Managing Infection in a Connected World

“The enemy can be a very good teacher.” If the Dalai Lama’s famous aphorism is true, then 2018 has been a master class in outbreak preparedness. The enemy is epidemics, and we still have lessons to learn.

In the Democratic Republic of Congo, Ebola reminded us of the value of coordinated responses. Rapid deployment of both information and resources has, so far, kept this outbreak from reaching the deadly proportions of prior epidemics.

In the state of Kerala on India’s Malabar Coast, the Nipah virus reinforced the risks that arise as expanding human populations disturb the fragile synergy of environmental, animal, and human health. The virus, which originates in fruit bats, is transmitted to humans through shared drinking water.

And in Pakistan, XDR Typhoid has shown us that this enemy quickly adapts to our efforts to thwart it. Spreading fastest in population-dense areas where sewage contaminates water sources, this strain of the bacteria has developed resistance to nearly every treatment we have for it.

These are costly lessons, and the dire price is paid by communities, families, and individuals. They have taught us that the best defense comprises a global response to contain the outbreaks by identifying vectors and risks of exposure; developing and deploying treatments to people in need; and sharing information and technology across cultural and geographic barriers.

Even in our connected world, geographic and geopolitical barriers can be the hardest for us to cross. But we must remember that the outbreaks themselves are not limited by those factors.

In fact, growth and mobility of the global community is increasing everyone’s exposure to outbreak. In just 100 years, the world population has grown nearly 400%. Naturally, more and more of those people are living close together, drawn to urban areas in pursuit of opportunities. By 2030, 60% of the world’s people will live in cities. Metropolitan areas are fertile ground for easy exchange of ideas and connections between cultures; they are also the ideal environment for pathogens to spread quickly and develop resistance to existing treatments. In densely populated cities, the impact of natural disasters is multiplied. During one of these emergencies and the aftermath, broken supply chains and disrupted, overwhelmed medical infrastructure make the people who survived these events even more vulnerable to infectious diseases.

That may be why outbreaks are becoming more difficult to predict – and more frequent. A new infectious disease has been identified every year for the past 30 years, and the last 10 years have seen many outbreaks of very rare or relatively unknown diseases. They don’t pause or wait their turn when a region is already in crisis.

We are learning from this terrible teacher. We have learned that being prepared for what we cannot predict is just as important as trying to predict what we can. Rather than waiting for outbreaks, regional and global organizations are in much more frequent contact and cooperation, ready for a coordinated response to an outbreak. Entities like The Bill and Melinda Gates Foundation and the Coalition for Epidemic Preparedness Innovations (CEPI) are funding prospective programs to develop the treatments that will be most critically needed in the future. My own company, PaxVax, is dedicated to developing specialty infectious disease vaccine candidates in areas of emerging or unmet need. Our team collaborates with leading stakeholders such as the CDC, the NIH, the US DOD, in order to bring forth vaccines to protect against infectious diseases where there are unmet needs.

The more quickly we can share what we learn and implement our solutions, the more effective we can be at protecting the people most vulnerable to outbreaks. When it comes to infectious disease, there is always more to know.

And the teacher is relentless.