lørdag den 26. januar 2013

Who emerged first: humans or viruses?

Should we understand emerging viruses before we bring them to Europe?

In November 2012  the French Institut Pasteur inaugurated a new center:Francois Jacob research center for the study of emerging diseases. The center is named after the Institut Pasteur scientist and 1965 Nobel medicine laureate. The background of the center, it says in the press release is: “In recent decades, we have witnessed growing concern in the scientific community about the emergence of new viruses and bacteria that can lead to widespread epidemics in record time. The Institut Pasteur has decided to step up its capabilities to deal with this new threat by building one of Europe’s largest research centers on its historical site in Paris”.
The cost of the building is 61 million EUROS and as it says in the press material, the François Jacob Center “is fitted with a wide array of state-of-the-art technological equipment and was designed to encourage open, collaborative research. It will eventually house more than 400 leading scientists who will work together in multidisciplinary teams, exploring new approaches to help combat and contain emerging and re-emerging diseases”.

The Pasteur Institute argues that new epidemics cause by viruses like SARS, Chikungunya, H1N1 influenza and dengue emerge every year and very 5 years a new virus threatens to disrupt economy, travel and global health and that some of the viruses have demonstrated an ability to spread faster than news.
While there is no doubt about the severity of these viruses and that they have been a wake-up call to broaden our concept of health there is something wrong with the basic rationale and arguments behind building a 61 million EURO laboratory in a part of the world where the risk of actual human exposure to these potentially dangerous zoonotic viruses is nil. And the consequences that the Institut Pasteur draws based on their perception of a world threatened by emerging viruses is even more of a wild shot. Starting with a lab in Europe to fight a transmission of wildlife/animal viruses to humans occurring in and near rain forests on the other side of the globe is bound to fail. This is the way we have tried for centuries to deal with global health threats since the earliest colonial days and we have never succeeded this way. We have succeded when we applied a broader perspective on health matters in both understanding and intervening against disease and mortality.
As Nathan Wolfe  has demonstrated we need to set up surveillance laboratories, not in Paris, London or Copenhagen, but in the countries where transmission occurs because only then can we identify emerging or re-emerging infections and only then can we intervene timely in the sociological and geographical environment where the transmission threatens to become human and serious (see Origins of major human infectious diseases and Bushmeat Hunting, Deforestation, and Prediction of Zoonotic Disease Emergence).
What Institut Pasteur, and other international research and funding agencies, like to sell is that what we are facing is viruses that emerge are “new” viruses and that they can be detected and controlled by flying blood samples to Paris and possibly controlled later by a vaccine. The fact is that none of these viruses are new or emerging. The only look that way because it is a convenient way for tropical researchers and global health bodies to justify their research and funding. The viruses, parasites and bacteria were here long before we were. We, humans, are the ones to have emerged and we have disrupted a biological environment in certain parts of the world by using former rain forest areas for farming, thereby increasing wild life density and increasing human exposure to wild life viruses that are new to us as humans but not to the globe as such.
We have emerged and created a new equilibrium and new transmission ways for viruses and parasites and to monitor, determine and control this we need to start setting up laboratories in (very-) low income countries as well as in some emerging (!) economies where the majority of human-zoonotic exposure and transmission occurs (see Global trends in emerging infectious diseases).
Virus do not follow the money hence viruses do not live and thrive in Paris where the funding is and the low income countries will never be able to raise funding for the types and quality of the laboratories that are necessary to identify and monitor potential human threats.The priorities of low income countries lie very far from helping high income countries protect themselves against theoretical threats from relatively rare viruses they have never heard of, when they themselves are facing children still dying of pneumonia or measles because of lack of penicillin and vaccines.
So maybe the 61 million EUROS would have been wiser and better spent in Brazil, Burma or Congo so that we could monitor not only virus DNA in blood samples from wild life hunters but also human interaction with wildlife and the socio-economic circumstances that lead to this changing interaction. Something is emerging in the borderland between forest and agricultural land and in the constantly changing borderland of mega cities in tropical and subtropical areas but it is human beings that emerge and not viruses or parasites. If we continue to solve global health problems in laboratories far away from reality, viruses, bacteria and parasites will very soon regain their global position and reestablish the ecology they enjoyed before humans interrupted them for a brief period of time. Global health is about investing where the problems live are not where funding and researchers like to live.
Morten Sodemann

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