Are We Ready for the Next Pandemic? - with Peter Piot

[Music] 100 years ago the world was very hopeful that the slaughter of World War 1 would come to an end and indeed a few months later in November there was the Armistice the end of World War 1 however the bad news nobody had anticipated including those who had survived in the trenches and so on was that the largest epidemic of modern times would hit the world the so-called Spanish flu the Spanish flu which killed more people than the whole of World War 1 and interestingly whereas World War one is in our collective memory my grandfather took us every year to the trenches to the poppy fields in Flanders where he had spent three four years and from Flanders Belgium but the Spanish flu is not remembered collectively not as a historic disaster and that's a quote from Laura Spinney a book I can highly recommend and that some called Pale Rider about the Spanish flu and how it changed the world when you look at it just here some fairly basic statistics you can see that there was a huge peak in mortality coming in actually three waves around starting in March 1918 and then a second much worse wave in autumn around the Armistice and then a third wave you know as you can see here in 1919 and it was devastating devastating also because it hit not only people who normally or usually die from influenza other people but also it was killing disproportionately young people young adults again the ones who came from the front now why is it called a Spanish flu there is a certain tendency in history in people to always blame others for a problem for some reason historic reason Naples is often blamed for all kinds of things syphilis gonorrhea also the influenza actually in Spain they called it the Naples disease and because of the war there was very heavy control censorship of Mews of the media there were no social media so it was fairly easy to you know to organize censorship and any bad news was not allowed to be published so even if it started the first you know cases came from actually from Kansas in in the US that you know in March 18 this is where the first known case occurred you can't find any trace of this in the popular media but Spain was not a party in in World War 1 so there the media were okay we're fairly free and so they were publishing about outbreaks in various Spanish cities and so it became the Spanish flu and but each country had a different name but just in Japan and in Japan the first victims were sumo wrestlers you know the very one and so it was the sumo disease the sumo influenza and and each country in Poland it was called a Bolshevik flue Enza etc etc that in itself is makes an interesting book and how you know how diseases are being named but basically what's the bad news you blame the others now also this was at the time when there wasn't disease surveillance there was not something like here public health England there was not even an understanding what the etiology what the causes of influenza it was thought to be Pfeiffer's bacillus which is a bacteria and which we know is not a cause of influenza which is a viral disease and so it was not so easy to come up with a definition or to know exactly what the you know what a disease how to define it and here you can see that one thing that we know and that is that it spread all over the world and you can see here a first wave in blue then the second wave and then you know we had an a third wave and just remember there was no commercial air travel in these days so in no time a virus spread all over the world where the fastest mode of transport was the Train but the movements of troops and also the demobilization afterwards helped and mass gatherings and celebrations of the Armistice and so on and religious festivals and just name it all that contributed but I still find it remarkable how how fast a virus could spread all over the world just by air because people have to breathe in the absence of what the kind of travel that we have now and so between 50 and 100 million people were killed you can say wow that's a big range and the reason for that is that there was no systematic recording of deaths in most countries the definition was not clear and so on but we know for sure that in some parts of the world and particularly when you're an island was affected by it you know up to 20% of the population could die and one example is the Western Samoa where about 22% of the population died and we you have it also not only in the in the South Pacific but you can see here the the enormous number of people who died all over the UK 250,000 now that was the immediate impact massive deaths hospitals couldn't cope cemeteries couldn't cope and it destabilized society but in a very acute way once it was over kind of life went back to normal kind of but not really because the Spanish flu had long term impacts as most epidemics the economic cost was huge but on the positive side it really woke up governments that oK we've got to do something is we have a responsibility you know for health and and that's kind of where the many European countries particularly that public health systems were built and were developed many orphans were left millions and millions of orphans and also interestingly it really nurtured a whole culture cult of nature living healthy lifestyles which was then afterwards captured by Nazi ideology and by communism so all this made that the Spanish flu had an incredible impact on society the responses were in these days were not based on much of scientific evidence even if the germ theory had been demonstrated by Pasteur