The Coming Plague (109 page)

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Authors: Laurie Garrett

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CDC director William Roper revoked the import licenses of the three biggest primate businesses—Hazelton, Worldwide Primates of Miami, and Charles River Primates Corporation of Port Washington, New York—setting off a loud outcry from the research community.
10
With AIDS researchers charging that the actions were bringing their efforts to a halt, and drug companies claiming that the CDC's steps amounted to a ban on pharmaceutical research and development, the federal agency was caught in the middle. The standoff dragged on until June, when CDC surveys of randomly obtained human blood samples revealed that many people who had never been near monkeys—including lifelong residents of the state of Alaska—had antibodies in their blood that would neutralize the Reston virus in a test tube.
11
The finding greatly reduced the significance of the infections seen in people exposed to the Philippine monkeys.
Later studies by McCormick, Fisher-Hoch, and their colleagues in the Special Pathogens Branch of the CDC showed that most monkeys survived even high experimental doses of infection with the Philippine virus, and that all survivors (27 of 42 animals) completely cleared virus from their bodies, as measured by PCR.
12
They also showed that the relative dangers of filoviruses varied dramatically depending upon whether they originated in Asia or Africa: African Ebola-like viruses were far more lethal.
13
Despite reassuring findings about the low pathogenicity of the Reston virus, the scientific community had experienced a rude awakening. Monkey importers were back in full operation by July 1990, but under far more stringent testing and quarantine guidelines. The CDC and WHO were forced to reexamine the primate handling guidelines that had been issued twenty years earlier, in response to the Marburg outbreak. The airline industry, which had briefly refused to participate in further transport of primates, resumed animal shipping, but with a new sense of the risks involved.
 
