What I'm going to talk about here are the
characteristics and traits of pandemic pathogens.
You just heard my colleague Crystal's talk
where she introduced the concept of GCBR.
I'm going to try and delve very deep into
that concept, to try to understand what is
it about certain pathogens that allows them
to cause a GCBR?
And I think the theme of this conference is
to be curious, and that's really what motivated
this project, was to be very curious about
what goes on there.
I have a picture of my blog there, Tracking
Zebra, if you're interested in infectious
disease, I do write a lot about that, and
that's my Twitter handle.
The aim of this project was really to develop
a whole new framework around the traits of
naturally occurring pandemic pathogens that
could constitute a GCBR in order to change
preparedness activities.
In the past, I'm going to talk about this
a little bit later, we've really focused on
list based approaches, that are largely derived
from the former Soviet Union's biological
weapons program.
There hadn't been a lot of fresh thinking.
It was very static.
I think that's what we tried to do in this
project.
So a couple of basic definitions, just because
I don't know if everybody has a biological
background.
Pandemics are infectious disease outbreaks
that occur over a wide area and affect a large
proportion of the population.
It doesn't necessarily have to be severe;
2009 H1N1 was a mild pandemic, but it was
still a pandemic.
An epidemic is an infectious disease outbreak
that occurs over a large number of individuals
within a population.
So, the SARS outbreak in 2003 would be an
epidemic.
An endemic is something that occurs regularly
within a population.
For example, the common cold is endemic in
the human population.
Those are just things to keep in mind.
What we're talking about are specific types
of pandemics that are very severe for the
GCBR, to meet GCBR criteria.
I'm not going to spend much time on this definition
because Crystal really went into some great
detail, but what I'm going to do is really
expand on what is it about those biological
agents?
What types of biological agents can cause
GCBRs?
Everybody is very focused on viruses, some
people are focused on bacteria, some people
on other things, that's what I'm trying to
understand is what traits does a biological
agent have to have in order to be able to
cause something this severe, to cause this
massive catastrophic loss of life, disruption
of society, that type of analysis.
I just want to draw a distinction, because
what I'm talking about here are pathogens
of pandemic potential, versus what's this
distinction that was made in Mike Osterholm's
recent book about pathogens of critical regional
importance.
When you have an outbreak like Middle East
Respiratory Syndrome, that doesn't mean...
just because it's not a GCBR doesn't mean
it's not important or that it's not going
to be very disruptive to people's lives and
to societies and to governments.
But what we're talking about in the GCBR is
something that's going to be global, like
the 1918 flu.
Something that's a lot different in scale
than even Middle East Respiratory Syndrome
or SARS.
Something much different.
There's lots of pathogens of critical regional
importance.
Even the Ebola outbreak in 2014 in West Africa
falls under this type of criteria, versus
this type of criteria.
The specific aim with this project was really
to, like I said, move away from this list-based
historical approach.
People had really just taken the Soviet Union
Biological Weapons program and added a couple
things here and there, but really hadn't thought
much about why were these things on there?
Challenge the assumptions that put them on
there, and really try to understand what was
it that made smallpox so scary?
What was it that makes pandemic flu so scary?
We really try to go into an inductive manner,
trying to make a whole new paradigm, looking
at the actual attributes.
We tried to do this by being totally microbignostic.
What I say microbignostic, that means we didn't
go into this project saying, "This has to
be a virus.
This has to be a bacteria".
We said it could be anything.
It could be a parasite, a protozoa, it could
be a prion.
So that was something that was totally new.
We really wanted to challenge thinking and
then take this paradigm, and hopefully use
it to move forward when we think about preparedness
and try and think of new infectious disease
outbreaks with this new paradigm in mind,
to get better at being prepared because we're
constantly surprised, which I'll get to later
in the talk.
What are the essential traits?
The next slide is a little busy.
I'm going to walk through it one by one.
Thinking about what does it have to have?
Talking to people and doing a lot of literature
review, there's a whole bunch of different
things that make up the alchemy of a pandemic
pathogen.
I'm going try and explain what this equation
means and all of this as best I can.
The first thing you need to do, is you have
to have a pathogen that can efficiently transmit
from human to human.