and coke and so on you know several decades before in the nineteenth century it was not yet commonly accepted and also it was not so clear how this virus virus did people didn't know it existed was transmitted and but some things made sense isolation quarantine but like this hospital that you can see here you know actually probably also contributed to the spread of it because you there it's a mixture of people who actually have it and others know and and something that also appeared and this is for an image from Japan where today in Japan and also in some other Asian countries when someone has a cold or so people walk around with a face mask that started in these days so that's interesting that that the the origin of it is not to protect yourself but it's in in Japan today's you want to protect others whether that's effective is available depends on what it is so there was a massive but very uncoordinated approach and it led to as I said the birth of a lot of modern public health systems should also say that most people actually we know today died from from complications from pneumonia from bacterial pneumonia and a big difference with today is that there were no antibiotics then today we can treat most of them so and why was there a this Spanish flu why was this so lethal so fatal we know it's a an influenza virus in and influenza can be you know I've got all kinds of types it's a virus that mutates all the time and it's of the so called h1n1 a type but of a completely new type so that nobody had any protection no no protective immunity because the reason that every year we need a different influenza vaccine is that the virus has mutated a little bit and so that we need a vaccine with the new antigenic make up the new coat and so on that will then induce antibodies against the new strain and when that's a completely different a new strain that we have absolutely no not been exposed to that's when you can have this fatal and massive epidemic now epidemics have always been there and we've seen the Asian flu Hong Kong flu Russian flu avian flu swine flu and so over the years and actually every year we shouldn't forget that influenza kills tens of thousands of people that's kind of so-called normal but what may become the biggest epidemic of a modern times is still going on and that's HIV and I'll come back of that already more than 30 million deaths now epidemics okay my background is microbiology infectious diseases and I've always been fascinated by epidemics by microbes since I was a child but it's also catching the interest now of people dealing with investments and with risks here this is from the annual report of the World Economic Forum they publish every year a very interesting report is called the global risks report this from January this year and it's based actually on on surveys what people think and believe there's a risk an epidemics are always in so together with social instability you know food crisis water crisis etc cyberattacks and just name it so they have now they're no longer just in the field of Public Health and of microbiologists we also know today that the economic impact of epidemics can be huge and it's always as close to art as science to estimate what's the global impact in economic terms but yet it's fairly a precise one for example we had South's this is the first major new epidemic of the this millennium sound stands for severe acute respiratory syndrome it's a virus of say a few words about that that appeared in southeastern China and in Hong Kong was really devastating there the impact could be measured in in a very quite precise way and so you see we're talking about billions and a huge new Spanish flu type of epidemic would cause trillions of damage most actually of the the economic cost is not so much caused by direct impact of the of the epidemic I mean that's more medical cost and all that and life's lost and so on but it is that fact then epidemics destabilized society and in the case of Hong Kong for example ok GDP was hit by about 3 percent but you know tourism went down by more than 60 percent tourism and all visitors the you know food and transport and so on and this is what's what's happening now of course it's not just us human primates who are affected by epidemics farmers know this very well and and I like wine so why in his cell so there's been a defining epidemic caused by Felix Syrah also about well more than hundred years ago and which wiped out the the you know the vineyards in the old continent in Europe and fortunately they had planted some vines in California so we had we could reinforce that and and without that we would not have our good wines in from Europe but animals so epidemics are there all the time and it's not just limited to two people so and their economic impact can be enormous and it's one of the reasons for example that you know antibiotics are so widespread they used in animal husbandry and for economic reasons and would sometimes very negative impact in on people now I mentioned SARS epidemic in Hong Kong and Hong Kong illustrates what we are going to increasingly be confronted with and that is very high density you know populations dense populations like in Mongkok for those of you have been in Hong Kong is the most densely populated place on earth I can't remember then the number of thousands of people per square kilometre and that's where you know the SARS virus which is a corona virus is a whole family a new family that we know and it probably comes from bats that are really living happily with the corona virus but when it you know the virus is then