New tools could catch disease outbreaks earlier - or predict them
Every year, the villages which lie in the so-called ‘Nipah belt’— which stretches along the western border between Bangladesh and India, brace themselves for the latest outbreak. For since 1998, when Nipah virus—a form of hemorrhagic fever most common in Bangladesh—first spilled over into humans, it has been a grim annual visitor to the people of this region.
With a 70 percent fatality rate, no vaccine, and no known treatments, Nipah virus has been dubbed in the Western world as ‘the worst disease no one has ever heard of.’ Currently, outbreaks tend to be relatively contained because it is not very transmissible. The virus circulates throughout Asia in fruit eating bats, and only tends to be passed on to people who consume contaminated date palm sap, a sweet drink which is harvested across Bangladesh.
But as SARS-CoV-2 has shown the world, this can quickly change.
“Nipah virus is among what virologists call ‘the Big 10,’ along with things like Lassa fever and Crimean Congo hemorrhagic fever,” says Noam Ross, a disease ecologist at New York-based non-profit EcoHealth Alliance. “These are pretty dangerous viruses from a lethality perspective, which don’t currently have the capacity to spread into broader human populations. But that can evolve, and you could very well see a variant emerge that has human-human transmission capability.”
That’s not an overstatement. Surveys suggest that mammals harbour about 40,000 viruses, with roughly a quarter capable of infecting humans. The vast majority never get a chance to do so because we don’t encounter them, but climate change can alter that. Recent studies have found that as animals relocate to new habitats due to shifting environmental conditions, the coming decades will bring around 300,000 first encounters between species which normally don’t interact, especially in tropical Africa and southeast Asia. All these interactions will make it far more likely for hitherto unknown viruses to cross paths with humans.
That’s why for the last 16 years, EcoHealth Alliance has been conducting ongoing viral surveillance projects across Bangladesh. The goal is to understand why Nipah is so much more prevalent in the western part of the country, compared to the east, and keep a watchful eye out for new Nipah strains as well as other dangerous pathogens like Ebola.
"There are a lot of different infectious agents that are sensitive to climate change that don't have these sorts of software tools being developed for them," says Cat Lippi, medical geography researcher at the University of Florida.
Until very recently this kind of work has been hampered by the limitations of viral surveillance technology. The PREDICT project, a $200 million initiative funded by the United States Agency for International Development, which conducted surveillance across the Amazon Basin, Congo Basin and extensive parts of South and Southeast Asia, relied upon so-called nucleic acid assays which enabled scientists to search for the genetic material of viruses in animal samples.
However, the project came under criticism for being highly inefficient. “That approach requires a big sampling effort, because of the rarity of individual infections,” says Ross. “Any particular animal may be infected for a couple of weeks, maybe once or twice in its lifetime. So if you sample thousands and thousands of animals, you'll eventually get one that has an Ebola virus infection right now.”
Ross explains that there is now far more interest in serological sampling—the scientific term for the process of drawing blood for antibody testing. By searching for the presence of antibodies in the blood of humans and animals, scientists have a greater chance of detecting viruses which started circulating recently.
Despite the controversy surrounding EcoHealth Alliance’s involvement in so-called gain of function research—experiments that study whether viruses might mutate into deadlier strains—the organization’s separate efforts to stay one step ahead of pathogen evolution are key to stopping the next pandemic.
“Having really cheap and fast surveillance is really important,” says Ross. “Particularly in a place where there's persistent, low level, moderate infections that potentially have the ability to develop into more epidemic or pandemic situations. It means there’s a pathway that something more dangerous can come through."
Scientists are searching for the presence of antibodies in the blood of humans and animals in hopes to detect viruses that recently started circulating.
EcoHealth Alliance
In Bangladesh, EcoHealth Alliance is attempting to do this using a newer serological technology known as a multiplex Luminex assay, which tests samples against a panel of known antibodies against many different viruses. It collects what Ross describes as a ‘footprint of information,’ which allows scientists to tell whether the sample contains the presence of a known pathogen or something completely different and needs to be investigated further.
By using this technology to sample human and animal populations across the country, they hope to gain an idea of whether there are any novel Nipah virus variants or strains from the same family, as well as other deadly viral families like Ebola.
This is just one of several novel tools being used for viral discovery in surveillance projects around the globe. Multiple research groups are taking PREDICT’s approach of looking for novel viruses in animals in various hotspots. They collect environmental DNA—mucus, faeces or shed skin left behind in soil, sediment or water—which can then be genetically sequenced.
Five years ago, this would have been a painstaking work requiring bringing collected samples back to labs. Today, thanks to the vast amounts of money spent on new technologies during COVID-19, researchers now have portable sequencing tools they can take out into the field.