You can have a disease that can be really
bad like Tetanus.
That doesn't transmit between humans, so it
can't be a pandemic pathogen.
When you're talking about a pandemic pathogen,
it has to be able to get from people to people,
so that's number one.
It has to have a moderate fatality rate.
It doesn't have to be really, really horrible
like a 90% fatality rate or 100% like rabies.
It has to be something that's kind of in a
sweet spot that it allows enough death to
occur that it causes disruption in the society.
Remember that the 1918 Influenza pandemic,
which killed 50 to 100 million people, only
had a fatality rate of two percent.
But because it was so widespread, it led to
disruption.
Contagious during incubation period.
I have bolded this because in multiple modeling
studies, and in experience, and Crystal alluded
to this earlier when she talked about smallpox,
if a disease is contagious during the incubation
period, when you're not sick, it's very, very
hard to control.
That's why the H1N1 pandemic had spread everywhere
before anybody even knew about it because
people were contagious one day before symptoms.
If a disease is contagious in that period,
it becomes very, very difficult for public
health interventions to have any impact.
The same goes with mild illnesses with contagiousness.
When you have the flu or the common cold and
you're out shopping, doing your normal daily
life, you spread that to other people.
It's very hard to stop that, versus something
like Ebola, when you're sick and highly contagious
you are in bed and you can't really move,
and move about in society.
So this is another key factor.
An immunologically naïve population.
Again, reflecting back on Crystal's talk when
she showed the map of the indigenous populations
in the Americas, in the pre-Columbian area
in 1492.
That was an immunologically naïve population
to smallpox, which allowed smallpox to spread
very rapidly through that population.
That's what a pandemic pathogen would require.
No vaccine or treatment.
You don't have any way to stop this.
That's another thing that fits into this.
Correct atmospheric and environmental context.
Infectious diseases happen in a context.
Is it happening during World War I like the
pandemic flu did in 1918?
Is it happening where there's been societal
disruption?
Like, for example, Yemen right now and the
Cholera outbreaks?
All of that's going to play a major role in
how prolific an infectious disease outbreak
is.
There's a lot of biology that has to go into
this too.
Not every pathogen can infect every type of
human.
You have to have a proper receptor.
So you've got to have some receptor that lots
of humans have that this virus or this bacteria
can actually cling onto.
It's also going to explain which organs it
affects, because obviously some organs are
more important.
If it affects your brain, your kidney, your
liver, your lungs, those are what you really
see with these pandemic pathogens.
And then it has to be able to evade the host
immune response.
It has to be something that is not easy for
the immune system to mount an effective response
against.
This is a fancy equation that showed up.
The point of this equation is not to memorize
it or to think about it, it's just that you
can take all of these things and give them
values, and come up with pandemic potential
of a pathogen.
You can look and vary them.
If you look at some other things, for example,
the more host types a pathogen has, the more
chance it is to emerge.
That's another thing that comes up, that these
things can infect more than one type of species.
That's where the concept of zoonosis comes
about, where something comes from an animal
species into humans.
But the more hosts something has, the more
likely it is to be able to infect humans and
cause a problem.
Thinking deeper about this.
We have that recipe there.
When you think deeper, there's a couple of
things that come out of this.
When you look at the way these things transmit,
the most likely way to cause a pandemic is
for it to be done through the respiratory
or the airborne route.
There's much, much less you can do to stop
an airborne virus or a respiratory droplet
spread virus.
If I had measles right now, you would all
be exposed.
It's very, very hard to do that.
But if it was something that was spread through,
for example, fecal/oral, like Hepatitis A
or Cholera, you can really delimit that with
sanitation.
Remember, there was a couple of cases of Cholera
in Mexico about five years ago, and everybody
panicked.
But there was just even a modicum of sanitation
- stopped Cholera.
It did not spread in Mexico.
You can't do that with respiratory viruses
and airborne viruses.
It's much, much harder through the respiratory
or airborne bacteria.
A vector borne transmission, so that means
through mosquitoes, through ticks, that's
something that's very interesting and it is
something that I think we struggle with trying
to figure out exactly how bad a vector borne
outbreak can get.
They are, in general, limited by the vector
range.
