HIGH FLYERS THINK TANK

Emerging diseases – Ready and waiting?

The Shine Dome, Canberra, 19 October 2004

Emerging diseases: The animal health perspective

Dr Martyn Jeggo
Director, CSIRO Australian Animal Health Laboratory, Geelong, Victoria

In giving this short presentation, can I first thank the Australian Academy of Science for inviting me to give it. Secondly, I was asked to talk very briefly about my own institute, so I hope you will bear with me for a moment while I just mention the institute that I now direct. I think actually it does bear significantly on some of the thoughts that we may have over today's proceedings.

Australian Animal Health Laboratory
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I assume many of you will know that the Australian Animal Health Laboratory (AAHL) is in some ways a national icon. It is certainly a global institute. It is one that is unlikely to be ever reproduced again around the world. I put an estimated cost [on Slide 1] of rebuilding it of about US$500 million, but it is probably considerably more. But probably crucial to AAHL is the fact that not only did the Australian people decide to build it but they have managed to provide the resources to maintain it in perfect condition during the last 18 years.

As we now look at other countries facing the issues of new and emerging diseases, and we see a number of institutes similar to AAHL being built around the world, I have serious concerns that, firstly, they will not allocate sufficient resources to build them in the first place, and, secondly, they certainly will not provide adequate resources to maintain them in the conditions that they should be in if effective bio-containment is to take place.

I mention there (Slide 1) that we have got facilities to work at bio-containment levels 1 to 4. We have got substantial accommodation for a whole range of animals, from primates down to mice, and in some ways I am claiming it is the most advanced institute of its type in the world – which I do not think is a claim likely to be challenged.

The final comment I have made (Slide 1) is that it is we are now the collaborating centre with OIE [Office International des Epizooties] – the World Animal Health Organisation – for new emerging diseases, and therefore we have a clear global role in this area in which we are talking today.

Some examples
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We have already heard some of the diseases from that threaten us Aileen [Plant] and from the previous speaker. We mentioned SARS and Nipah virus and there is a range of them. I have just put up a few there (Slide 2), but a couple of important points emerge pretty quickly from those diseases.

Apart from one, they are diseases that affect animals and humans. I think that is something we need to bear in thought today, that it does appear that these new and emerging diseases are increasingly those that cross the host barrier. They are not specific to animals alone.

Secondly, there are some old favourites there. There is foot and mouth disease, and I will get back to that in a moment. When we think about new and emerging diseases there are some favourites that aren't going away. Somebody mentioned tuberculosis, but if you look at what is happening in the UK with the control of tuberculosis at the moment, you can see that it has certainly gone backwards as an animal disease and we have severe problems with it. And there are others like that, so we must be careful not to just think of the new but to think of those diseases that have been around for some time that we still haven't got to grips with.

But let's talk about a success story. It is extremely pleasing to see Frank Fenner in the audience today, because he was one of the guiding lights in the global eradication of smallpox, and the animal profession has been struggling for a number of years now to achieve the same with an animal disease and we are almost there: rinderpest, or cattle plague.

Rinderpest or cattle plague
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I worked with this for many, many years, some 15 years, with the UN, globally eradicating that disease. It now remains only in the ecosystem along the Kenya and Somalia border, and I reckon within the next two to three years we will have eradicated one more disease from the globe. So we have an animal disease matching that [eradication] of smallpox. And that is no small achievement.

It may be worthwhile today, if you wish, to talk a little bit about why that was achieved, because in some ways it wasn't about great government, it wasn't about great infrastructure, it wasn't about great leadership. It actually was a technical success, because there was a vaccine, one shot of which gave lifelong immunity and protected against all strains that caused the disease. And I would argue with you that we need that technology, we need that type of instrument, to succeed.

This is a disease that loved wars. This is a disease that was in the Kurdish triangle, one of the most unsettled areas of the globe in the 1980s and 1990s, and yet from there it was got rid of – because of that vaccine. I think we need to bear that in mind when we talk about managing the risks from new and emerging diseases and also our conventional diseases. Good vaccines are still extremely important.

If I had been talking to you, I suggest, 15 years ago, I would not be here. Fifteen years ago, in Australia and indeed the world it was pretty certain that we had controlled animal disease. It wasn't such a big issue, most of them had gone away. Foot and mouth disease was out of Europe; it was being removed from South America quite successfully: it wasn't in the Southern Cone any longer, Brazil was getting rid of it, Argentina had pretty much got rid of it, certainly Uruguay had got rid of it, Chile was okay. Things were looking pretty good.

We didn't have SARS, we didn't have BSE, that was all looking very well. We were closing lots of veterinary institutes, a lot of vets were thinking, ‘Where am I going to go with my future?' and the world was moving away from animal disease.

And then, fortunately or unfortunately, depending where you are coming from, a whole load of things changed. We got BSE. We got SARS. We got avian influenza. And we also had, most importantly perhaps, in terms of financial implications of animal disease, foot and mouth disease.