The Honolulu war games exercises and the Reston virus incident were pieces in a larger picture of sharply heightened concerns in some scientific circles about preparedness for confronting the emergences of new disease. Five major U.S. government studies addressed the issue between 1988 and 1994.
14
In addition, several international agencies and organizations addressed various aspects of the emerging disease preparedness issue.
15
These reports, though produced by different groups of scientists and physicians, shared a sense of urgency and despair over the status of public health infrastructures and infectious diseases research in the United States
and Europe. The solutions varied strikingly, however, reflecting the agendas of the various institutions involved.
American scientists, particularly virologists and those who were practitioners of the fledgling field of microbial ecology,
16
tended to support large-scale monitoring and surveillance schemes. Satellites, biological containment laboratories, computers, and PCR devices were the tools they hoped to use to spot changes in ecologies that might promote microbial emergences. Failing that, they hoped to be equipped to swoop in with a scientific rapid strike force that would identify and destroy emerging microbes before an outbreak progressed to an epidemic.
The most ambitious of these proposals, ProMED,
17
sponsored by the Federation of American Scientists, was the brainchild of Stephen Morse. In his claustrophobic, cluttered office at Rockefeller University, the bearded, bespectacled driven Morse burned midnight oil for years searching for answers to how best to help humanity stay one step ahead of the microbes.
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When he and Nobel laureate Joshua Lederberg discussed that matter for hours on end in 1988 while planning the historic 1989 “Emerging Viruses” conference, Morse thought a fairly modest approach would suffice. Resurrecting the old Rockefeller Foundation international network of tropical laboratories would, he then thought, provide adequate protection.
But as the enormity of the scope of the emerging disease problem became apparent, the scale of Morse's envisioned surveillance net grew. The ProMED scheme involved a vast international network of monitoring systems that would keep an eye on diseases emerging not just in hospitals and clinics but also in agricultural crops, livestock, wild-caught animals, and sampled water supplies. The system Morse imagined would serve as a watchdog not only for natural emergences but also for uses of biological weapons.
Such a far-flung network could only work if supported politically by the United Nations. Accordingly, Morse and his ProMED colleagues, drawn from the ranks of biologists from all over the world, convened at WHO headquarters in Geneva during September 1993 in hopes of mustering more formal support for the initiative.
“The perception is growing that more needs to be done to prevent the emergence of new epidemics,” the Federation of American Scientists' Dr. Barbara Rosenberg told the gathering. “This perception comes from
both
the bioweapons and public health communities … . There is a deep worldwide undercurrent of concern about emerging diseases, and an obvious need to develop a comprehensive, global plan.”
D. A. Henderson, who had once led efforts to eradicate smallpox, told the Geneva gathering that “there is a growing belief that mankind's wellbeing, and perhaps even our survival as a species, will depend on our ability to detect emerging diseases … . Where would we be today if HIV were to become an airborne pathogen? And what is there to say that a comparable infection might not do so in the future?”
Years earlier, Karl Johnson had voiced darker concerns. After conversing at length with colleagues at a tropical diseases meeting in Seattle, he pulled Joe McCormick and a reporter aside, drawing the pair into a cranny away from crowds.
“I worry about all this research on virulence,” Johnson had said, his tone deadly serious. “It's only a matter of months—years, at most—before people nail down the genes for virulence and airborne transmission in influenza, Ebola, Lassa, you name it. And then any crackpot with a few thousand dollars' worth of equipment and a college biology education under his belt could manufacture bugs that would make Ebola look like a walk around the park.”
With genetic engineering it was a simple enough matter to insert genes coding for just about anything into the DNA or RNA of a virus.
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Johnson believed that discovery of the Ebola genes for hemorrhagic disease could lead to their insertion into a virus, such as influenza or measles, that was adapted for respiratory transmission. And he wasn't alone among biologists in expressing that concern.
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By 1993 some 125 nations had signed the Bioweapons Convention,
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yet the agreement had no teeth.
As a result, scientists living in countries with historic border and regional tensions worried that even a poor, backward nation could develop bugs that would produce famine by wiping out crops, cause widespread veterinary or human disease, or target economically crucial commodity crops to cripple a rival's economy.
“It can easily be done,” Dr. A. N. Mukhopadyay said in Geneva. As dean of agriculture for G. S. Pant University in Pantnagar (Nainital), India, Mukhopadyay was particularly concerned that tensions between India and its neighbors could lead some country in the Indian subcontinent to carry out agricultural sabotage against its enemies. “This is not science fiction,” he said.
Barbara Rosenberg asserted that biological weapons posed special diplomatic problems not encountered with their nuclear or chemical counterparts. “None of the equipment is so high-tech that it could not be homemade by any nation intent on developing BW capacity,” she warned, adding that “no nation is immune to the dangers.”
Microbiologist Mark Wheelis, of the University of California at Davis, was among those who believed that PCR technology could be used to finger bioweapons culprits.
“It's the molecular equivalent of finding the murderer's fingerprints on the gun,” Wheelis said, noting that even as technology was creating new opportunities for bioweaponry, it was also opening up novel options for detection and deterrence.
The ProMED leaders ardently believed that the same international mechanisms that would permit monitoring and verification of bioweapons
violations would also be ideal for watchdogging natural emergences of dangerous microbes.
But that made many scientists from developing countries nervous.
“I think a critical aspect of emerging disease questions is global partnership. It is crucial, essential, for people living in developing countries,” Dr. Natth Bhamarapravati, president emeritus of Mahidol University in Bangkok, said. “We must do nothing to undermine that sense of partnership.”
Japan's Isao Arita, a former leader of smallpox eradication efforts, felt that it was already extremely difficult to get past nationalist and cultural suspicions in order to carry out entirely beneficial programs, such as vaccination campaigns; if public health efforts were linked with punitive arms enforcement issues, many countries would deny access to both enterprises.
“The efforts must be separated,” Arita concluded.
If public health disease emergence were to be separately executed on a global scale, what might a system look like, and who—what agency—would be at its helm? Arita wasn't sure.
Neither Arita nor D. A. Henderson were terribly enthusiastic about the obvious solution—namely, handing over control to the World Health Organization. After their experiences leading the smallpox eradication efforts, both men were fed up with WHO.
“We conquered smallpox
in spite of
WHO,” Henderson said.
“By the time WHO realized there was an AIDS epidemic it already existed on four continents,” Henderson added. “That's WHO preparedness and emergency response for you.”
But if WHO wasn't adequate to the task, who, or what, was?
Henderson felt that the U.S. Centers for Disease Control was best suited for the job.
“WHO has pathetically few resources of its own,” Henderson said.
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In addition, the Geneva headquarters was often at odds with its scattered regional offices, which, he asserted, were “staffed by one or two [virologists] only. Inevitably, those who staff such units are prized more for their administrative skills in bringing experts together rather than for their own professional expertise … . I therefore see no option but to acknowledge CDC as an international resource, to fund it appropriately, and to acknowledge its mandate in legislation.”
In Henderson's view, worldwide preparedness could be coupled structurally with such programs as the South American polio eradication effort and UNICEF's global campaign to vaccinate the world's children against the leading preventable pediatric diseases. And active surveillance would best be conducted through a series of fifteen tightly networked tropical outpost laboratories, staffed by CDC scientists, colleagues from local public health institutions in the host country, and academic researchers drawn from some fifty U.S. universities.
Henderson estimated that the entire system would cost $150 million per
year to operate, adding, “Can we afford to invest in such a program? A better question is whether we can afford
not
to invest in a program that could be a determinant in our own survival as a species.”
The Henderson proposal was similar to one that had been outlined fifteen years earlier by Jordi Casals,
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and had over the years received support from Tom Monath, Robert Shope, Frederick Murphy,
24
and most of the scientists who had played roles in outbreaks of hemorrhagic or arboviral diseases.
25
It was formally endorsed by the U.S. Institute of Medicine.
26
In response to the Institute of Medicine's report on emerging diseases, the CDC gave Dr. Ruth Berkelman the task of formulating plans for surveillance and rapid response to emerging diseases. For a year and a half Berkelman coordinated an exhaustive effort, identifying weaknesses in CDC systems and outlining a new, improved system of disease surveillance and response.
Berkelman and her collaborators discovered a long list of serious weaknesses and flaws in the CDC's domestic surveillance system and determined that international monitoring was so haphazard as to be nonexistent. For example, the CDC for the first time in 1990 attempted to keep track of domestic disease outbreaks using a computerized reporting system linking the federal agency to four state health departments. Over a six-month period 233 communicable disease outbreaks were reported. The project revealed two disturbing findings: no federal or state agency routinely kept track of disease outbreaks of any kind, and once the pilot project was underway the ability of the target states to survey such events varied radically. Vermont, for example, reported outbreaks at a rate of 14.1 per one million residents versus Mississippi's rate of 0.8 per million.
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