For example, mosquitoes frolic in places that
are going to be much more conducive to their
habitat, so it's going to be very hard for
them to live in a temperate climate.
I live in Pennsylvania, we don't have mosquitoes
year round there.
But there are parts of the world that mosquitoes
thrive in all year round.
That's why I talked about specifically aedes
mosquitoes, which are the mosquito that's
responsible for spreading Dengue, Chikungunya,
Zika, Yellow Fever.
They are basically covering half the population
of the globe.
That is something that's a little bit different
with vector borne.
In general, we don't think vector borne could
do this because the host range, the range
of the vector, is kind of limited.
The other thing to think about is, talking
about global catastrophic biological risk,
we talk about deaths, but is fatality everything?
This is a question to pose to yourself.
There's two purposes for an organism.
To survive and to reproduce.
What if you had a disease like Zika?
It was much more widespread.
Or Rubella?
Pre-vaccine.
If you decrease the reproductive fitness of
a species, could that lead to a GCBR?
I think the answer is yes.
I don't think that Zika or Rubella really
make that criteria, and maybe if we were talking
about this, if Rubella occurred now, maybe
it would fit in the GCBR.
But back in the 1960s, people coped with Rubella,
but it is one way to think about a GCBR that
doesn't end up killing everybody.
The other thing is, there's another virus,
HTLV, which as been in the headlines a lot
in the last couple of weeks because of some
studies that have come out of Australia.
HTLV is the most carcinogenic virus.
It causes human t-cell leukemia.
This was the first human retrovirus that was
discovered.
What if an infectious agent causes cancer
in everybody?
Would that lead to a GCBR?
That's something just to think about, that
it's not always going to necessarily be death.
I think you have to be very broad and active
minded about this.
There's also something I wanted to talk about
called sapronotic disease.
That's a term that we found from the plant
world and the animal world, where you have
this idea that if an infectious agent is killing
everybody that it's infected, it's not very
good because it's going to run out of people
to infect.
But what if it doesn't care?
What if that's a secondary source?
What if it's an amoeba that eats things in
pond scum, but only intermittently infects
humans?
Like the brain-eating amoebas that always
grab headlines?
How does that fit into this?
If it doesn't necessarily need to be in humans
to thrive.
That it has other things.
It could eat dead bark on a tree, or it can
eat stuff on the bottom of the forest floor.
That's another way to think about a pandemic
pathogen, I think is really interesting that
came out of this talk.
The first set of conclusions we drew from
this project were, the traits that are most
likely to be possessed are going to be respiratory
droplet transmission, fecal/oral much less
likely.
The aedes vector-borne agents, those mosquitoes,
have a special status because there's widespread
mosquito prevalence and there are certain
viruses that get very high levels in your
blood that these mosquitoes can just kind
of pick off.
That's why we've seen explosive outbreaks
of Dengue, Chikungunya, Zika, why we've seen
Yellow Fever resurface.
So they are a special category.
They probably don't fall as high as respiratory/droplet,
but that's something to keep in mind, that
these could possibly do that.
So then the next thing we try to do is think
about, okay, we've said respiratory/droplet
transmission.
So we have to make a choice, we have to think:
is it gonna be virus, bacteria, fungi, parasite?
So I say there's no agnostics in a foxhole.
We had to push people that we talked to in
this thing, and push ourselves to think, what
would it really be?
So I think that viruses are very formidable
in this realm.
They mutate much, much more rapidly than bacteria.
The transmission and replication cycle in
a human is much faster than in bacteria.
And you heard this earlier today, that there's
no real broad spectrum antiviral agent.
I have a picture there, this is from Epcot
Center, for penicillin.
So when we think about bacterial infections,
we can usually, even in the face of antibiotic
resistance, craft together some regimen that
works.
And lots of them are nonspecific, they kill
wide varieties of bacteria.
They have a spectrum.
We don't have that so much with antiviral
agents.
We've got a certain drug for flu, a certain
drug for Hepatitis C, a certain drug for HIV.
We don't have broad spectrum antivirals.
And that's a major chink in the armor against
viruses.
When you think about bacteria, they really
are limited.
Because of broad spectrum antibiotics, they're
slower, they're less mutable.
There are some caveats.
