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The Virus Next Time

By Eric Poeschla, M.D.


Ebola has seized the world’s attention. Justifiably so, as the virus continues to spread in West Africa, to devastating effect. Documented cases have now surpassed 18,000, with over 7,000 dead – many more than in all previous Ebola outbreaks combined. The dead and suffering include many health workers, whose sacrifices have both saddened and inspired. Ebola is a science fiction nightmare come true.

 

But Ebola is not new. We have known about this virus and its deadly potential for four decades, since it first emerged to kill hundreds near Zaire’s Ebola River in 1976. Worldwide emergency measures are vital now. Several physicians I know will soon head to Sierra Leone to volunteer in Ebola treatment units. However, another vital battle is fought daily on an equally critical battlefield: the research laboratories in our nation’s universities.

 
As a physician and virologist, I can offer both reassurance and concern in these waning weeks of 2014. There is little doubt that this particular epidemic can be extinguished if the right resources are brought to bear, though that could be many months and deaths from now. The rescue will cost billions and require concerted efforts of governments, nongovernmental organizations, health workers, safe burial teams and many others.
 
The two dozen cases in the U.S. and Europe so far and the transmissions to nurses in Dallas and Madrid underscore that Ebola is not just Africa’s problem. We will no doubt see further, sporadic importations into the U.S. (Denver’s designated hospitals and the medical school have prepared extensively for this contingency). However, I am confident that secondary transmissions to health workers and the public can be prevented effectively with the upgraded infection control practices now in place.
 
I am less confident that we as a society have learned another critical lesson, one that comes from seeing this fearful epidemic in proper context.
 
Ebola is a zoonosis. That is, like most “emerging and re-emerging” infections, it came to us from an animal species. The zoonosis we now call HIV-1 crossed into humans from chimpanzees, also in West Africa. SARS virus came to us from bats in southeast Asia. For Ebola, bats are also the likely source. Ebola is not an airborne virus (and contrary to some recent speculation, it is extremely unlikely to evolve that capacity). By contrast, a novel influenza virus, one that might emerge by rearrangements of influenza genomes within pigs and fowl in Asia, could spread via the air and kill many, many more than Ebola has.
 
There are numerous other viral threats, such as Dengue, Chikungunya, Nipah, MERS, and recently right here in Denver, Enterovirus D68. Last week, one of my high school classmates came very close to dying from that virus in Pennsylvania. Because population growth, migration, deforestation and other pressures are expanding what virologists call the human-animal interface, perhaps most concerning are infectious agents yet unknown and unnamed, akin to HIV-1 in 1981.
 
Scientific research, not reactive emergency treatment and quarantine campaigns, is what solved past infectious disease problems like polio and measles, saving countless lives and vast sums of money down the generations. Research produced penicillin and the miracle drugs that rendered HIV/AIDS manageable. It is hard, inspiring work. While I too laugh at the characters on The Big Bang Theory, the real scientists I know, down the hall, across the campus, are not nerdy, neurotic misfits, but the opposite: heroic adventurers into the unknown.
 
And yet we starve this intellectual enterprise, this life-giving activity, this priceless insurance. Viewed against the scale of the threats, the amount America spends on research to prevent these terrible epidemics from happening, or to treat the afflicted effectively when they do, is dismayingly minuscule. The substantial reductions in funding by the National Institutes of Health over the past decade has led many promising young biomedical scientists to abandon the goal of a research career. Established researchers have been forced to shut their labs.
 
It is as if we had decided to manage fire risks not by researching the best fire prevention and fighting strategies, but by waiting for deadly conflagrations to engulf New York, Chicago or Denver, and then reacting with an emergency fire engine construction program. We must be motivated by foresightedness, knowledge, and yes, patriotism, to dedicate more of our great wealth to being ready for the virus next time.  Because there is no doubt about it: they will come. We need to support the heroes in our laboratories. We need significant investment in fundamental scientific research into preventing and treating emerging infectious diseases.
 
Eric Poeschla, M.D.
Head, Division of Infectious Diseases, Department of Medicine, University of Colorado Denver School of Medicine
This essay was published in slightly condensed form in the Denver Post on December 25, 2014, under the title “Funds for Infectious Disease Research are Dangerously Low”: