Monday, April 28, 2014

Pandemics: what everyone needs to know

Dr Phil in his personal protective equipment (PPE). [NB observant readers will note that these disposable surgical masks do not prevent infection with infectious agents and no, they aren't available in dog sizes].
Recently SAT had the pleasure of chatting with Nobel Prize Laureate, former veterinarian and immunologist Professor Peter Doherty. Aside from writing so many papers that his CV is literally longer than your average honours thesis, Professor Doherty is one of those scientists who takes his civic duties very seriously. He believes that scientists have a duty to educate others, and as someone who looks very closely at the body's response to infectious diseases, he is determined to share his knowledge about this subject.

Infectious diseases can be dramatic, they can be terrifying, and the concept of a pandemic is behind successful thrillers like Outbreak, Contagion and 28 Days Later. We read in the papers about the constant threat bioterrorism, and there are movies about that too but my adrenal glands can only handle so much.

The word pandemic causes a little bit of panic in all of us (wordsmiths will note that it also contains a little bit of "panic") - and as Professor Doherty argues in his book Pandemics: What Everyone Needs to Know , our response can be just as life threatening.

...when it comes to pandemics, the pathogen - the infectious cause - is only half the equation: the other half involves who we are and what we do. Thinking that way should also cause us to extend our concern about pandemics to a much greater challenge - that of achieving a more equitable and environmentally sustainable earth (xxxvi).

For example, despite all our fears about Ebola and SARS taking over the world, two of the worst pandemics of the twentieth century - HIV and hepatitis C - emerged slowly and it in many countries public health policy was (mis)informed by judgement e.g. worrying about whether giving out condoms or providing needle exchanges was eating away at the moral fabric of society. If we truly believe in evidence-based medicine, we need to assess the facts without judgement. That means understanding risk and responding appropriately.

Several years ago when it was widely peddled in the press that Australia would almost inevitably fall victim to a zoonotic avian influenza pandemic, pharmacies and the internet sold out of antivirals like Tamiflu and hospitals were almost overrun with the "worried well" - all gathering in a place where they are most likely to transmit/contract infectious disease and competing with the genuinely ill for medical attention.

Of course good public health doesn't happen in a vacuum and Professor Doherty urges us to think carefully about our own role and that of the Government.

...question candidates directly about the issues that concern you and vote accordingly. Put public health and pandemic preparedness on that list.

Professor Doherty's book provides a very rational, non-judgemental look at pandemics including TB, henipahviruses, influenza, mad cow disease - but also a relatively painless review of microbiology, immunology and epidemiology of infectious disease. According to Professor Doherty,

...everyone should have a clear understanding of how viruses and other pathogens are transmitted. We also need to engage with the nature of infection and immunity, including the way that vaccines work and how we are all protected by maintaining a good level of herd immunity. It is essential, for example, that every child (and parent) should be aware of the basics of personal hygiene, particularly cough etiquette and hand sanitation.
In the case of a pandemic, awareness of these principles is more likely to save us than any single antibiotic or antiviral agent. This is definitely a book worth reading and Professor Doherty is a wonderful ambassador for good science. 

If you're interested in learning more about infectious diseases, Professor Doherty will be addressing the Australasian Society for Infectious Diseases Zoonoses conference in July this year. For more information visit here.

(Also if you're reading about MERS - Middle East Respiratory Syndrome - in the papers today, check this link).

UPDATE: if you want to read more about Ebola and the important role of epidemiologists, click here to learn about Australia's Dr Kamalini Lokuge experience in volunteering in Guinea, and the problems that fear and poor understanding can cause).