We do have multi-drug resistant bacteria that
can be challenging, and antibiotic resistance
is probably one of the most pressing public
health threats that we face.
But they still don't rise to the fact of causing
a GCBR.
Because even if you think about everything
becoming resistant, we would be pulled back
to the pre-penicillin era.
But people still lived during the pre-penicillin
era, in a way that they were still flourishing,
human populations were still growing pre-penicillin.
So I think that's important to remember.
But we have seen a major outbreak.
For example, we talked about Yemen and the
cholera outbreak that's occurring with the
bombing that's going on, and the infrastructure
problems, it's been the worst cholera outbreak
in history.
And we had a bad plague outbreak just a couple
of years ago in Madagascar, with 1200 people
infected.
So in certain resource-poor areas, you can
see bacteria get very close to causing a GCBR.
But it would be hard for it to do anything.
So you think back to the Black Death back
in the 1300s and 1400s.
There were no antibiotics and I think that's
why the Black Death probably does qualify
for a GCBR at that time.
So the other thing, what about fungi?
Fungi are everywhere in the environment, there's
tons of them everywhere.
But the fact is, they're temperature restricted.
They don't like to grow at human temperatures.
And there's a lot of hypotheses about why
this is.
They think that humans actually came through
what's called a mammalian filter, that we
evolved the ability to have a 98.6 degree
Fahrenheit or a 37.5 degree Celsius temperature
as a way to avoid fungi.
And we see fungi decimating salamanders and
frogs, and all of these other types of species
that have lower body temperatures.
And it's very, very hard for fungi to infect
humans, they usually have to be immuno-compromised.
There's been a few scary things, like candida
orus, which is a multi-drug resistant fungi
that preys on hospitalized patients.
Cryptococcus gattii, which is one that kinda
is around the soil and trees.
And then there was this Exserohilum outbreak.
That was related to contaminated steroids,
which you might've heard about that getting
injected directly into people's backs.
But again, they needed something to be able
to do that.
Some of these fungi are sapronitic and they
can be very, very high mortality rate because
they don't transmit well between humans.
But the temperature restriction makes it very
hard for them to cause a pandemic.
Prions, you probably heard of mad cow disease,
it's probably the most famous prion disease.
Those don't spread very well between humans,
unless there's cannibalism.
This is a graffiti in Pittsburgh, there's
a guy who writes kuru all over the city of
Pittsburgh.
Kuru was a disease that was found in Papua
New Guinea among the indigenous tribes there,
where they were engaging in ritualistic cannibalism
of each other after someone died, and that
kuru was really decimating that population.
But unless you have people directly exposing
themselves like that, in that manner, prions
are unlikely to do that.
We've seen scrapie for example, in the sheep
species, and then chronic wasting disease
in elk.
Those things have done - because there's so
much different saliva contact between people
and the way these animals eat and interact
with each other, that don't really apply to
humans.
It's interesting, because when you think about
prions, chronic wasting disease, they actually
had to burn down a forest to stop it from
spreading, because it was so endemic in those
elk and in deer in that region.
So that's a testament to what a prion can
do, but it's very restricted when you think
about how this could do this in humans.
This is something that most people don't know
about.
So we look to try to see, was there ever an
extinction event from an infectious disease
in any animal species?
And there's one.
This is the Christmas Island rat, and it basically
was driven to extinction, by a vector-borne,
so mosquito-born, trypanosome.
Trypanosomes are parasites, much bigger than
bacteria viruses.
And the Christmas Island rat basically was
rendered extinct because of it.
But does this apply to humans?
I don't think it does, because the poor Christmas
rat couldn't go anywhere, it was on an island,
there was nowhere for it to run.
Humans can outrun a vector, and like I said,
vectors are limited in where they can actually
cause disease and where they can spread infections.
And if you can outrun that vector, if you
can move to places where it isn't there, you
can probably avoid it.
I think that when you look at the human trypanosome
diseases, they haven't done anything near
what they did to the Christmas Island rat.
There are some concerns when you talk about
parasites and protozoa, about certain drug-resistant
forms of malaria, especially if they make
it from Asia to Africa, being able to maybe
cause something on a GCBR level.
But we haven't seen that yet.
There's lots of other things to think about
when you think about infectious disease.
