It can be challenging to keep track of outbreaks these days. No sooner does one epidemic relinquish its place as the top news story than another has replaced it. A major MERS outbreak in South Korea made headlines where Ebola left off, only to be overshadowed by the worst avian influenza outbreak among poultry the United States has ever seen.
In December 2014, several strains of influenza that are deadly to chickens and turkeys (called highly pathogenic avian influenza (HPAI) – H5N1, H5N2 and H5N8) began to ravage the flyways of the Midwest, extending up into the Northwest and out to California. These particular strains do not affect people. They probably entered the region with migrating wild birds and then passed to commercial poultry and backyard flocks.
Although far less serious strains occur from time to time in the United States, this was the first outbreak of HPAI in 15 years. Cases appear to be abating, but only after more than 48 million birds (primarily commercial chickens, turkeys and ducks) were culled. Although most of the birds were not symptomatic, they were euthanized as part of a massive strategy to control the spread of the disease.
The good news is that the biosurveillance systems in place identified the emerging disease, with the national veterinary diagnostic laboratories at the ready to confirm the virus in samples and federal agencies poised to provide response support. The bad news is the disease has insidiously touched almost every American’s life by dramatically increasing the price of eggs and everything that we eat that contains them.
Successful components of our fragile agricultural system can be brought down by weak links, which some evidence suggests in this case may have been at the biosecurity level. The staggering loss of life is compounded by the estimated billions in economic losses. Unfortunately, the only stockpiled vaccine was designed for different influenza strains and would not have been sufficiently effective to justify its use.
Despite all the ingenuity of the 21st century, a devastating disease ravaged birds for six months with no medical countermeasures of any kind to combat it. The only option was euthanasia. This is not a successful system. It does not inspire confidence for a comparable human outbreak.
Why are these threats emerging?
A convergence of factors, including global increases in livestock farming; greater intensity and integration of that farming; and more frequent interfacing among humans, livestock and wildlife, is allowing pathogens like influenza to emerge with greater frequency and virulence. While these winds of cultural and industrial change may not be easily redirected, US policies certainly can be.
Although the United States has arguably the best avian influenza surveillance in the world, that alone is not enough. In 2013, the Government Accountability Office (GAO) reported that the changing landscape of emerging disease required a new approach to disease detection. The more traditional disease-specific approach to detecting outbreaks must make way for a more dynamic approach more likely to identify unknowns, one that will require ingenuity, resources and significant cross-agency coordination to implement.
The Department of Agriculture (USDA) has been moving in this direction. GAO recommended USDA develop a strategy that would support national homeland security efforts to enhance the detection of biological threats that cut across animal health, human health and multiple sectors of critical infrastructure. Despite advances in its surveillance approach, USDA has not yet produced its strategic vision for how its efforts are coordinated with other national efforts to defend the nation’s food systems from terrorist attacks and major disasters.
What policy shifts are needed?
To effectively prepare for emerging infectious disease and bioterror threats, we must take animal populations into more serious consideration and address the animal-human interface. This is difficult to do when funding for animal health research is an order of magnitude less than that for humans.
The National Animal Health Laboratory Network, a consortium of veterinary labs designed to look for homeland security threats at the front lines, is chronically underfunded and must appeal to Congress and the administration annually for its rather minimal annual request of $15 million. Further, the United States lacks a nationally reportable list of domestic and wild animal diseases comparable to that for humans. In 2014, USDA published a concept paper on what such a list would look like, but it has not been implemented.
Biosurveillance is one of the most important tools available for mitigating the consequences of emerging infections. The US has indeed been a leader, and has increased its surveillance of livestock and wildlife in the last decade, but most surveillance systems, including these, are focused on the known pathogens, not the unknown.Like others across the world, animal surveillance efforts in North America are less common than those for human surveillance, and only a portion of the animal data they do collect are integrated with human data analyses. We cannot expect to expeditiously detect the next outbreak of a zoonotic disease if our animal and human health communities work in silos.
On the human side, the Department of Health and Human Services is still operating off of a 10-year old pandemic influenza plan which states that a key capability needed for effective response to a human outbreak is domestic influenza vaccine manufacturing capacity sufficient to produce “pandemic vaccine for the US population within 6 months of the onset of an influenza pandemic.”
Six months?
How many people will have died during that time? The unwillingness to think outside the box and fund innovation in medical countermeasures (diagnostic tests, vaccines and therapeutics) is stifling our ability to respond. We fund safe investments, but those may not be the ones that keep people safe.
What all of this requires is centralized leadership. The laudable efforts of hard-working public servants throughout the government lack a harmonizing and forward-looking force at the White House to ensure needed activities occur and that efforts are coordinated. The White House has made impressive strides toward interagency coordination, but, in reality, a total paradigm shift that employs a much greater level of centralized prioritizing, planning and operating with respect to the crossovers of animal and human health is necessary. We will release a report this fall that addresses the elements of what this governance structure should contain.
Meanwhile, an outbreak of a much worse strain of highly pathogenic H5N1 is brewing in West Africa. It has spread across five countries in six months and has led to the destruction of 1.6 million birds. Unlike the US strains, this virus has much greater potential for human spillover. The United Nations Food and Agriculture Organization released a statement saying that without timely intervention, “further spread is inevitable.”
We are certain that influenza and other viruses will continue to emerge in birds and other animal and human populations, that they will do so increasingly, and that the locations where they emerge will even be predictable to a certain extent. We can make educated guesses about the what, where and when, but the one thing that requires no guessing is the threat from emerging infectious diseases will continue unabated. Rather than waiting until catastrophe occurs to shore up our defenses, we would much rather endorse a forward-looking approach aggressive enough to meet the threat.
Former Senator Joseph I. Lieberman and former Homeland Security Secretary Tom Ridge are chairmen of the Blue Ribbon Study Panel on Biodefense, which is recommending changes to US policy and law to strengthen national biodefense while optimizing resource investments.
