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What we need to do now about the threat of infectious diseases: a Q&A with Michael Osterholm

This article is Part 2 of an interview with Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota and co-author of “Deadliest Enemy: Our War Against Killer Germs,” recently published by Little, Brown and Company. You can read Part 1 of the interview here. It focused on the growing global threat of emerging infectious diseases. In Part 2 of the interview, Osterholm discusses some of the steps he says governments and institutions will need to take to prevent “the unthinkable” from becoming “the inevitable.”

MinnPost: As you make clear in the book, each of us — and each of our families — is at risk of these infectious diseases.

Michael Osterholm: I’ve had an aunt die of HIV — a Catholic nun because of a blood transfusion. And I had a son who was severely ill with La Crosse encephalitis from a mosquito bite because I was watering in the woods, not realizing I was watering a tree hole [where Aedes triseriatus, the mosquito that transmits La Crosse encephalitis likes to breed]. It’s a disease I’d worked on and studied for 20 years before this happened.

Everybody is going to begin to know someone — more often a family member — who is either severely ill or dies because of influenza or antimicrobial resistance or some another infectious disease. As I said, the [Review on Antimicrobial Resistance] report clearly lays out that by 2050 the number of deaths due to antibiotic resistant infections will exceed that of cancer and diabetes. That’s real.

MP: That’s also quite scary for most of us.

MO: I know that people call me “Bad News Mike,” but let me say two things about that.  One: Look at the things that I’ve been predicting for years. Look at how many of them have happened. Two: I’m tired of having people just talk about the problems, which is why we’ve tried to lay out answers in this book. Our key message is not to scare you out of your wits. It’s to scare you into your wits.

MP: “Anticipating climate-change effects” is one of the priorities you list in the book. You write that we should think of infectious diseases as fire and climate change as fuel. How does climate change fuel the spread of these diseases?

MO: There are any number of ways, and some that I’m sure we haven’t even yet considered or thought about. But, without a doubt, [the effects of climate change on] vector-borne disease issues are huge, particularly mosquitos. For example, [as the result of] intuitive decisions made centuries ago, a number of the world’s cities were located [where] people didn’t experience yellow fever or malaria. Why? Because the elevations were too high for mosquito populations to grow, based on temperature. Today, we’re seeing mosquito populations move not just north and south, but also [to higher] elevations, and some of these cities, like Mexico City, are now reporting Aedes aegypti populations [carriers of Zika, yellow fever, dengue and chikungunya], when they had been basically free of these vector-borne diseases until now.

MP: New vector-borne diseases are now in Minnesota, too.

MO: Yes, but now we’re talking about a longitude/latitude kind of issue. There’s also a thing called diapause, and Minnesota is a good example of that. Mosquitos stop feeding often very early in the fall — in September — and don’t start feeding again until late March or April. We’re now seeing some evidence in Alaska that [the mosquito] diapause is shortening, meaning that the mosquitos are now surviving much later into the fall. Why is that important? Because many of the mosquito-borne diseases are what we call cycle-enhancing diseases, where the mosquito transmits to a few birds, the birds then get infected and transmit to more mosquitos. And if you get additional cycles at the end of the season, those can be by far the most dynamic transmission cycles for humans for disease.

MP: We now have an administration in the White House and a majority party in Congress that seem bent on denying the existence of climate change. What is that going to mean for our efforts to control these infectious diseases?

Michael Osterholm
Michael Osterholm

MO: At this point, my hope is that, in spite of what the U.S. government does, the private sector and other countries in the world will see that cleaner energy and the impact of climate change go hand in hand, and they’ll continue to move forward. I just saw an interview with the CEO of General Electric, [Jeff Immelt], who said that they’re going to continue to pursue clean energy issues and that they believe climate will have a major impact on their business and the world over time. 

We have to understand that, because of our lack of taking on these issues now, we’re transferring the very serious outcomes that will occur to our kids and grandkids. I think that’s the cruelest thing any generation can do. I’m less concerned about what this world is going to be like for me, but it scares the hell out of me what it’s going to be like for my kids and grandkids.

MP: And speaking about kids, the new administration has taken what seems to be a very troubling position on vaccines. President Trump, for example, has appeared to embrace the discredited anti-vaccine theories of people like Andrew Wakefield and Robert Kennedy, Jr.  One of your “crisis agenda” priorities in your book — in fact, it’s your top priority — is to “create a Manhattan project-like program to secure a game-changing influenza vaccine and vaccinate the world.” How will that happen in the current political environment?

MO: We live in a time when people discount more and more the validity of science. One of the challenges we have is that anybody can have their own opinions, but you can’t have your own set of facts. And science is all about facts.

We’re going more and more to a pre-vaccine era. People forget how many deaths in Minnesota, for example, used to occur in children from measles and rubella before we had vaccinations — or how many children died from pertussis [whooping cough] before we had a pertussis vaccine.

MP: Or how many children survived those illnesses, but had life-long injuries, such as brain damage, as a result.