Helminths, ectoparasites, amoeba, non-carbon
based, so that's something when you talk about
the mission to Mars, and thinking about how
you're going to deal with organisms that may
or may not come back there.
So there's lots of different things to think
about, but really our consensus was that viruses
are most likely going to be the GCBR agent,
because of their mutability and their rapidity
of spread, and their lack of an antiviral.
But when you get into viruses, there's so
many viruses.
There's lots of different rules and exceptions.
Would the virus, would its genes be RNA, or
DNA?
Will it copy itself in the cytoplasm of a
cell or will it be in the nucleus?
Will it have a segmented genome like flu?
Flu is one of the most prolific viruses, and
the reason why it's so good at infecting people
is because it can shuffle its genes, because
they're all on a segment, and it can basically
be like a deck of cards that switches different
genes.
So that's something that is really important
to think about, whether it's segmented versus
non-segmented.
Does it have a really big genome like MERS
and SARS?
Or is it a very small genome?
And then what about these ones that are spread
by mosquitoes?
They get very high levels of the blood in
people, are those the kind of viruses that
are gonna be able to cause?
In just a couple of headlines a monkey pox,
which is a DNA virus that people are very
nervous about in the wake of the smallpox
eradication, people aren't vaccinating for
smallpox routinely anymore, now monkey pox
has resurged and the vaccine used to be, it
was protective against monkey pox.
So when you think about viruses, there's lots
of different things to think about.
Probably when you think about GCBR-level risks,
flu probably goes to the top of this list,
because it's done it so many times before.
And we do have this scare right now that's
been going on since probably the 1990s, regarding
avian influenza.
That's a picture from my local county fair
in my hometown outside of Pittsburgh.
And when you think of avian flu, one of the
scariest versions of this is H7N9.
We're right now in the sixth wave, but in
the fifth wave we saw some very, very scary
things happen.
You saw changes showing this virus being more
likely to be able to transmit between humans,
we've seen antiviral resistance in this strain,
we've seen the genetics of the strain change
so much that the vaccine that's stockpiled,
there was a mismatch.
And we've seen it evolve high pathogenicity
in chickens.
This is the CDC's ranking of viruses.
A and B are both H7N9.
So it's at the highest risk for emergency
impact.
So this is probably one of the scariest viruses
that we face.
And it meets a lot of those criteria that
we talked about.
When you look at the steps in pandemic emergence,
there's a bunch of steps that a virus has
to do, this is specific for influenza.
We're already down to around 3 to 4.
The infection is replicating sufficiently
to produce infectious virus, but we're seeing
very stuttered human transmission.
But we're getting down that road with H7N9.
So this isn't something that's very theoretical,
what I'm talking about, this is something
that we're dealing with today, now, in China,
with H7N9.
I think what the CDC does is they actually
rank the different properties of the virus,
which I think is a very good thing to do.
It might not always be accurate, but it does
definitely give you some framework for how
to evaluate viruses, and that's what we were
doing with this framework, was trying to take
this type of an assessment tool of viruses,
of influenza, and apply it to the whole microbial
world.
And that's what this new paradigm that we
tried to do was going to try to accomplish.
So what do you do when you come up with these
ideas, when you come up with these types of
lists of things that might cause this?
You can do what CEPI did.
CEPI is the Coalition for Epidemic Preparedness
and Innovation.
It's a major funder for vaccine research,
and what they did is they came up with a list
that they took from the WHO blueprint for
research, and picked some to actually go after.
I think that's one way to do this, where you
have diseases that meet this criteria, then
you invest money to go into it, to develop
vaccines.
A couple of other things, just a couple other
headlines just to show you.
People did think about space bacteria, but
it's unlikely that space bacteria, if they're
adapted to Mars, are going to be able to do
very well in humans on Earth, because there's
totally different conditions that would allow
them to flourish on one planet, that wouldn't
apply to another planet.
We talked to lots of people that were thinking
about salamanders and frogs, which are being
decimated by these sapronotic pathogens, but
don't necessarily affect humans.
So a couple more conclusions there.
Any microbe is capable of causing a GCBR.
But we believe that RNA viruses are the most
pressing and likely threat, because of their
mutability, their zoonotic potential.