introduced in a very dense population this is ideal and it can spread but secondly not only did it hit Hong Kong very well but someone traveled from Hong Kong to Toronto in Canada and cause then a new wave of epidemic they're killing tens of people in intensive care units and some and that's a big difference with the time of the Spanish flu even if I said okay it's spread all over the world in no time today that's a matter of hours and out of days travel that used to go by boat you know I don't know what would have taken to go from Hong Kong to Toronto in 1918 but that was probably more a matter of week or so or more than that got to cross the Pacific Ocean and then go by a train through the Canadian Prairies and so on so that's a that's one there was the first one where we saw okay it's no longer a local issue we need to care about other example is Merced see another corona virus infection that comes from camels and it's spreading in the Middle East mes Middle East respiratory syndrome and here a Korean businessman flew from Abu Dhabi to SIL capital of Korea and in field well went to an emergency room in the waiting room you know examined etc and then does something that is quite common in Korea is medical shopping and so when from one hospital to another and and that caused the death of about 50 people and I'm not saying the person is guilty but that's you know through overcrowding in in in you know in waiting rooms and in intensive care units again it's an epidemic that continues in the Middle East the Gulf states but then it could hit Korea and then finally these are all transmitted through you know through air through to breathing basically but then something happened that was also unexpected a few years ago in in Brazil there was a an epidemic caused by Zika virus now Zika is the name of a forest in Uganda near Entebbe it's actually owned by the Medical Research Council and because in the 40s in 1947 a virus was isolated from monkeys in in the Zika forest by the Uganda fires Research Institute while they were looking for a you know the ecology for the the spread of yellow fever vaccine and by accident they found this virus and it was a virus without a disease and you know as there are so many viruses and it took then about 70 years before it was clear that this was also a major risk to health and it caused a huge epidemic first in the Pacific Islands but then in particularly in Brazil and the biggest problem was okay not so much for adults because it gives you tanguay fever like syndromes in other words a bad influenza plus skin ration and and joint aches and so on but if you're pregnant the baby is born from mothers who are infected with Zika virus particularly during the first trimester are born with neurological complications and microcephaly so small brain small heads just like we've seen we we had here with rubella German measles before there was a vaccine today we don't know this anymore thanks to vaccines there is no vaccine against Zika the big difference with the previous epidemics is that this is transmitted by a mosquito by mosquito called Aedes aegypti that is also transmitted in yellow fever dengue chikungunya and because of climate change and warming is spreading you know you know it's fielder around the world now Ebola because Ebola is something that I spent some time on but also when you think of the two defining epidemics of our time it's not influenza which has killed so many people in still kills but in in the imagination in the media it is Ebola and it's AIDS these are the two defining epidemics and when I was much younger in 1976 my life changed when I was training training in microbiology in in the lab in Antwerp we received a blue service from Kinshasa which was the capital of what was then called a year now the Democratic Republic of Congo and it contained two glass files there was no plastic it was all in class and with a little note and asking is this yellow fever and it was blood from a Catholic missionary a nun who had died with what they thought was maybe yellow fever and the we did the usual things to isolate viruses these days was more like cooking it's like very artisanal you inject mice you put it on cells and so on and the new waits and then you look at an electron microscope and what did we see under the electron microscope was was this this image and we had never seen this so we had to go to the library this for the younger people there was no you know no we couldn't Google or whatever to go to a library and then you had to if you know what that is you know and then and go and then consult on applause you know with images and photos of viruses and we were lucky that we had all that and now Institute I was working in co-op comets in Antwerp and we saw that this looked exactly like Marburg virus now Marwick is a city in Germany where there they have vaccine manufacturing plants and we're making a polio vaccine and few years before about total of I think it was 30 people in Marburg and in Yugoslavia then Yugoslavia had died with Marburg virus infection while they were manipulating monkey kidney cells that had been infected with Marburg virus and coming from Central Africa so we thought it was that and then was a moment of panic and we got a telegram from the World Health Organization saying we should stop all research all investigations with these viruses because we did not have the containment I mean and we send it here in London to Porton Down and where there was a military lab with absolute maximum security what we call now bsl-4 level and there were only four labs in the world these days three