MO: Exactly. We’ve also had bills submitted to most of the legislatures in the country this spring to bring back the unlimited use of raw milk. And yet we know from history that many thousands of people died each year from consuming contaminated raw milk before milk-pasteurization laws were put into place. So this anti-science kind of environment is out there, and it would be really unfortunate if we let it take over. It very well could become a real part of government decisions over the next several years. But I think [the situation] will be self-correcting. In the end — after we see potentially many hundreds of individuals being harmed or die because of it — we will, I hope, get back on course.

MP: What are key things policymakers need to do immediately to reduce the threats from infectious disease?

MO: Influenza vaccine. Influenza vaccine. Influenza vaccine. We need a game-changing influenza vaccine. In 1984, I was chastised by many of my colleagues because I was so negative about [Health and Human Services] Secretary [Margaret] Heckler’s announcement that we’d have an AIDS vaccine in three years. I said I didn’t think we’d see one in my lifetime — and for reasons that I knew. Retroviruses post such a challenge, and making a vaccine for them is akin to a beam-me-up-Scotty machine. So I expressed that pessimism then. Today, all these years later, my prediction has hung right in there. Having said that, I am absolutely optimistic we can have a game-changing flu vaccine where [people receive] one shot every so many years. It could protect very well against the H1, H2, H3, H5, H7 and H9 viruses, which are the key ones we worry about for a new pandemic. Imagine if we could vaccinate most of the world with a vaccine like that. We could take influenza pandemics off the table, which is every bit  — if not much more — of a global public health victory than even the eradication of smallpox.

MP: What else needs to be done right away?

MO: We have got to get serious about antimicrobial resistance. And that means limiting the use of antibiotics globally and finding new antibiotics. Today, that’s a real challenge because of the fact that you’re talking about potentially a billion dollars to bring a product to market. And even the recent announcements about these $25 million efforts  — that’s not even going to get you close to a new antibiotic. And why would a company want to invest a lot [in antibiotic research] today? Imagine this: You tell a company, “Make us a new product. Invest all this money, but then, once you have it, don’t sell it unless you absolutely have to. And then we’ll make sure you get the least amount that you can for it.” Who’s going to do that?

MP: That’s why we need government involvement.

MO: You need government to be in there. This is as strategic as any missile or tank could ever be. This is why this is national security.

We also need to actually enhance the vaccine world. There are many of these infections today — Clostridium difficile is a good example — where we can actually develop types of vaccines that could prevent us from ever getting infected, so we don’t have to treat it, whether it’s resistant or not. I think one of the most highly successful organizational operations in the world today is IPCC, the Intergovernmental Panel on Climate Change. We need an IPCC for antibiotic resistance as much as we need one for greenhouse gases.

MP: Can you explain the “One Health” approach and why that’s important?

MO: Virtually every major infectious disease challenge has, in one way or another, a link between humans and animals. To have the world of veterinary medicine separate from human medicine [demonstrates a failure] to understand how critical that connection is. I’ve been in the Middle East working on MERS [Middle East respiratory syndrome] in camels. If we had an effective vaccine in camels today, we could take that whole risk off the table for humans. Look also at the issues around Ebola. Where does Ebola come from? It comes from the animal population. One of the things I’m working on right now as part of a group is how we’re going to vaccinate the great apes of the world to save them from dying. They’re dying of Ebola. At the same time, animals are the source of Ebola to humans. So one of the things we have to understand is that connection, and we really need to have almost one seamless type of medicine today, not just veterinary medicine and human medicine, but a one-health approach. Look at Lyme disease. Look at every disease we deal with. Animals are playing a huge role.

MP: What can individuals do about this issue, other than vote for elected officials that support the kinds of efforts you’re talking about?

MO: This is where I have to be somewhat careful because it surely could come off as self-promotion, and it’s not. But, first, I hope people read my book. People have to understand what the real threats are, and I think our book comes as close as anybody has to laying those out. Second, they have to understand that they can’t do much about making vaccines, or they can’t do much about making public policies that end up having an impact on how antimicrobial agents are used. But they can petition their government to do that. Science not translated into policy is a bunch of scientists sitting around a table talking about their published papers. Policy without science is often decisions that are wrong-headed and dangerous. What we need to do is merge those two. So, I think keeping current [on the topic] and petitioning your government — that’s what individuals can do.

***

FMI: You can follow the latest information on infectious diseases at the CIDRAP website. Osterholm is also moderating a discussion about new and re-emerging infectious diseases on Thursday, April 13, 11:30 a.m. to 1:00 p.m., at the University of Minnesota’s Coffman Union. The discussion will be with Dr. Julie Gerberding, an executive vice president at Merck and a former director of the Centers for Disease Control and Prevention (2002-2009), and Amy Kirchner, director of the Food Protection and Defense Institute at the U’s College of Veterinary Medicine. The event is free and open to the public; it can also be viewed live via a webcast.

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