Christopher Jerde, a researcher at the UC Santa Barbara Marine Science Institute, points to the Oxford Nanopore MinION sequencer as one example. “I tried one of the early versions of it four years ago, and it was miserable,” he says. “But they’ve really improved, and what we’re going to be able to do in the next five to ten years will be amazing. Instead of having to carefully transport samples back to the lab, we're going to have cigar box-shaped sequencers that we take into the field, plug into a laptop, and do the whole sequencing of an organism.”
In the past, viral surveillance has had to be very targeted and focused on known families of viruses, potentially missing new, previously unknown zoonotic pathogens. Jerde says that the rise of portable sequencers will lead to what he describes as “true surveillance.”
“Before, this was just too complex,” he says. “It had to be very focused, for example, looking for SARS-type viruses. Now we’re able to say, ‘Tell us all the viruses that are here?’ And this will give us true surveillance – we’ll be able to see the diversity of all the pathogens which are in these spots and have an understanding of which ones are coming into the population and causing damage.”
But being able to discover more viruses also comes with certain challenges. Some scientists fear that the speed of viral discovery will soon outpace the human capacity to analyze them all and assess the threat that they pose to us.
“I think we're already there,” says Jason Ladner, assistant professor at Northern Arizona University’s Pathogen and Microbiome Institute. “If you look at all the papers on the expanding RNA virus sphere, there are all of these deposited partial or complete viral sequences in groups that we just don't know anything really about yet.” Bats, for example, carry a myriad of viruses, whose ability to infect human cells we understand very poorly.
Cultivating these viruses under laboratory conditions and testing them on organoids— miniature, simplified versions of organs created from stem cells—can help with these assessments, but it is a slow and painstaking work. One hope is that in the future, machine learning could help automate this process. The new SpillOver Viral Risk Ranking platform aims to assess the risk level of a given virus based on 31 different metrics, while other computer models have tried to do the same based on the similarity of a virus’s genomic sequence to known zoonotic threats.
However, Ladner says that these types of comparisons are still overly simplistic. For one thing, scientists are still only aware of a few hundred zoonotic viruses, which is a very limited data sample for accurately assessing a novel pathogen. Instead, he says that there is a need for virologists to develop models which can determine viral compatibility with human cells, based on genomic data.
“One thing which is really useful, but can be challenging to do, is understand the cell surface receptors that a given virus might use,” he says. “Understanding whether a virus is likely to be able to use proteins on the surface of human cells to gain entry can be very informative.”
As the Earth’s climate heats up, scientists also need to better model the so-called vector borne diseases such as dengue, Zika, chikungunya and yellow fever. Transmitted by the Aedes mosquito residing in humid climates, these blights currently disproportionally affect people in low-income nations. But predictions suggest that as the planet warms and the pests find new homes, an estimated one billion people who currently don’t encounter them might be threatened by their bites by 2080. “When it comes to mosquito-borne diseases we have to worry about shifts in suitable habitat,” says Cat Lippi, a medical geography researcher at the University of Florida. “As climate patterns change on these big scales, we expect to see shifts in where people will be at risk for contracting these diseases.”
Public health practitioners and government decision-makers need tools to make climate-informed decisions about the evolving threat of different infectious diseases. Some projects are already underway. An ongoing collaboration between the Catalan Institution for Research and Advanced Studies and researchers in Brazil and Peru is utilizing drones and weather stations to collect data on how mosquitoes change their breeding patterns in response to climate shifts. This information will then be fed into computer algorithms to predict the impact of mosquito-borne illnesses on different regions.
The team at the Catalan Institution for Research and Advanced Studies is using drones and weather stations to collect data on how mosquito breeding patterns change due to climate shifts.
Gabriel Carrasco
Lippi says that similar models are urgently needed to predict how changing climate patterns affect respiratory, foodborne, waterborne and soilborne illnesses. The UK-based Wellcome Trust has allocated significant assets to fund such projects, which should allow scientists to monitor the impact of climate on a much broader range of infections. “There are a lot of different infectious agents that are sensitive to climate change that don't have these sorts of software tools being developed for them,” she says.
COVID-19’s havoc boosted funding for infectious disease research, but as its threats begin to fade from policymakers’ focus, the money may dry up. Meanwhile, scientists warn that another major infectious disease outbreak is inevitable, potentially within the next decade, so combing the planet for pathogens is vital. “Surveillance is ultimately a really boring thing that a lot of people don't want to put money into, until we have a wide scale pandemic,” Jerde says, but that vigilance is key to thwarting the next deadly horror. “It takes a lot of patience and perseverance to keep looking.”
This article originally appeared in One Health/One Planet, a single-issue magazine that explores how climate change and other environmental shifts are increasing vulnerabilities to infectious diseases by land and by sea. The magazine probes how scientists are making progress with leaders in other fields toward solutions that embrace diverse perspectives and the interconnectedness of all lifeforms and the planet.