Recent Movement of South Asian topotype O India-90 lineage
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Not only did we get it in Europe, but people should be aware that it also, at that time, devastated South America, breaking out of Brazil and Argentina and destroying those programs that were in operation there.

Most of you are well aware of the outbreak in the UK and of the various figures that are quoted. We talk up to something like US$30 billion in lost resources, and, if it were to occur in Australia, although various estimates have been made we are talking approximately A$16 billion lost to the economy if we had a major outbreak of foot and mouth disease. Foot and mouth disease is an emerging disease. You have just watched that slide show. You saw what happened in the last seven years. And that's an old favourite. That has been around for a long, long time, ladies and gentlemen, so we do have to think carefully when we talk new and emerging diseases.

And I like our control of foot and mouth disease. Certainly until the last year or so, our control was something that we had been using for the last hundred years: we go in and we kill. We destroy a large number of animals in the hope that that will stop the outbreak.

Now, we need to move beyond that. That is no longer acceptable to the public, to the scientists and to the animal welfare and others who are concerned with animals. It cannot go on. So we have to find new solutions. And again I challenge you: those solutions will be technical. We need to talk a little bit about that and what sorts of technologies need to be employed to solve the problem of managing an outbreak of foot and mouth disease.

The other big lesson we learnt from foot and mouth disease – which I don't think was entirely obvious at the time – was the knock-on effect. While there was an economic effect of the disease on the livestock industry, it was the other industries in the UK that really took the brunt of the costs. In fact, half of the losses were associated with losses in tourism and the rural economies, with people not allowed to go into those rural areas which they were used to using at the weekend and so on.

So now, I think, from the foot and mouth disease outbreak we have a new perspective of how disease impinges on our society, and it is not just the effect on those that have animals but the whole of society. I think that is something we also have to bear in mind.

Beyond the borders
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This is a pretty obvious statement, that diseases don't respect borders. We have known it; everybody in this room knows it. But the fact remains that, when we now look at the control of the diseases, we do really have to look well beyond the national. We have to look internationally – we have to look in our region, and we have to look globally. We know the amazing spread of SARS out of China rapidly into Hong Kong and subsequently into Canada and elsewhere, and we know now that these things are global.

And there are a number of drivers for that, one of which is the global movement of people. Another one is the globalisation of the livestock trade itself, in terms of livestock diseases, but we could apply the same rules to plant and fish diseases and human diseases.

We have got vectors that are changing. Some of this is related to global warming. I can give you two clear examples. One is the movement of bluetongue up from its traditional areas in the south Mediterranean, up now into Europe, into Bulgaria – and that is all about global warming and the movement of vectors up into those areas. We saw Rift Valley fever, during the last El Niño effect, work its way down from its traditional locus in Ethiopia all the way to the south of Africa, with subsequent losses in both animals and humans. So the vectors are moving.

The word that has been coined by FAO is ‘transboundary' animal diseases, the so-called TADs. I would think that is a good way now describe these things. We need to think in terms of diseases that cross boundaries and we need to think not nationally any longer but globally. And that, I think, has a number of repercussions which we have yet to get to grips with.

Managing the risk
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Livestock diseases have a unique element which really separates them significantly from human diseases. That is the issues towards trade.

In 1924 an organisation was set up called the OIE to deal with and manage those risks of livestock diseases on trade. That is unique. There isn't really a similar organisation for plants or humans, and I think there are many lessons to learn from that.

For many, many years that organisation operated under the concept of zero risk: we would not take a risk in trading. However, we all know now that that is not the way forward, and that we have to manage the risk, we have to accept that there is some risk with animal diseases, with human diseases, and we have to learn how to manage that risk.

One of the biggest problems that we then have in doing that is to deal with the concepts of ‘perceived' versus ‘real' risk. I think we have had one or two interesting comments made already by speakers this morning in talking about SARS: what is the real risk of SARS? If we talk about BSE, what is the real risk of BSE, when 150 people have died so far? That is not really very many for a disease for which one case cost America at Christmas US$10 billion. I think we really have to get to grips with what we really mean by risk here, and I can't help referring back to the risk associated with AIDS versus the risk associated with BSE.

Can 'new research' really help?
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Can new research really help? I am obviously biased here – I work for CSIRO and obviously I believe it can. But I go back to our first speaker, who said, ‘Please produce some deliverable outcomes, some things that will really make a difference.' I think that is one of the things we have to do: make sure that our research is really delivering.

That doesn't mean to say that we are doing near-market research that has to have a product in one or two years. The basic research that is going to underpin that is critical, and I think as we look at avian influenza we need to know a lot more about the pathogenesis of this disease in hosts such as ducks before we can really get effective ways of dealing with it. But that research does have to have that as the outcome, a more effective way of dealing with the actual infections.