were military one in the Soviet Union one in Fort Dietrich to the US and one here Porton Down and then one civil one that's at the Centers for Disease Control in Atlanta and it's in Atlanta at the Centers for Disease Control that they could demonstrate this was not Marburg but it was a new virus so so they really confirmed this was new so I was exciting but I was particularly curious to know what is this fire is doing to people how is it spreading you know and so on and and by the way the name Ebola is because viruses need a name is the name of a river that is flowing not too far from what was the epicenter of the first known Ebola outbreak in northrend Congo and noren see and it all started around a Mission Hospital you can see here and the calorie in the mind in a sense were five missionaries Belgian missionaries who died with it they were caring for patients the women and and this the priest had been caring for the death and and I'm mentioning that because it's such a remote area that it may not have been without them we may never have known and the we arrived there I I had never been to Africa and had zero experience in you know investigating epidemics so why on earth did I go there I was I was excited that because I saw this as a great opportunity and there were not that many people who were eager to go and there was not a yeah there was it's not like today where we have a quarry like it this country we have a rapid supporting we had volunteers during the Ebola outbreak in West Africa so I could go and this is the kind of protection that we had it was very primitive of paper gown motorbike goggles and latex gloves and that's it and yet we we couldn't really care for patients we try to do that but was we wanted to you know to do a few things one in an epidemic the most important type of information that you need is to know what's the cause of the epidemic and how is that in pathogen virus microbe were ever transmitted is it through water food insects sex blood air direct contact I mean the usual ways that viruses are transmitted and that there was a number-one priority because otherwise you don't know what you have to do and that's what's the situation in the Spanish flu 100 years ago people didn't really understand it secondly in science you always need confirmation we had one isolate and so we needed more samples from other patients to to confirm that this was indeed that virus was associated with this disease we also of course needed to take care of patients as much as we could but there was not much we could do frankly and lastly is of course was so-called stop the epidemic that was these were our terms of reference to use that bureaucratic term and it was also you try to define an epidemic in terms of three questions time place and person time how is it evolving over you know what's the epidemic curve for example we go to a picnic particularly with this kind of weather and you know the cream is is contaminated with staphylococci by by midnight everybody's on the loo or and say you know it's a it's a very acute type of weapon or norovirus and so on case of HIV slow spread because it's sex and all that and in here this is what we saw and we arrived actually to be totally transparent around here so when the epidemic curve was going down in other words the epidemic was already going out which is the best time to come in an epidemic and as an epidemiologist because people may think that it's thanks to your work but but ideally you want to come here but that means because then you can prevent that it goes up right these Peaks but that was not the case because very remote area and so on and so that was important to know we wonder okay why we did it go down here and what happened around this time about a week before is that the hospital in this remote area had been abandoned by patients people had said you know people died in those when they said there's something wrong with that Hospital and that was also confirmed in other ways one is that 11 out of 17 hospital staff had died too that the closer you would live to the hospital the more likely that you had Ebola and we also found that there was an excess of pregnant women and of women who were just and it turned out that all of them had gone to the hospital to the antenatal care unit or that the liver there and so all this put together without any computers or whatever and some very primitive statistics led us to identifying the mode of transmission because what was clear is that you needed very close contact with a patient with Ebola and I was any sense good news not so much for health care workers or family members but that meant that the risk of major spread was far more limited and but in addition to caring for a patient and having close contact there was something else that we found is that attending a funeral was very risky and the reason is that at a funeral or in the local culture people really take their time to say farewell to their loved ones it's actually a moving ceremony ritual and something that in our cultures we've forgotten we just don't want to deal with deaths and it's done left to professionals to clean the body and so on there it's done by the family now that's very moving but it's very risky because someone who dies with Ebola is covered with often with blood not always but but certainly vomit is diarrhea so in other words full of virus and that is a very risky moment also the one thing that we did not find in these days was that is also sexual transmission so that came later that came out of the work in in West Africa years later now since 76 have been