Scientists and Religious Leaders Need to Be More Transparent
[Editor's Note: This essay is in response to our current Big Question series: "How can the religious and scientific communities work together to foster a culture that is equipped to face humanity's biggest challenges?"]
As a Jesuit Catholic priest, and a molecular geneticist, this question has been a fundamental part of my adult life. But first, let me address an issue that our American culture continues to struggle with: how do science and religion actually relate to each other? Is science about the "real" world, and religion just about individual or group beliefs about how the world should be?
Or are science and religion in direct competition with both trying to construct explanations of reality that are "better" or more real than the other's approach? These questions have generated much discussion among scientists, philosophers, and theologians.
The recent advances in our understanding of genetics show how combining the insights of science and religion can be beneficial.
First, we need to be clear that science and religion are two different ways human beings use to understand reality. Science focuses on observable, quantifiable, physical aspects of our universe, whereas, religion, while taking physical reality into consideration, also includes the immaterial, non-quantifiable, human experiences and concepts which relate to the meaning and purpose of existence. While scientific discoveries also often stimulate such profound reflections, these reflections are not technically a part of scientific methodology.
Second, though different in both method and focus, neither way of understanding reality produces a more "real" or accurate comprehension of our human existence. In fact, most often both science and religion add valuable insights into any particular situation, providing a more complete understanding of it as well as how it might be improved.
The recent advances in our understanding of genetics show how combining the insights of science and religion can be beneficial. For instance, the study of genetic differences among people around the world has shown us that the idea that we could accurately classify people as belonging to different races—e.g. African, Caucasian, Asian, etc.—is actually quite incorrect on a biological level. In fact, in many ways two people who appear to be of different races, perhaps African and Caucasian, could be more similar genetically than two people who appear to be of the same African race.
This scientific finding, then, challenges us to critically review the social categories some use to classify people as different from us, and, therefore, somehow of less worth to society. From this perspective, one could argue that this scientific insight synergizes well with some common fundamental religious beliefs regarding the fundamental equality all people have in their relationship to the Divine.
However, this synergy between science and religion is not what we encounter most often in the mass media or public policy debates. In part, this is due to the fact that science and religion working well together is not normally considered newsworthy. What does get attention is when science appears to conflict with religion, or, perhaps more accurately, when the scientific community conflicts with religious communities regarding how a particular scientific advance should be applied. These disagreements usually are not due to a conflict between scientific findings and religious beliefs, but rather between differing moral, social or political agendas.
One way that the two sides can work together is to prioritize honesty and accuracy in public debates instead of crafting informational campaigns to promote political advantage.
For example, genetically modified foods have been a source of controversy for the past several decades. While the various techniques used to create targeted genetic changes in plants—e.g. drought or pest resistance—are scientifically intricate and complex, explaining these techniques to the public is similar to explaining complex medical treatments to patients. Hence, the science alone is not the issue.
The controversy arises from the differing goals various stakeholders have for this technology. Obviously, companies employing this technology want it to be used around the world both for its significantly improved food production, and for improved revenue. Opponents, which have included religious communities, focus more on the social and cultural disruption this technology can create. Since a public debate between a complex technology on one side, and a complex social situation on the other side, is difficult to undertake well, the controversy has too often been reduced to sound bites such as "Frankenfoods." While such phrases may be an effective way to influence public opinion, ultimately, they work against sensible decision-making.
One way that the two sides can work together is to prioritize honesty and accuracy in public debates instead of crafting informational campaigns to promote political advantage. I recognize that presenting a thorough and honest explanation of an organization's position does not fit easily into our 24-hour-a-day-sound-bite system, but this is necessary to make the best decisions we can if we want to foster a healthier and happier world.
Climate change and human genome editing are good examples of this problem. These are both complex issues with impacts that extend well beyond just science and religious beliefs—including economics, societal disruption, and an exacerbation of social inequalities. To achieve solutions that result in significant benefits for the vast majority of people, we must work to create a knowledgeable public that is encouraged to consider the good of both one's own community as well as that of all others. This goal is actually one that both scientific and religious organizations claim to value and pursue.
The experts often fail to understand sufficiently what the public hopes, wants, and fears.
Unfortunately, both types of organizations often fall short because they focus only on informing and instructing instead of truly engaging the public in deliberation. Often both scientists and religious leaders believe that the public is not capable of sufficiently understanding the complexities of the issues, so they resort to assuming that the public should just do what the experts tell them.
However, there is significant research that demonstrates the ability of the general public to grasp complex issues in order to make sound decisions. Hence, it is the experts who often fail to understand how their messages are being received and what the public hopes, wants, and fears.
Overall, I remain sanguine about the likelihood of both religious and scientific organizations learning how to work better with each other, and together with the public. Working together for the good of all, we can integrate the insights and the desires of all stakeholders in order to face our challenges with well-informed reason and compassion for all, particularly those most in need.
