September 30, 2020

Waiting for the disease

In the early days of 2020, from the Coalition for Innovation in Response to Epidemics, an international organization working to fund vaccine research, a report was prepared that was doomed to appear in media around the world . It warned of the extremely high probability that a new virus would embarrass international health systems at any time. A not-so-well-known virus, one of the deadliest that exists in nature and that could “become the next Ebola,” the report said, “unless efforts to find a vaccine are redoubled.”

The virus showed its face in 1999 when a strange animal mortality in the Malaysian town of Sungai Nipah caught the attention of experts. The most numerous victims were pigs. Within months, the farmers themselves began to become ill with encephalitis and pneumonia. Half of the infected died. Two decades later, in December 2019, the International Nipah Virus Conference was held in Singapore, the first global effort to understand the threat of this microorganism. It reported that periodic outbreaks have occurred in Malaysia and Bangladesh, with mortality rates of between 40 and 90 per 100 of those infected.

Becoming a nightmare

The virus has all the necessary characteristics to become a nightmare: it is born between farm animals, it is transmitted from person to person, it has no cure or vaccine, it is terribly deadly. It is not the new Ebola, it is worse. But the conclusions of the congress did not enjoy the desired repercussion. The reason: During those days, half the world began to pay attention to a coronavirus born in Wuhan, China, which has continued to cover covers since then.

The coincidence in time has undoubtedly removed the Nipah virus from the media focus, much more worrying than SARS-Cov2. But Nipah is still there, hiding on some farm in Southeast Asia waiting to become the first great modern pandemic. Covid-19 is a 20th century disease and we attack it with 20th century tools. Nipah could be the evil of the 21st century, the expected “disease X” with which virologists have been alerting us for decades. An infectious virus like the flu and deadly like Ebola, a threat that will force health authorities around the world to rethink their containment strategies.

Epidemics are children of their time. The black plague traveled all over Europe from its origin in Asia, taking advantage of the commercial lines of the Silk Road. A climate change that caused severe droughts in Central Asia led to the death of some of the natural carriers of fleas that transmitted the infection. and that they find shelter in horses first and in humans later. Without trade routes and climate change, the worst pandemic in history would not have occurred, killing 25 million Europeans and between 40 and 60 million people in Asia and Africa in the 14th century.

In the 21st century the favorable conditions for pandemics are different. The problem is that we are not always aware of which ones. In 2016, the World Health Organization created the Blueprint plan to try to develop research projects aimed at fighting the epidemics of the future. The first conclusion of the experts was discouraging: We continue to face health crises in the wrong way. The time has come to stop treating epidemics in isolation by struggling with each new outbreak that comes, and to start treating its root causes of origin. Viruses have to stop being in control of the times because sooner or later one will emerge for which we do not have the capacity to react.

That was the reason why the WHO decided to coin the term “disease X” as a symbol of a pandemic that we have not yet known but that would pose a serious danger to humanity as a whole. A kind of still nonexistent enemy for which we must prepare. It is no longer enough to invent new vaccines every time a new virus arises somewhere on the planet, it is a kind of endless race in which humanity has to lose. A senseless vicious circle. Every time we invent a vaccine we know that sooner or later a version of the virus that escapes it will appear. Even when? There are believed to be about 1,600,000 unknown viruses capable of infecting humans. They are myriads of virus variants that have affected us at some time in history. Of the SARS typology alone, there are 50 dangerous variants.

Sequencing the genome

Facing that threat requires more than just sitting around waiting when another bug will attack us. The Viroma Global project is a good start. Scientific organizations around the world have set out to sequence the genome of as many viruses as possible that can infect humans. The endeavor is monumental, it has international financing of more than $ 1 billion and aims to have its first results in 2028.

Having a genetic catalog of the most threatening microorganisms would bring us closer to achieving the greatest wish shared by all virologists: a set of universal vaccines: the universal flu vaccine, the universal Ebola vaccine, the universal coronavirus vaccine. It is not easy, the viruses mutate and adapt at a speed much higher than our ability to react. But if we want to face the new era of pandemics with guarantees, we will have no choice but to try.

The race for the universal vaccine is just one of the new tools for the new time we are facing. Some experts begin to propose that the most effective strategy is to try to stop the next blow at origin. We know that the vast majority of viruses that can kill millions of people start by residing in animals from farms or temperate forests.

Just as the Silk Road created the medieval plague, the human ecological footprint of this 21st century, less and less respectful of contact with animals, can lead to the next catastrophe. Deforestation, intensive uncontrolled farming techniques, the loss of wild areas of intersection between humans and wild animals, the global food trade … are the ideal breeding ground for the virus of the 21st century. By intervening in these processes we will be closer to taking the lead. A new era, with new threats, requires new tools.

In summer, the definitive vaccine

The problem is knowing how long it will take to have these new tools. The global response to a pandemic is spectacular. Resources are mobilized with some speed, new lines of research are opened and clinical reaction times are shortened. There are those who assure, like the Spanish virologist Luis Enjuanes, that this summer we will have a viable vaccine against the coronavirus. In times of severe crisis, the system knows how to react.

But fear tends to be forgotten soon, and the reality is that, between epidemic and epidemic, nothing is done to modify the structural conditions that will lead to the next one. We passed SARS, we passed AIDS, we passed Ebola … and we did nothing to avoid the next one. As is often said of forest fires (which must be extinguished in winter with preventive measures and not in summer with containment measures) Epidemics must be avoided before they infect us. We don’t know what the next face will be, but we know it will come.

Some experts believe that it is therefore necessary to change the structures of research, diagnosis and development of drugs. Instead of investigating and acting on individual viruses, a global approach is required to the causes by which a pathogen infects us, whatever their origin. And genetics can help us do this. At the moment, the closest step seems to be the achievement of the first vaccine to cover all types of seasonal influenza that has been announced since 2017.

But much cheaper and perhaps more effective would be to increase investment in early warning in places of origin, in farms, forests and farms in tropical areas where we know that the breeding ground for the next pandemic is being produced. It is there where we will have to look for the first signs of new diseases, unknown virus reservoirs and transmissions between animals and humans that are likely to become a threat. Only in this way will we be able to anticipate the fearsome epidemic X.

At the end of 2019, the World Health Organization produced its report on the great health threats expected in 2020. Coronavirus was obviously not among them. These are the main health concerns before the arrival of Covid-19

* Environmental pollution. It can kill 7 million people prematurely every year.

* Non-communicable diseases. Diabetes, cancer, heart disease. They account for 70 percent of global deaths.

* Global flu epidemic. The WHO alerted in 2019 of the arrival of a common flu pandemic. But it did not warn when it would occur, nor did it predict the Covid-19 pandemic.

* Poverty. 1.6 billion people live in places where environmental and health conditions lead to certain premature death.

* Antibiotic resistance. Every year 1.5 million people die from resistant bacterial infections.


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