President of the International Society for Infectious Diseases, Professor Paul Ananth Tambyah explains to Rachel Sully the importance of recognising, declaring and responding to infectious diseases such as Mpox, and the dangerous impact this can have on low- and middle-income countries.
Infectious diseases are illnesses caused by pathogens or their toxic products and are mainly transmitted from animals to humans through direct contact (i.e. scratches; bites) or consuming undercooked infected meat; between humans through close contact; or less commonly from prolonged contact with a contaminated inanimate object. Emerging infectious diseases that have pandemic potential are a major worldwide threat to global health security, and have most often been of zoonotic origin, such as monkeypox (Mpox). When these infectious diseases are uncontrolled, they can escalate into pandemics. The global nature of pandemics is driven by factors such as population density, international travel, and zoonotic transmission, where diseases spread from animals to humans.
Moderna have produced a new mRNA vaccine for Mpox, which is demonstrating reduced virus levels and prevention of severe cases in monkeys, showing potential of replication in humans. However, continued investment into Mpox vaccines is vital to boost supplies and ensure access to all, especially to control outbreaks in low- and middleincome countries (LMICs).
Systems such as the Program for Monitoring Emerging Diseases (ProMED), managed by the International Society for Infectious Diseases (ISID), play a crucial role in addressing the challenges posed by emerging infectious diseases. ISID president, professor Paul Ananth Tambyah emphasises the significance of ISID and ProMED in enhancing global health security through timely detection and communication of disease outbreaks.
What is the role of ISID in raising awareness for diseases?
ISID is the largest professional society that brings together clinicians, scientists, public health professionals and the communities interested in infectious diseases.
Our mission is to support health care providers, NGOs and governments around the world in preventing, investigating, and managing infectious disease outbreaks and endemic infectious diseases, especially neglected tropical diseases.
How does ProMED gather data on diseases such as Mpox?
ProMED is an internet-based reporting system dedicated to rapidly sharing information around the world on infectious disease outbreaks and acute exposures to toxins that affect human, animal and planetary health. By providing early warning of outbreaks, public health precautions can be taken in a timely manner to prevent epidemic transmission and to save lives across the One Health continuum. ProMED has enabled ISID to uncover some of the most dramatic outbreaks in recent history – including publishing the first reports of Covid in 2019, Ebola in 2014, and SARS in 2003.
It is human-led and curated reports and commentary are provided by a global team of experts in a variety of fields including virology, parasitology, veterinary and plant diseases. The ProMED team is constantly scanning for, receiving and reviewing, evaluating and posting information concerning global health security to readers in almost every country in the world.
What impact do PHEIC declarations have on global responses and what are the dangers of downgrading these too early?
A PHEIC declaration is the strongest global alert the WHO can formally make and signals the need for a coordinated international response. Countries around the world are prompted to respond quickly, streamline funding, and accelerate the development of vaccines and diagnostics. The ultimate purpose of a PHEIC declaration is to kickstart action to limit the spread of emerging and re-emerging disease risks before they escalate to a pandemic.
Downgrading PHEIC warnings too early may result in a loss of urgency, funding and global collaboration in response to a disease outbreak. The danger of prematurely downgrading a PHEIC, is that after high income countries have brought them under control, infectious diseases often continue to devastate local communities in LMICs, just out of the media spotlight. Mpox is a prime example. Unlike Covid-19 that attracted international attention for four years, Mpox is at risk of falling down the priority ladder once the current news cycle ends, since most of those infected live in LMICs. This could result in new strains developing and recurring outbreaks a few years later.
What are the difficulties of treatment in LMICs?
The key difficulties include the high prevalence of other infectious diseases, the limited healthcare infrastructure, shortages of trained healthcare workers, as well as poor health literacy and the stigma attached to certain diseases. Another major challenge is political instability and conflicts that can devastate healthcare infrastructure, displace populations and disrupt the delivery of vaccines.
What changes can be made in local health systems in affected countries to help raise awareness?
Local health systems must prioritise building robust surveillance systems and foster a willingness to share and receive data on outbreaks with other countries for a coordinated response. Nations should consider involving experts beyond human health in their health strategies, for example veterinary and environmental experts. Recognising the interconnectedness of human health with the environment and animals – known as the One Health approach – is increasingly urgent in the face of climate change.
Finally, robust, tactical public outreach around infectious diseases is also important. Education around how diseases spread is imperative to ensure that people take appropriate action.
Do you think advancing technologies, such as AI, can help with predicting the spread of diseases?
AI can help in many ways, including patient education, screening, laboratory science and disease surveillance, but there is no substitute for the human touch in any of those areas.
Many centres are already using AI to provide targeted health education to both patients and providers, and this will only improve as the technology gets better.
What drives you to continue advocating for change in this area?
I have been very fortunate to have grown up in a rapidly developing Singapore, which is part of the dynamic Southeast Asian environment. This region faces tremendous challenges – such as the Nipah virus, enteroviruses, SARS, avian influenza – but, at the same time, it possesses a lot of energy and a will to develop the capacity to deal with infectious diseases at the local and regional level. Much of this could be replicated in other emerging parts of the world, and I am k een to share what I have learned, and continue to learn, from friends and colleagues across disciplines from around the world.
References:
- N. Madhav, B. Oppenheim, M. Gallivan, P. Mulembakani, E. Rubin and N. Wolfe, in Disease Control Priorities, Third Edition (Volume 9): Improving Health and Reducing Poverty, The World Bank, 2017, vol. 4, pp. 315–345. DOI: 10.1596/978-1-4648-0527-1_ch17
- B. McCloskey, O. Dar, A. Zumla and D. L. Heymann, Lancet Infect. Dis., 2014, 14, 1001–1010. DOI: 10.1016/S1473-3099(14)70846-1
- J. M. van Seventer and N. S. Hochberg, in International Encyclopedia of Public Health, Elsevier, 2017, pp. 22–39. DOI: 10.1016/B978-0-12-803678-5.00516-6
- A. Beaney, Moderna Mpox mRNA vaccine shows early promise in monkey study, https://www.clinicaltrialsarena.com/news/mrna-modernampox-study-monkeypromise/?cf-view (accessed 21 September 2024)
Dr Rachel Sully is senior formulation scientist at SiSaf