many outbreaks all in Central Africa you know offer in ready bola and in blue Marburg two related viruses so around Congo in Gabon and Uganda and so on and and that was the dogma was this is a Central African thing because the viruses of our is most probably we still don't know for sure is a fruit eating but and by the way but are very special animals from a biological perspective and they hardly ever developed cancer they can harbor all kinds of viruses that kill in no time other animals so their immune system and their system for repairing their DNA and so which beats our DNA is constantly you know being degraded and so it's very remarkable i no know much about biology but but i've read a lot about it and it's absolutely fascinating we should study bats much more but then everything changed in 2014 when there were the first reports and there was in March 2014 that there was a bola virus infection in West Africa and and I was in three countries in addition Sierra Leone Liberia and Guinea and it started in we know today around Christmas in 2013 in a town called kakadu in a border town in guinea conakry but the borders are very artificial they come from colonial times and but people are you know crossing the border all the time they have relatives on the other side of the border they they marry with someone etc they're straight and so on and the roads are quite good which is a big difference from Congo and it took about three months to know that this was Ebola so first case on a 23rd of December we know today and labert become confirmation was on the 21st of March so a lot of precious time was wasted now Liberia and Sierra Leone just came out of very brutal civil war and leading to not only a collapse of society in general also professionals left the country infrastructure not there and so on so labs Guinea decades of corrupt dictators ship similar problem similar results and also you can only find what you're looking for nobody was looking for Ebola in West Africa but for other things so it was actually institut pasteur in you know in in Dakar in in in Senegal that they could prove that this was Ebola and then there was some you know a bit of support and all that but not really much and you can see how the cases started to build up in may/june and I remember and early July that I was interviewed by Christiane Amanpour of CNN and I said this is a really is completely different from what we've seen before three countries involved capital cities were only quote-unquote six hundred cases but said this is different this requires a state of emergency and special measures because we've never been confronted with it and after that interview I told my someone a flemish guy I was just not supposed to create panic soil usually we kind of try to you know just stick to the facts and I wonder maybe I exaggerated but unfortunately this is what was required in order to stop this epidemic and it's only in August so eight months five months after they the diagnosis that the World Health Organization declared that this was a public health crisis and that is a there's a specific term that then triggers international support and all that and that was a clear failure of global governance and that you know will have dramatic consequences and the first question that we thought was or maybe it's Ebola but maybe this is a different strain because Ebola has different types of Ebola and some are more lethal than others and maybe it's out okay this one that we didn't know that popped up but today unlike in 76 we can know in a few hours at most day whether a virus is identical or not from another one that we know and so you can do you know through gene sequencing we could we knew very rapidly on that this was a classic so-called Zaire strain so it was not a new virus and in this woman editorial in science magazine and so I said this is really it's about society and populations it was a perfect storm it was a perfect storm a virus that was unknown people had no experience with it but entering countries that were not prepared for any shock Liberia for example had 51 registered physicians you know for a population about 5 million Sierra Leone a few more getting much more no infrastructure also a total distrust of what authorities would say when you come out of civil war and the government says we have an epidemic pizza or maybe because we were in the opposition and we were you know and they want to do that they have an agenda and so on also norms and beliefs about transmission of disease were also very different so and then the great delay in action in epidemics what's crucial is act early and the reason is because by definition people are always infected by somebody else so if you can prevent and the development of an epidemic very early on you're not only preventing the next case but also then several generations and that's what what did not happen and it led to major social unrest because life came to a standstill okay hospitals were closed women who had to deliver know where to go you break your you know your leg have an accident all you know life goes on no care but also schools are closed university was closed Commerce came to a halt some point of his harvest season the farmers couldn't sell their commerce and to make things worse airline stopped flying into these countries and so that was also a major disaster and you know the countries are living the main economies they're driven by mines mining and the price of commodities was going down etc so it was really a major social issue an economic issue and some people were even killed during these riots and