Contents
What is needed to develop a vaccine, how they searched for patient zero with HIV, and what dangers already known viruses can pose, is described in the book “The Sworn Enemy. Our fight against deadly infections
Ebola, malaria, the Zika virus – we hear about outbreaks of these diseases in the news, but we don’t worry much as long as the outbreaks are somewhere far away – in South America or Subequatorial Africa. Due to the lack of interest in developed countries, pharmaceutical companies are not ready to invest in the costly development of vaccines against these diseases. However, viruses evolve, and over time, their infectivity may increase, and the mode of transmission may change. All this creates the conditions for a future deadly pandemic, for which the world will be completely unprepared.
American epidemiologist Michael Osterholm co-wrote this book with non-fiction writer Mark Olshaker. For many years, Osterholm has been investigating outbreaks of infections while working at the Centers for Disease Control, and since November 2021, he joined the Advisory Council on COVID-19 under the President of the United States. The authors began work on the book during the 2014-2016 Ebola pandemic in West Africa, and completed it during the Zika outbreak that spread from the Pacific Islands to North and South America.
What is this book about?
The US Centers for Disease Control is behind the discovery of diseases such as HIV infection, toxic shock syndrome in women, and a dozen lesser-known local infectious outbreaks in the US. Part of the work of specialists takes place “in the fields”, in studying the causes of diseases and possible ways of infection. The other part is the prevention and fight against the most dangerous diseases for the population. Talking about deadly infections, the authors focused on four main threats to humanity and possible ways to counter them.
Pandemic Threat
The first priority is given to counteracting infections with pandemic potential. Every few years, a new pandemic strain of influenza appears, which gradually mutates and then circulates around the world as a seasonal disease for several years. The task of specialists is to predict the strain of the next season and facilitate the release of a suitable vaccine. In addition to the flu, the coronavirus also has this potential. During the COVID-19 pandemic, decisions had to be made “from the wheels”, in practice, to evaluate the effectiveness and constantly adjust them. If in the case of influenza it was known that the closure of schools and universities reduces the rate of increase in the incidence, then with the coronavirus this measure was not so effective.
Diseases with high mortality, such as Ebola, do not have pandemic potential due to their low contagiousness. Fortunately, they are usually not transmitted by the most contagious route – airborne droplets. But the mode of infection can change: this is already happening with the Zika virus. For a long time it was believed that its only route of transmission was through the bites of infected mosquitoes, but in recent years there has been evidence that the virus has mutated and began to be transmitted sexually.
Regional and endemic diseases
Thanks to strict quarantine measures, the spread of Ebola, SARS and Middle East Respiratory Syndrome (MERS) have been contained within their regions of origin. However, the complete eradication of these diseases is still out of the question. During the last major Ebola outbreak in Guinea, Sierra Leone and Liberia, more than 28,6 thousand cases of the disease were recorded, almost 40% of them ended in death. Such bursts of morbidity cause not only direct damage. Closed borders reduce income opportunities for seasonal workers, crops are lost, and the lack of access to health care during the outbreak leads to increased deaths from HIV, tuberculosis and malaria.
Some regional infections – malaria, dengue fever, West Nile fever – are carried by mosquitoes. There are a number of measures to control these vector-borne diseases, such as chemical spraying of areas where mosquitoes breed, or the introduction of genetically modified or sterilized individuals into the population. So far, none of these measures has met with resounding success. Meanwhile, mosquitoes of the genus Aedes, vectors of many vector-borne diseases, in particular yellow fever, returned to the Western Hemisphere, from where they were expelled with great triumph by the 1970s with the help of large-scale dusting. If, after another outbreak of yellow fever in Angola or the Congo, an infected person flies to Central or South America, this is fraught with a new epidemic, for which no health system in the region is ready.
Bioterrorism and virus leaks
The leak of a virus from the laboratory is not the plot of a popular science film, but a very real situation. So, 50 years ago, only one strain of influenza circulated in the world at a time. However, in 1977, Soviet scientists, experimenting with vaccines against one of the weakened versions of the “Spanish flu”, leaked among laboratory employees. The strain instantly spread throughout Siberia and the Far East, and then throughout the world.
With the development of genetic engineering, it becomes possible to recreate the virus in the laboratories of intruders and terrorists. The infamous 2001 anthrax attack against US media companies and government agencies infected 22 people, killing five. The culprit turned out to be a biosecurity researcher with a mental disorder.
Lack of medicine
The authors are most concerned about the development of microbial resistance. Every year the number of strains of infections that are not treatable with available drugs is increasing. In the United States, according to the CDC, every year about 2 million people become infected with antibiotic-resistant bacteria, of which 23 die. In some states, up to 40% of streptococcus strains that cause pneumonia are not treated with penicillin.
According to experts, in the next 35 years, antimicrobial resistance could lead to the death of 300 million people worldwide. There are many reasons for the development of drug resistance: from the unreasonable use of antibiotics for the treatment of viral diseases, including SARS and influenza, to the uncontrolled use of antibacterial drugs in agriculture.
The development of a new class of antibacterial drugs is an expensive and extremely time-consuming process, and for pharmaceutical companies this work is of moderate commercial interest. These medicines will be used in special cases, they will have to compete with old and very cheap generics, and in order to remain effective, their use should be limited, not encouraged. The economic interest of pharmaceutical companies in the development of new vaccines is also low. For example, the world’s top five drugs – for the treatment of autoimmune diseases, hepatitis C and diabetes – bring in $49 billion. For comparison: the total sales of the world’s five largest vaccine manufacturers amounted to $23,4 billion.
Quotes
“Two highly developed city-states, faced with the COVID-19 epidemic in its early stages, tried to respond to it as quickly and efficiently as possible. Hong Kong has closed schools. Singapore is not. As it turned out, there is practically no difference in the rate of infection spread.”
“If the current trend does not change, antimicrobial resistance may become the most ferocious killer, leaving cardiovascular and oncological diseases far behind. Every year more people die from MRSA (methicillin-resistant Staphylococcus aureus, which is often infected in hospitals) than from AIDS.”
Why read a book?
To expand the picture of the world and learn about the most common infectious diseases of recent years: from HIV to the Zika virus. And the chapter on microbial resistance may be most helpful. According to the authors, each of us can make a contribution to collective security. The simplest thing is to stop taking antibiotics “just in case” and reduce your stay in medical facilities if the risk of nosocomial infections outweighs the potential benefit.