3.How Infectious Disease Outbreaks Are Shaping Our World & Vice Versa

How infectious disease outbreaks are shaping our world and vice versa?

VetPubHealth Journal ISSUE 17 IVSA Standing Committe on One Health April 2020 Philippe Weissenberg -Anaboli IVSA Munich Over the past decades, the number of outbreaks caused by infections has been on the rise, causing severe damage to countries’ communities, economy and public health security . The main protagonists that have embodied the most recent outbreaks are amongst others Vibrio Cholerae, Ebolavirus, Influenzavirus, SARS-CoV and most recently the novel coronavirus SARSCoV-2. Be it bacteria or viruses, these deadly microorganisms are constantly proving us that the smallest entities often come up as the biggest threat. But what is the extent of the damage they are causing, and Are we heading towards the right direction to master future potential outbreaks? In 2020, approximately 200,000 years after the beginning of modern humankind , the menace of a pandemic is still pervading the world despite the astonishing medicinal, scientific and socio-economic progress we have made. One might argue that the challenge lies within the vast array of currently unknown infectious agents. In reality, our efforts to prevent future outbreaks of infections are not sufficient, in spite of knowledge of possible solutions. To make matters worse, re-emerging diseases that we considered to be on the decline – such as malaria and tuberculosis – have managed to make their comeback. Today’s reality shows that infectious diseases still remain one of the leading causes of deaths on a global scale . In the first instance, it is the health concerns that prevail in such an outbreak. But what we are really looking at is just the tip of the iceberg. It is fair to say that disease outbreaks have put us through multiple tests that have enabled us an auto-evaluation of our societies’ structure. The first victims of an outbreak are the affected community of individuals, and ultimately the complete health system. As the most recent Covid-19 outbreak has demonstrated, an important outbreak can easily overwhelm the nation’s health system without any major effort . This aspect particularly raises concerns with regard to the treatment of people in need of medical care for diverse health issues, that could become fatal if not treated properly and in due time. In addition, health workers are also at risk of contracting the diseases, thus potentially reducing the labor force in this important domain. Consequently, a single epidemic may aggravate other diseases that have so far been under control, substantially multiplying their fatality rate due to the fragile health care system we are relying upon. Besides medical aspects, outbreaks disrupt our everyday lives, leading to closures of educational institutions, commercial establishments, public services, and even borders. This state of “lockdown”, with the primary goal of breaking the chain of infection through social distancing, generates considerable damage to countries’ economies. Discontinuation of trade, decline in tourism, closure of businesses; all these elements can quickly lead to an important recession, for which a country would need years to recover from. To put it into numbers, the World Bank has estimated that a pandemic causing over 28 millions of deaths (for comparison, at least 50 million deaths have been recorded amidst the 1918 Influenza Pandemic ) could result in a loss of as much as 5% of global GDP . The UN has also projected a global economic slowdown, estimating a loss of at least 1 trillion USD in 2020 alone – corresponding to a deficit of 2% of global economy – as a consequence of the recent Covid-19 outbreak . 12

VetPubHealth Journal ISSUE 17 IVSA Standing Committe on One Health April 2020 The evolution of pathogens, with antimicrobial resistance (AMR) in the front line, is also linked to our economy. In fact, AMR is responsible for higher morbidity and mortality rates in humans and livestock, therefore considerably hampering our industries’ success. Again, projections by the World Bank estimate a drop of as much as 3,8% in global GDP by 2050 due to AMR . Because of the augmented cost of newly conceived effective drugs, some developing countries are struggling to get access to these, making them vulnerable to a possible new outbreak. With increased resistance against medicines, along with constant mutations of pathogens in more deadly strains – as depicted by the Influenza virus – a more costly treatment combined with a longer treatment period are required. AMR and mutating microorganisms are therefore accountable for the health system overload, completing a vicious spiral.With nation’s economies being weakened, there is a huge political challenge lying ahead for world leaders, whose art of weathering the storm could prove decisive for their popularity. These economic blows often lead to an inevitable political crisis. In the US, the Covid-19 outbreak has even managed to redistribute the cards for the 2020 election. Almost overnight, the US’s remarkable economy has had to suffer an important financial setback, which could prove to be a blow for President Trump’s reelection. In times of distress during an outbreak, the political stakes are high, and fighting the virus becomes equally as important as maintaining a nation afloat. Today, it is obvious that the measures being taken are not adequate to prevent another outbreak from happening. Mass migration, trade and travel are effectively helping accelerate the spread of an outbreak. In fact, the phenomenon of globalization contributes substantially to the emergence of outbreaks. But globalization is generating another major issue: climate change. There is undoubtedly a correlation between global warming and the emergence of new diseases. With rising temperatures and shifting environments, we are witnessing an expansion of disease-carrying vector’s habitats, leading to an increased risk of contamination. The Aedes aegypti mosquito, responsible for spreading diseases such as Dengue, Zika and yellow fever, is a perfect example to illustrate this. Moreover, increased rainfall also contributes in augmenting the mosquitoes’ breeding rate. Rising temperatures are likewise proving to be of importance. Studies have suggested that a slight incrementation of 2-3°C would lead to an additional 3 to 5% of the world population being potentially exposed malaria , corresponding to about 300 million people that are exposed to the infectious agent. It is safe to say that diseases considered specific to some areas are on the verge of spreading to other parts of the world. In terms of demographics, the important rise in population numbers – mainly in developing countries – is also playing its part. Because of the rapid population growth in countries at risk of infectious diseases possessing fragile healthcare systems, the inability to cope in time with an emerging outbreak is enhanced. With the majority of the world population now based in an urban environment , urbanization is another element to consider. Higher population density allows for an easier spread of diseases and often increased contact with wild animals, thus giving zoonoses a bigger opportunity to arise. The Lassa fever is a perfect example of urbanization’s detrimental consequences. In fact, as soon as urbanization was on the rise in West Africa, contact with the infectious agent’s host – a particular endemic rodent – was becoming more common, giving this particular disease a chance to emerge. But the demographics’ influence doesn’t end here. Due to increased life expectancy, senior communities are not considered an exception anymore, hence opening up more doors for pathogens’ introduction in a population as a result of the elderly’s biologically weaker immune system. With regard to research, arguments such as laboratory-made catastrophes that could possibly occur – sometimes deliberately – while carrying out research about a deadly pathogen are being raised. This reluctance to move forward is substantially impeding 13

VetPubHealth Journal ISSUE 17 IVSA Standing Committe on One Health April 2020 the fight against preventing diseases from emerging. Before conducting any research, it first needs to be labelled as economically profitable in order gain financial support from the pharmaceutical industries. In fact, while vaccines are often placed on top of the problem-solving list, they are barely profitable to the big manufacturing companies in comparison to standard drugs .Moreover, as the recently reported feud between German pharmaceutical giants CureVac and President Trump has demonstrated , it appears as if countries are more focused on selfishly winning the “race” by getting their hands first on the valuable remedy to the disease, rather than trying to cross the finish line together in order to find a more rapid, global solution that would come out as a success story resulting from international cooperation of powerful nations. There is no doubt that outbreaks will continue to emerge in the future, causing a lot of uncertainty and damage to our health, communities and economies. Still today, there is too much incoordination, lack of action and financing in order to prepare for our next pandemic. To quote the philanthropist Bill Gates in one of his speeches back in 2015: “if anything kills over 10 million people in the next few decades, it’s most likely to be a highly infectious virus rather than a war.” . His vision and warning couldn’t have been more accurate, as we are desperately waiting today for a solution to help us combat this novel coronavirus pandemic. Additional investment in research, greater global cooperation, more thorough food safety controls… These are just few of the lacking measures that would contribute in preventing a new sanitary crisis. A more conscious approach to the problem, combined with a greater implication of the political, pharmaceutical and medical bodies would be an important step forward. Past outbreaks have unsuccessfully tried to remind us of how vulnerable we are, but that apparently wasn’t enough in order for us to take adequate measures. Now it is up to the young generations to point us in the right direction. KF Smith (2014). Global rise in human infectious disease outbreaks. https://www.ncbi.nlm.nih.gov/pubmed/25401184 J. Galway-Witham & Chris Stinger. (2018). How did Homo Sapiens evolve?. ScienceMag. https://science.sciencemag.org/content/360/6395/1296 World Health Organization (2018). The Top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/thetop-10-causes-of-death Denise Chow & Emanuelle Saliba (2020). Italy has a worldclass health system. The coronavirus has pushed it to the breaking point. NBC News. https://www.nbcnews.com/health/ health-news/italy-has-world-class-health-system-coronavirushas-pushed-it-n1162786 Center for Disease Control and Prevention. (2018). Influenza (Flu). https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htm The World Bank. (2018). World Development Indicators United nations. (2020). This is how much the coronavirus will cost the world’s economy. World economic Forum, https://www. weforum.org/agenda/2020/03/coronavirus-covid-19-cost-economy-2020-un-trade-economics-pandemic Adeyi O.O. et al. (2017). Drug-Resistant Infections : A Threat to our Economic Future, Vol. 2 : Final Report. The World Bank. http://documents.worldbank.org/curated/ en/455311493396671601/pdf/executive-summary.pdf W. Shao, X. Li, M.-U. Goraya, S. Wang, J.-L. Chen. (2017). Evolution of Influenza A Virus by mutation and re-assortment. International Journal of Molecular Sciences. J.A. Patz et al. (2003). Chapter 6-Climate change and infectious diseases. Climate change and human health-risks and responses. World Health Organization. https://www.who.int/globalchange/ climate/en/chapter6.pdf United Nations. (2017). World Population Prospects: The 2017 Revision. United Nations. (2018). World Urbanization Prospects: The 2018 Revision J Kay Richmond. (2003). Lassa fever: epidemiology, clinical features, and social consequences. The BMJ. https://www.ncbi.nlm. nih.gov/pmc/articles/PMC286250/ Ronald M. Atlas. (1999). Combating the threat of Biowarfare and Bioterrorism: Defending against biological weapons is critical to global security. Bioscience. https://academic.oup.com/bioscience/article/49/6/465/229529 M. Kremer & Christopher M. Snyder. (2003). Why are drugs more profitable than vaccines. Cambridge Massachusetts: National Bureau of Economic Research. https://www.nber.org/papers/w9833.pdf David E. Sanger et al. (2020). Search for Coronavirus vaccine becomes a global competition. The New York Times. https:// www.nytimes.com/2020/03/19/us/politics/coronavirus-vaccine-competition.html Bill Gates. (2015). Lessons from Ebola-We’re not ready for the next pandemic. GatesNotes. https://www.gatesnotes.com/Health/ We-Are-Not-Ready-for-the-Next-Epidemic References: 14