also journalists and nurses who were going to come to work were killed sorry now at the end of the day the epidemic stopped eleven thousand people were killed thanks to heroic efforts from people on the ground local people but also major support from elsewhere and UK was really at the forefront we concentrated on Sierra Leone for historic reasons Americans on Liberia and the French on Guinea that's still part of history today and we had lots of volunteers coming through public health England to nurses and doctors and so on and in the end of August or early September I sent a note to an email to all staff at the London School of Hygiene Tropical Medicine and I said this is a crisis going on humanitarian crisis public health crisis it's our duty to support and I encourage everybody to volunteer and we had in 48 hours more than 400 volunteers out we were then about 1,500 people and I it was my proudest moment because I know that people are here for a reason not everybody could go of course but it was people from the IT department from communications from of course from the labs and some and when you think of it epidemics what you need I mean it's the medical care sure but it's coordination it's logistics it's communication that's why also the Armed Forces was so important to to to contribute and to come in and that was the case in Sierra Leone with the UK and forces and in Liberia Americans now a silver lining on all this was that for the first time ever in such a dramatic outbreak there was actually some research was done social science research was mathematical modeling and so on but also you know therapeutic and vaccine related research so so we could evaluate are some of the experimental therapies do they work do they protect and the answer was in general either no or we don't know because the number the sample size was to show too small but the major I think advance was particularly on the vaccine field thanks to actually funding from anti bioterrorism funding from particularly coming from the military in the US and also from in Canada from the Public Health Service some experimental vaccines existed jsk had one Johnson and Johnson Johnson and Merck and the Merck vaccine was evaluated in guinea in so-called ring vaccination where the vaccine was given the contacts of someone with Ebola and then was a trial design our school developed a trial design and it showed it demonstrated that it was really highly highly effective to stop the spread of Ebola and in in Sierra Leone our school continues to work on another vaccine that's particularly aiming at protecting healthcare workers and the general population because imagine if you can put the healthcare worker you don't need to have this incredibly cumbersome you know protective clothing and so on and you wouldn't have this absolute disaster in healthcare workers more than 500 were killed during the world the West Africa outbreak 500 healthcare workers in countries that already have a shortage so the lessons were that a perfect storm can generate major epidemics even in the past it was more to that you have to act early public trust is absolutely key you know it's not a bunch of experts that's gonna you know solve the problem if public is not you know doesn't have confidence we saw new clinical features for example sexual transmission and all that there was a real failure of global governance but R&D was possible now today as we speak there is an outbreak of Ebola going on in again in DRC and I would say this good news one being a swift response by the Congolese it's one of the most disorganized countries in the world I think I've worked there and but yet they've got experience they can make diagnosis in Kinshasa and they act immediately led by the Minister of Health himself and the World Health Organization and MSF Doctors Without Borders where they are very proactive the advantage was that it's in a very remote area hard to reach when you see that makes it tough to get there but also it makes it tough to get out you can only get in with bicycles or motorbikes or helicopters even a four-wheel drive doesn't get there so and that means that it's been contained and vaccines have been used for the first time so I'm quite optimistic that we will see the break coming to an end soon now it's when you look at most epidemics in today's world and we know that from the deployment of the rapid support team of the UK that are actually linked to humanitarian crisis Yemen where there's a yeah absolutely bloody civil war going on or and not only Civil War but with lots of international players there have been the largest cholera epidemic ever more than a million cases South Sudan the same when the raw hinga were massively displaced and killed in Burma and went to Bangladesh there was big outbreaks of bacteria and other vaccine preventable diseases indicating that they had not been protected so we can expect more and more because with the increase in in integral in humanitarian crisis now the final epidemic I'm going to talk about before also trying to answer the question are we ready is a new situation and that is when an epidemic becomes endemic epidemic is when you see a continuing increase in cases endemic is that when there is there are new cases and it stays a more or less of the same level it's simmering and that's the case for HIV HIV came out of the blue in and was the first cases were diagnosed in 1981 six gay men in California and it was thought to be a gay disease which I never understood why a virus would care about the sexual orientation of a human host because what's the purpose in life of a virus it's finding a host so it can survive and the sex between humans is yeah that's the way to do it in this case but so all of these six or eight initial cases cumulatively 70 million people now over seventy million people have become infected all connected with each other because only sex can transmit it or contact with blood blood transfusions sharing of needles or because your mother had it when you were born and that gives a new idea of blood relatives and also of what's going on in the world more than 70 million people connected underground and it really got out of control particularly in some African countries but it was a massive response it really around millennium gave rise to what we call today Global Health a combination of activism of people in our country so in in the gay community but also like in South Africa here see there were massive movements of people living with HIV South Africa which is now six million people living with HIV and you know and because within HIV D the time between infection and that you become ill can become can be as long as 10 years so there's time to yeah to agitate so we had massive mobilization we came on the world's attention through the UN and so on and I was then head of UN aids you an even created a body to to coordinate the fight against HIV and thanks to these massive efforts and also a scientific breakthrough because in 1996 it was shown that you can treat HIV if you combine three different drugs and why do you need three different drugs because like influenza it's a virus that mutates all the time and so the risk that it becomes resistant if you gives just one drug is enormous but with three statistically is the risk is much much lower and and that was a changed completely the game in high-income countries in the NHS you know in September these drugs were available I was announced in July so in three months time and people survived it was no longer a death sentence it changed how we looked at this epidemic however the price was far too high was bought in US dollar terms $14,000 per person per year and that was out of reach for most people in the world where there isn't a an insurance system or where they had to pay it out of pocket and most of the patients were actually in living in low and middle income countries and here you see that how the price of these drugs of one year treatment in Uganda dropped from twelve thousand dollars to what it is now about three hundred in other words a dollar a day and that's a something that I became absolutely obsessed with that to lower that price but also at the same time making sure that innovation continues because we need new drugs because development resistance is derived and so over the years the number of people on therapy went up and we are now well above twenty million and these twenty million people would have been dead without these these drugs hence the headlines the end of AIDS and UN even said that by 2030 the epidemic will be out don't believe that that's not going to happen there isn't there are major achievements with those successes see a decline of 50 percent in mortality new infection going down but still 2 million new infections per year in the world 2 million including here in London although it's also gone down so we are counting in a in a situation where it's no longer that epidemic but we see everyday the same level of infections now what do all this epidemic self in common Ebola influenza you know HIV and that is that their so-called zoonosis a zoonosis is a an infection that affects us better comes originally from other animals and HIV comes from chimpanzees originally you see bats that are you know our reservoir for several quite a few viruses corona viruses and probably ebola influenza there's a whole panoply of animals from you know particularly poultry that where the virus is yeah living in and and can mutate ree-ree combine and then when it jumps to people that's when you get this epidemic so these are zoonosis and that's why even if we are being quite successful in bringing down infections infections eases in in in general people in our countries die from cardiovascular diseases diabetes and so on and cancer not from infections although it's sometimes pneumonia that is the final hit you know and old age particularly but it is a combination of urbanization so high-density populations enormous mobility you know climate change that increases the spread of several insects mosquitoes that transmit diseases infections conflict deforestation food demand population growth all that makes that we will be a be exposed to more and more of these emerging infections the risk is getting bigger and then there is one man-made type of epidemic that we are confronted with and where we say the UK particularly led by James Sally Davis the chief medical officer and Lord O'Neill you know they've drawn the world's attention that there is a real threat of antimicrobial resistance because of overuse and misuse and abuse of antibiotics which would mean if it if this materializes that we are confronted with untreatable infections now what about the future okay going towards the end when I was in my final year in medical school I went with something that we call today career counseling but I don't think that term existed then and it's and I wanted to work on infectious diseases and infections and my professor said no future in infectious diseases don't we have antibiotics though we have vaccines don't we have sanitation and it was also thought in these days that you could not treat in viral infections because in order to kill the