Bacterial antimicrobial resistance unlikely
to reach GCBR levels, and GCBR level of widespread
fungal disease is unlikely due to its temperature
restrictions, and very select conditions for
a prion-caused GCBR.
The last part of the talk, I just want to
emphasize a few things.
We're always surprised about infectious disease,
and I list a bunch of them here.
H1N1 coming from Mexico, Zika, SARS, MERS,
and there's lots of people investing in surveillance
and prediction approaches.
I think there's two basic approaches.
There is this global virome approach, where
people will go out and sequence everything
that they want to do, and try to find a list
of viruses that are out there.
It tells you maybe what's coming, but it's
very expensive, and 99 percent of those viruses
are probably not gonna pose any threat to
humans.
What if the next GCBR or the next pandemic
is not viral?
So that's one way to do it.
Or there's another way to do it.
I think this is the way I favor.
It's looking at people that are getting infected
by novel diseases.
Looking at people like bush meat hunters,
people who work in abattoirs, looking for
what's called viral chatter, things that go
from the first forays of a pathogen into humans.
And then, looking at different hot spots.
Instead of trying to sequence things, focus
on things that are actually causing infections.
And then you think about unknown diagnoses,
50% of our septic shock cases, even in the
United States, don't have a diagnosis, and
I think that people just treat for symptoms
and not necessarily for fevers.
So I think that going about this, we're going
about this a little bit wrongly.
I think going after these unknown etiologies,
all over the world, trying to figure out where
these infections are occurring and actually
running things down to specific diagnoses,
instead of just saying, "You've got some viral
syndrome."
I think that's the way to go about it.
And I think the... this headline just came
out of Nature a couple of days ago, that really
validates what we're saying that pandemics,
you should spend much more on surveying actual
infections, not on trying to predict things
by viral cataloging.
I'm just gonna, in the interest of time, just
one or two more slides I want to show you.
So, what's out there, is lots of biological
dark matter.
We've got lots of viruses out there, lots
of bacteria out there that nobody knows about.
And I think we're at the stage now, that we
have this tricorder culture, that Captain
Kirk is holding there from Star Trek, where
Bones, the doctor, would just scan someone
and know exactly what they have.
We've got lots of new technologies, and I
think that you can start and figure out what
disease X is going to be, and that's the new
WHO nomenclature for the unknown unknown.
And I do think we're at that point now, but
only if we actually harness these diagnostic
tests.
And just to conclude here that, when you think
about infectious disease risk, you have to
also think about human actions and that there
are human actions that can enhance pandemic
potential.
Mistakes, political or scientific, fears of
the unknown and also, complex disasters.
So, if there's a war, for example, at the
same time as an infectious disease, it can
raise something to a GCBR-level.
So I'm gonna conclude here, people keep asking
me for books to read.
There are lots... that are first trying to
get into this field.
These are some of the ones that I could think
of, that I think are interesting.
This is an article I wrote for The Atlantic,
Why Hasn't Disease Wiped Out the Human Race?
If you just Google that, you'll find that
under my name in the Atlantic, where I try
to summarize some of the stuff that I talked
about here.
And then, these are some interesting books
that I think are really... that really give
you a flavor for this, and a few other ones
that I didn't have pictures of.
A Viral Storm by Nathan Wolf and Level 4:
Virus Hunters of the CDC by McCormick, that's
the book that really got me interested in
all of that.
It came out in 1996 and this is the book that
really started for me when I was a little
child.
That was the one that my parents read me over
and over and over again, which is the story
of the rabies vaccine.
So, thank you for your interest and I'm happy
to take any questions in the time that's remaining,
and I have office hours as well and feel free
to follow me on Twitter or read my blog.
Thanks again for your attention.
All right.
Thank you.
That was an awesome presentation and we do
have some questions coming in via the app.
We've got a few minutes, so we'll see how
many we can get through.
So, first question, what are the challenges
in creating a broad-spectrum antiviral?
You alluded to it a bit, but, tell us more.
So, in general antiviral therapy has lagged
antibacterial therapy by a long shot.
