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Stalking the Wild Pathogen: Viral Threats to Modern Humanity

Writers and filmmakers have long liked apocalyptic stories. But out in the real world, it might well be that the most likely cause of our specie's demise will be a microscopic bug we cannot defeat, and that we vanish, or vastly diminish, not with a bang but a whimper.
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"This is the way the world ends; Not with a bang but a whimper." -- T. S. Eliot

Writers and filmmakers have long liked apocalyptic stories. In the last century the dominant cause of the end of humanity became a nuclear Holocaust, but a giant asteroid hitting Earth has also been popular. And then there are those pesky zombies. That's science fiction -- so far. But out in the real world, it might well be that the most likely cause of our specie's demise will be a microscopic bug we cannot defeat, and that we vanish, or vastly diminish, not with a bang but a whimper.

In our ever-ongoing battle to stay at least one step ahead of the many infective pathogens bedeviling humankind, our species has benefited much from "dumb luck," says Nathan Wolfe, author of the recent book The Viral Storm: The Dawn of a New Pandemic Age -- which the Boston Globe calls "quietly terrifying." Therein, he warns that "microbial threats will grow in coming years in their ability to plague us, kill people, destroy regional economies, and threaten humanity in ways more severe than the worst imaginable volcanoes, hurricanes, or earthquakes."

This is no mere speculation -- note that, as the New York Times just observed in an article about a new influenza strain spreading from birds to seals, "Four times in the past century, a new strain of flu has emerged that can spread quickly in humans. One of those strains, which emerged in 1918, killed an estimated 50 million people." In the past few weeks, there has been an outbreak of ebola virus in central Africa, a cluster of a new flu infections linked to contact with pigs in some American states -- and then there's drug-resistant staph and gonorrhea, malaria, H1N1, SARS, HIV, BSE, anthrax -- and uncountable others, for as Wolfe also admits, "We know very little about what's out there."

Wolfe is a Stanford human biology professor whose academic and professional pedigree includes Harvard, Oxford, Johns Hopkins, the CDC, field research around the globe, a Fulbright, Science, Nature, Scientific American, The Economist, and much more. He is founding CEO of Global Viral Forecasting, a company in San Francisco aimed at early tracking and control of epidemics. This recent interview is from a new edition of the San Francisco Medical Society's journal, San Francisco Medicine, with an "infectious diseases" theme, and much more about AIDS, vaccine controversies, drug resistance, hepatitis, pertussis, and more.

As you can read here, Wolfe is not full of doom, but wary of the future, if we confront -- and fund -- the threats faced. Otherwise, the bugs may yet prove they are the truly dominant form of life on this planet.

Your book is both scary and optimistic. To start, please distill your message about the current risk for serious pandemics.

We live in this moment in history where the level of interconnectivity between human and animal populations is certainly higher than it's ever been, and where we can move from one country to another in the course of hours, with high population density of both humans and animals in many areas. So we've created an environment that can be thought of us a viral mixing vessel worldwide, and any agent that is in animals has the potential to enter humans and go global. And the vast majority of important pandemics of the past emerged from animal populations. So today something that emerges anywhere in the world has the potential to quickly impact us anywhere else.

As we speak, the international HIV conference is occurring in Washington -- what primary lessons has that pandemic taught us about emerging pathogens?

HIV is a good model in the sense that it is [thought to be] a chimpanzee [virus] that crossed to humans in Central Africa and then spread around the world in a dramatic way, so that even though it existed for many decades in Africa the first place we detected it was in places like Los Angeles and New York. It demonstrated how a spillover of a single agent into humans and can be launched globally. And although it continues to be devastating, it could have been much worse, in the sense that HIV transmission rates, compared to say HPV, that has a much higher capacity for transmission and infects on average 25-35 percent of sexually active adults. So had HIV been a little bit more transmissible, we could have hundreds of millions of infected individuals instead of tens of millions.

You write of the kinds of "threats that keep you awake at night." What might those be?

