Peter Horby: Emerging infectious diseases
Research on emerging infectious diseases can only be conducted during outbreaks. Although virology has improved, a well calibrated and effective public health response is often lacking. Epidemiological and clinical research as well as mathematical modelling will give us answers during the epidemics and help us provide better diagnostics and better treatments.
Q: What are emerging infectious diseases?
Peter Horby: Emerging infectious diseases are infectious diseases that are either increasing in the extent of spread or in the number of cases; sometimes, but more rarely, they are new infections that we have not encountered before. Most often these infectious diseases arise from animals, so they are new to the human species, and often cause rather alarming outbreaks, although they are often limited in size.
Q: How common are emerging infectious diseases in the UK and the rest of the World?
PH: These aren’t esoteric infections, we see them all the time. One we will all be aware of in the UK is mad cow disease, bovine spongiform encephalopathy, which caused a huge impact here; not a huge number of human cases, but a big impact on the agricultural industry. If we look globally, they are very common, we see them all the time recurring. People will be familiar with pandemic influenza, which re-emerges from animal sources and causes large epidemics, SARS, Avian Influenza, and more recently the Ebola virus outbreak in Western Africa.
Q: Can you tell us about your research?
PH: We’ve learnt from past experience with these emerging infections that we can expect them to come along. However, most of the time our response to them is inadequate when it comes to research. Areas have improved a lot, particularly in virology, where the response to identifying the pathogen and characterising the pathogen is much better. The improvements to public health, in terms of gathering the data needed to have a well calibrated and effective response, have not been as good. We still don’t know where SARS came from or where the Ebola virus comes from, and in the case of most emerging infectious diseases, we don’t know how to treat them. We are trying to change that. Research can only really be done on these infections during outbreaks, but traditionally the way in which research has been done is not well suited to this. We are trying to change methodologies, establish networks and conduct both epidemiological public health and clinical research, to give us answers during the epidemics that will ensure good public policy and public health response and the best available clinical treatment.
Q: What are the most important lines of research that have developed in the last five or ten years?
PH: With emerging infections new technologies have been brought on board. The real advance is the introduction of these technologies and methods into the outbreak context. We are now able to collect not just basic public health information, but also the data we need to do more advanced mathematical modelling with mathematical modelling groups; the biological samples we need for virologists to look at pathogen evolution and the difference in the genetics of the pathogens; the biological samples from humans so that we can look at the antibody responses; and we are able to conduct clinical trials. A good example now is the current Ebola virus outbreak, where we are mobilising clinical research networks to try and get some of the therapies, which are really only in the lab, into patients in a time frame that allows us to assess their efficacy and maybe make a difference during this outbreak but certainly know that for the next outbreak we have therapeutics that we know will work.
Q: Why does your research matter and why should we put money into it?
PH: Emerging infectious diseases are probably one of the biggest threats to health. Pandemic influenza is number one on the UK list of civil emergencies that is likely to occur. But, broader than that, they have a direct impact on other health problems. We have seen with Ebola that the health care system in West Africa is under a lot of stress and there are probably as many people dying from other diseases because they are not getting adequate care due to the Ebola virus outbreak. Beyond that, the economic impact is massive. SARS is estimated to have cost between 18 and 60 billion dollars to the economies in South East Asia, even though only 800 people died. The Ebola outbreak in West Africa is estimated to reduce the GDP of those countries by between 2 and 10% and these are already economies who are struggling to emerge from eras of civil war, so this could have a devastating impact. If we can improve the evidence base for the response to these outbreaks then we can improve the public health response, the clinical management and the control of these outbreaks, then we can make a big difference both to the patients and the economic impact that those outbreaks cause.
Q: How does your research fit into translational medicine within the Department?
PH: This is a classic example of translational medicine, because what we are doing is directly focused on providing answers, in real time, that influence policies both in public health but also clinical practice. We are doing that by collecting information on the disease dynamics that influence the public health interventions but also on the disease dynamics in patients. That will impact how patients are treated, the diagnostics that are used and the therapies that are given.
This interview was recorded in October 2014.