrs Katie Bufton, Kington Herfeordshire

I do agree with Dr Karesh and as you will see I have been discussing this whole issue on Fergus Flu Blog as 'Sensibleoldgrannie.' I think we should be careful with our imports of fresh fruit and vegetables as there are epidemic levels of cholera, dysentry and salmonella in other countries. As I have said before, if you don't look after the poor and ill, you must expect to suffer similar consequences by ignoring them. We are all interdependent on each other and what can happen to someone the other side of the planet can also happen to us. I am also concerned about the number of cruise ships becoming incubation sites for diseases. What happens to waste from these ships, is it thrown overboard? The potential for marine mammals becoming ill from what we throw away and they eat, worries me. Just as in the past, waste food from humans was fed to pigs and they consequently became ill from our diseases. I think the media could be more pro-active and helpful as you are being now a!

nd hopefully, once people are aware of their personal responsibility, will start the slow process of change. It is only through crisis, that we shake ourselves free of the lethargy and indifference that afflicts us during times of plenty.
Ms Francis, sOUTHAMPTON HANTS

No, I don't believe we can stop a determined virus. We are not even sure how they come to be, or where they appear. There is competing theories on where the 1918 flu orginated from, and why it disappeared so suddenly. We should focus on identifying and observing and vaccinating against new viruses until it can be fully determined how and where they begin.
Scott Brooks, Ohio, USA