[Ed. Note: Don't miss the other perspectives in this Big Question series, from a science scholar and a Rabbi/M.D.]
Scientists: Don’t Leave Religious Communities Out in the Cold
[Editor's Note: This essay is in response to our current Big Question series: "How can the religious and scientific communities work together to foster a culture that is equipped to face humanity's biggest challenges?"]
I humbly submit that the question should be rephrased: How can the religious and scientific communities NOT work together to face humanity's biggest challenges? The stakes are higher than ever before, and we simply cannot afford to go it alone.
I believe in evolution -- the evolution of the relationship of science and religion.
The future of the world depends on our collaboration. I believe in evolution -- the evolution of the relationship of science and religion. Science and religion have lived in alternately varying relationships ranging from peaceful coexistence to outright warfare. Today we have evolved and have begun to embrace the biological relationship of mutualism. This is in part due to the advances in medicine and science.
Previous scientific discoveries and paradigm shifts precipitated varying theological responses. With Copernicus, we grappled with the relationship of the earth to the universe. With Darwin, we re-evaluated the relationship of man to the other creatures on earth. However, as theologically complex as these debates were, they had no practical relevance to the common man. Indeed, it was possible for people to live their entire lives happily without pondering these issues.
In the 21st century, the microscope is honing in further, with discoveries relating to the understanding of the very nature and composition of the human being, both body and mind/soul. Thus, as opposed to the past, the implications of the latest scientific advances directly affect the common man. The religious implications are not left to the ivory tower theologians. Regular people are now confronted with practical religious questions previously unimagined.
For example, in the field of infertility, if a married woman undergoes donor insemination, is she considered an adulteress? If a woman of one faith gestates the child of another faith, to whose faith does the child belong? If your heart is failing, can you avail yourself of stem cells derived from human embryos, or would you be considered an accomplice to murder? Would it be preferable to use artificially derived stem cells if they are available?
The implications of our current debates are profound, and profoundly personal. Science is the great equalizer. Every living being can potentially benefit from medical advances. We are all consumers of the scientific advances, irrespective of race or religion. As such, we all deserve a say in their development.
If the development of the science is collaborative, surely the contemplation of its ethical/religious applications should likewise be.
With gene editing, uterus transplants, head transplants, artificial reproductive seed, and animal-human genetic combinations as daily headlines, we have myriad ethical dilemmas to ponder. What limits should we set for the uses of different technologies? How should they be financed? We must even confront the very definition of what it means to be human. A human could receive multiple artificial transplants, 3D printed organs, genetic derivatives, or organs grown in animals. When does a person become another person or lose his identity? Will a being produced entirely from synthetic DNA be human?
In the Middle Ages, it was possible for one person to master all of the known science, and even sometimes religion as well, such as the great Maimonides. In the pre-modern era, discoveries were almost always attributed to one individual: Jenner, Lister, Koch, Pasteur, and so on. Today, it is impossible for any one human being to master medicine, let alone ethics, religion, etc. Advances are made not usually by one person but by collaboration, often involving hundreds, if not thousands of people across the globe. We cite journal articles, not individuals. Furthermore, the magnitude and speed of development is staggering. Add artificial intelligence and it will continue to expand exponentially.
If the development of the science is collaborative, surely the contemplation of its ethical/religious applications should likewise be. The issues are so profound that we need all genes on deck. The religious community should have a prominent seat at the table. There is great wisdom in the religious traditions that can inform contemporary discussions. In addition, the religious communities are significant consumers of, not to mention contributors to, the medical technology.
An ongoing dialogue between the scientific and religious communities should be an institutionalized endeavor, not a sporadic event, reactive to a particular discovery. The National Institutes of Health or other national organizations could provide an online newsletter designed for the clergy with a summary of the latest developments and their potential applications. An annual meeting of scientists and religious leaders could provide a forum for the scientists to appreciate the religious ramifications of their research (which may be none as well) and for the clergy to appreciate the rapidly developing fields of science and the implications for their congregants. Theological seminaries must include basic scientific literacy as part of their curricula.
We need the proper medium of mutual respect and admiration, despite healthy disagreement.
How do we create a "culture"? Microbiological cultures take time and require the proper medium for maximal growth. If one of the variables is altered, the culture can be affected. To foster a culture of continued successful collaboration between scientists and religious communities, we likewise need the proper medium of mutual respect and admiration, despite healthy disagreement.
The only way we can navigate these unchartered waters is through constant, deep and meaningful collaboration every single step of the way. By cultivating a mutualistic relationship we can inform, caution and safeguard each other to maximize the benefits of emerging technologies.
[Ed. Note: Don't miss the other perspectives in this Big Question series, from a science scholar and a Reverend/molecular geneticist.]