Yes, there are a couple of categories, such as a virus with a long latency between transmission and the appearance of symptoms, again such as HIV, but with higher transmission, such as via air. The other might be viruses [that] are distinct from what we've seen in the past so that all of our techniques don't identify them. And although we have a general sense that we now really know most of what forms of life exist on our planet, that is definitely not the case with respect to viruses or microorganisms in general, where most of such life remains relatively unknown.

Do you feel that climate change will add to the risks you work with?

Yes. It's not what I work on, but we have colleagues who really worry and work on this.

In terms of doing something about these risks, you refer to the "Holy Grail of Public Health" being some new prevention measures.

If we again think of this moment in history with respect to how we interact with animals and how we transport both animals and humans posing unprecedented risk, it also presents some interventions. We now have new techniques for surveillance and communications -- cell phones, novel sequencing technologies that allow us to identify unknown agens without having to culture them, and so forth. I should say that I lead two organizations in this respect -- Metabiota, a for-profit group devoted to creating new surveillance systems for governments around the world, and Global Viral, a nonprofit [that] develops leaders and exploration of the microbial world -- both are devoted to exploring risks and opportunities with respect to microbial threats and working with universities, governments, and businesses to improve that.

How would "crowd-sourcing" using cell phones and digital surveillance work?

There is some fascinating work done in this area, such as a demonstration project conducted by folks at Google called "flutrends" -- the hypothesis being that when people feel ill, they often search their symptoms online. Flutrends aggregated a massive amount of search data and showed they could monitor influenza via search patterns in a way that was as accurate and faster than the CDC's reported measurements. The question for groups like ours is how many new such approaches there will be -- new inexpensive diagnostics at point-of-care, and so on.

Those are the things that lead to your more optimistic notes.

Yes. Certainly there will be major epidemics that harm the human population. But I also think that if we continue to invest in the next generation of surveillance tactics, we have the potential to get ahead of some of the pandemics that would have been totally missed or not identified until much later.

Beyond that technological optimism, do you think leaders and political and financial constraints will continue to hinder such progress? Public health programs are being cut around the world, and some politicians want to cut things even more drastically.

There definitely are challenges. NIH, for example, has had budgets cut, but on the other hand some newer organizations have emerged. There are wonderful foundations like Skoll and others who support this kind of work, and a growing recognition in both public and private sectors about emerging infectious diseases. There are a huge number of scientists, including young ones, involved in this. That said, yes, it would be terrible thing to cut basic safety mechanisms even though times are tough -- there are things we need to stay on top of no matter what, as the risk are just going to get more intense, not less.

Prevention has long been short-changed.

Right, but if you look back a few decades at things like cancer or heart disease, there [are] much more robust communities of scientists and organizations focusing on prevention then before. The real challenge is to move that forward on the population level for pandemic prediction and prevention -- the techniques are coming online, and what we really do need now is a sort of "global immune system" in this dramatically more linked-in world.

In your book you envision a sort of idealized "global control room" monitoring the planet for threats with what you call "digital epidemiology" -- is that a real possibility?

This is the exciting part where we see everything we know and can do being linked in to monitor and respond with tracking, diagnostics, and treatment interventions, all much faster than now. This might be run by governments, independent organizations, or a combination, and be decentralized or not -- but we have a sense there will be an inevitable change and improvement in how we respond and prevent the threats.

2012-09-28-wolfe.jpgWhat did you think of the big epidemiological Hollywood film of last year, Contagion?

It was done by an incredibly smart group, who pulled in a large group of experts to make sure it was accurate scientifically -- I played a small role. And they reached many, many people. I think it helped to remind people that where you have a risk of contagious diseases that has not disappeared at all, in a way that would be entertaining. It's an example of how to deal in [a] contemporary way with difficult, complex problems, not necessarily through old-fashioned academic or government efforts -- and perhaps to help ensure that systems are in place to protect us from such disasters.

You seem to be always on the go around the globe -- Do you still enjoy the fieldwork and hassles of travel?

Yes, very much. It's about the people -- being able to interact with people around the world who are trying to get together to do something useful and important. That makes it all worthwhile.

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