We haven't had many antivirals ever, until
actually the modern era with HIV and hepatitis
C. Viruses are much trickier to make an antiviral
agent against, because remember that viruses
don't have their own machinery, they're inside
a human cell, so they're going to be using
your ribosomes, all the stuff that you use
to make protein.
So, many of these things can be very toxic
because they're going to be hitting things
that your cells do as well.
So you have to find something on the virus
that only affects the virus and minimally
impacts your own cellular function.
So that's very hard.
Whereas, in a bacteria or a fungi, they're
doing their own thing, so you can find things
that target just them.
With antivirals, it's very hard, you have
to make sure, the toxicity would be too high
if it's actually blocking your proteins synthesis
and not just the virus's.
So I think that's the biggest challenge, is
the fact that viruses use your stuff to actually
do their functions and you can't explicitly
target a virus the same way you can target
a bacteria or a fungi or a worm or whatever
else it could be.
How does monoculture kind of fit into this?
I mean, farming of animals mostly, maybe other
things that humans cultivate as well that
kind of become global.
Does that increase our risk in a material
way?
So that was something that we thought, with
the monoculture you're thinking about, we
were thinking mostly about humans here, so
are humans a monoculture?
And I don't think that that's the case, because
it's said that the human immune system, within
all the different humans that live on earth,
can actually respond to any type of antigen.
There's been some papers written about this,
that the diversity of the human immune system
globally, is enough that there's nothing that
could really drive humans to complete extinction
on its own.
But, when you think about monoculture for
other things, for animals or for plants, that
clearly makes them vulnerable to a pathogen
that could wipe them out, but not so much
for humans.
I think that there's enough genetic diversity,
that we would be able to survive, at least
a good proportion of us, with an infectious
disease outbreak.
How about things that may be dormant for a
long time or asymptomatic for a long time,
how does that kind of change the analysis
of this stuff?
That's an interesting question.
So when we talked about GCBR and the definition
that we use to bound this, we talked about
sudden, the word sudden.
And when you think about a disease like HIV,
what gave HIV the ability to cause this global
pandemic like no other, basically, was the
fact that it has this long latency period
where people were still infectious, for 10
years about, from infection to when they would
start showing symptoms, and in all that time
they were contagious.
So, that was very advantageous for HIV.
When you're talking about GCBRs, then we're
talking about the speed of it, but I do think
that when you talk about this long latency
and dormant period where someone can transmit
a disease, that's a very, very huge advantage
that a pathogen would have, and able to disseminate
through a population.
It's unclear whether that would qualify as
a GCBR because there would be time to prepare
there, there would be people looking at it
the way HIV is.
And I think we struggled a lot with our definition
of GCBR because HIV meets a lot of these criteria,
but in terms of its rapidity, it's much different
than the black death or 1918 flu.
Couple of questions about synthetic biology
and apparently ever-lowering barrier to entry
into synthetic biology with now kind of hacker
spaces for biology.
How much does that worry you and how much
should it worry me?
So, synthetic biology and the democratization
of biology and the biohacker culture, is kind
of a two edged sword.
You got a lot of great minds now being engaged
in awesome research and that could probably
lead to new treatments, new cures, new discoveries,
new types of knowledge, and I think that's
a great thing.
But the issue, I guess, is that there are
people that would try to use this for nefarious
purposes and I think that there's a fine line
that has to be walked there.
And I would say that, although it's becoming
very, very simple to do synthetic biology,
it's not easy to do.
It's still not something that someone can
do in their back yard or without any kind
of proper training.
So, I do think that, some of that risk is
a little bit misplaced, because I don't think
that people can just concoct these chimeric,
crazy things in their garage and release them.
But I do think that it's important that they
start to respect norms of biosafety and understand
that when you work with these pathogens, even
if you're not going to create the Andromeda
strain, you need to be careful and actually
understand that there is a science of biosafety
and it's really important that you actually
follow that so that you're not going to expose
yourself or others to risk.
So I think that this is something that people
have been engaging with this community to
try and teach them this type of stuff, but
I do think they should be able to flourish.
I think it's really great that they're able
to do this type of work without the confines
of a traditional academic career.
Cool.
Well, unfortunately, that is all the time
we have here, but you will be available for
office hours around the way in our next break,
which begins now.
So, how about another round of applause for
Dr. Amesh Adalja.