So I think new research can help but it has to be properly managed. And certainly the key to it, to my mind, is better understanding the disease. And, Aileen [Plant], I apologise: I can't really believe that we can really say SARS is a thing of the past when we don't even know where it came from. Without knowing where it came from, how can we possibly manage future risks from SARS? And that is the sort of research that I still think needs doing in the SARS arena.

Obviously critical is rapid diagnosis. We all know that, and I cannot but commend to you the Biosecurity CRC, which is pouring a lot of money into developing proved and rapid systems of diagnosis. And there is a great deal of interesting and fascinating technology out there which I think can pretty soon make a major difference. We need to harness that, and that CRC is focusing on doing that.

The other area that I think has great potential is concepts of remote sensing, and using geographical information systems as a decision support tool to provide overlays of information that enable you to better predict what might happen if a range of issues come together. I am certain if the UK had had these systems working they would have got foot and mouth stopped a lot earlier than the two weeks it took them, and they may well have saved themselves a few bob.

And we have got improved communication technology which links on to these technologies – how we can get that information back to central places who can sit there, analyse, predict, and then subsequently, if there is an outbreak, manage it in a more constructive and more effective way.

So we have got technology that can really make a difference. Are we really harnessing it?

One of my own particular drives in the last two years has been to put together a global consortium working on foot and mouth disease, trying to develop a new generation of vaccines and anti-virals, and we are very close to getting the required money to do that. The business plan is prepared and in the next couple of weeks we expect to get the funders back together, to get that money in place.

The key issue here is not that we are tackling foot and mouth disease so much as the fact that that is perhaps the way forward. For these problems that are global, we need global research consortiums working together, not competing. SARS was a wonderful example of how we got together. It fizzled out to some extent once the papers in Nature had been published, and there is still, I think, significant research to do. But we don't have the same energy going in, for example, to avian influenza.

When I say that, that is perhaps a little unfair. We do have a meeting this week at AAHL, with people from around the world, to look at the research issues with Avian Influenza. But my main message here is, ‘Let's work together globally. Let's work together to solve these problems, because they are threatening all countries, not just Australia. And putting that together is going to be a bit of a challenge for us.'

Some 'big gaps'
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So what are the big gaps? Obviously, effective surveillance is the key: to be able to have a timely response we have got to know what is coming at us. I still think there is much to do. I think personally that the animal world and, to some extent, the human world have done a reasonable job, but what about the plant world, what about the fish world? Are we really putting enough resources into surveillance, and what does that really mean in terms of bringing the information together – taking into account that the risks that we have got in Australia are as much outside Australia as in Australia? So it is not just looking after our home territory but looking beyond that.

What are the drivers to newly emerging diseases? What drove SARS out from wherever it lives? We really don't know that. We can speculate, I'm sure Aileen [Plant] can give us some good ideas, but we need to know more about it.

What is driving this current epidemic of Avian Influenza? What are those influences, and what are the things that might move that virus genuinely into being a pathogen for humans? That is the big risk, that is the big scare. Do we really understand all the drivers? Certainly the pig was critically important in 1918. I don't think the pig has got anything to do with it now. But we need to understand much more about that.

I have already mentioned the need for collaboration and partnership, but I also would say to you that we also need to know more about where these pathogens are. Nobody has touched on the subject of counter-terrorism yet, or agro-terrorism, but it is sitting out there and I certainly have concerns about what is being held in laboratories and the risk that that poses to us of emerging diseases. Certainly, for example, right now no laboratory in China is allowed to work with SARS virus because it has escaped from their labs. So we need to have that in mind as well. We need to know what we have got, where it is, and whether it is properly being looked after.

At the end of the day, we have got the developing countries, with all the constraints and problems that they have, and yet they pose a significant risk to us. Do we really understand that? Are we doing enough? It goes well beyond – although I will never belittle – the issue of AIDS. It goes into their effective surveillance, their ability to pick up a disease early enough to prevent it in their own country, let alone threatening the rest of us. What are we doing about that developing country situation, bearing in mind that we still have a situation where 600 or 700 million people in the world earn less than a dollar a day? That perhaps overrides all these comments.

I mention bio-terrorism and I hope I may be forgiven for that, but certainly it is a major concern at the moment, driving a lot of the agenda, for example, of work being done in the United States through the Department of Homeland Security. Certainly there are initiatives taking place in this country which I think impinge on and can help the issue of new and emerging diseases.

Finally, I would like to come back to that comment of risk. I think it is very important that we do understand what the risk is, and that we don't over-generate risk to get our favourite virus, our favourite infection worked on but that we look at it from a national and global perspective: what are the big risks out there? BSE is certainly threatening Australia at the moment, and I think it is important that we work with everybody – and I include the public – to understand those risks.

Conclusions
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There is no doubt that the risk from emerging zoonoses is increasing, and that it is not just the causative agent but all the factors that govern them that we have to deal with.

I think the threats can be managed and I think that SARS was a great example of how they could be managed, but we need to think differently and I think we need to think globally. We did in SARS. Can we with the other diseases?