virus you would have to kill the cell in other words the host today we know that that's wrong and yet I went for it but after the Ebola outbreak in West Africa in 2014 there was a an outbreak of panels to review what went wrong and I co-chaired one with Harvard University and we all came to the same conclusions and the conclusions was that the first thing that's most important one that there will be more epidemics to the risk in the world is is increasing but that the the most important thing is the local capacity for early detection and early response it's not a global response that we see in the newspapers and all that and but that's not there so we have to invest in that that double yet show the World Health Organization was not fit for purpose and needed to become far more child responsive and so on that we need to engage with people on the ground when all this is not rocket science but that's the way there was also a really bad behavior by scientist by Public Health in organizations not sharing samples not sharing data in the midst of an epidemic which is vital to have very rapid and real-time information and finally that we need a system for developing therapies and vaccines where there's no market incentives no pharmaceutical companies gonna make big money with a vaccine against Ebola or whatever this you know there's no market and yet in this case certainly when J&J American and and GSK all invested in this with and knowing very well that they're not gonna make me much profit out of it or no profit at all I would say so what has happened since then have we made progress the answer is yes one I think very important is that this kind of epidemic what's now called global health security a new term now is now on the top agendas of the g7 g20 World Economic Forum and so on so I think that's important because also that may lead to money we have also the UK has established the all UK public health rapids support him that is a hybrid between public health England which is part of the Department of Health and Social Care and the London School of Hygiene tropical medicine academic institution so that we can be deployed rapidly it's about twelve people at the moment they're in in Congo but they and one of the concerns that we or that some people had was what are they going to do in between two epidemics the government was concerned that they would be people paying people for doing nothing we will say but the reality is that they've not been without two weeks of an epidemic and that actually burnout is now the biggest issue because people have to go from here to there so we are now expanding that to a network of volunteers and they've been in in many countries in just in one year also on the R&D front good progress we have the so-called coalition for epidemic preparedness innovation sepi which brings together big pharma governments NGOs small pharma academia and to invest in vaccines where there's no market incentive and here are the priorities and we put that together in a good year which is also a record now another issue that we have we have vaccines we have science and then paradoxically we have also a growing a God could save an epidemic in some country of skepticism forward science vaccines and you know part of fake news which led to a collapse in vaccine coverage since quite a few countries here we had the Wakefield episodes that we're over that but there are others and so the final question is what is there going to be the next big one if you give a talk like this in California everybody knows the bait then the big one is big earthquake which will wipe out Silicon Valley among other things but it will happen we don't know when and the same is true for a big epidemic of a respiratory virus influenza or another one that mutates all the time and the risk is enormous you know we were 1.9 billion people in 1918 we are seven six one six today huge mobility but we have epidemics antibiotics and we have we're much better organized now so I think that the answer to the question is yes and no we the risk is increased but I think we are definitely better prepared but the key is to invest in countries and it's a final slide like this is now four years ago when for - for my 65th birthday my wife Heidi and I we went to where the first epidemic had happened in young buku I wanted to see what was happen in the meantime and so on and after that first outbreak there was a meeting hosted by the World Health Organization and where many promises were made we will never let this happen again it's like after every war we will strengthen the systems we will build capacity I mean you can just make a whole list and when we came there it was really depressing the hospital was in worst state and before this man you can see their Cecotto he's a survivor of Ebola from 76 he runs the lab the only decent the equipment is this la is this microscope this is the centrifuge that people had no money so they leave their bicycle to have drugs and so on so the lesson is that that's something that we should not let happen and this is why it's important that we have this international solidarity to use that old-fashioned world because in today's world an epidemic an outbreak 5,000 miles from here can affect this tomorrow so thank you very much if you want to know more visit us [Applause] [Music]

Channel: The Royal Institution

Views: 317,054

Keywords: Ri, Royal Institution, peter piot, lecture, pandemic, globalisation, medicine, disease, epidemiology, disease prevention, friday evening discourse

Id: en06PYwvpbI

Length: 61min 55sec (3715 seconds)

Published: Wed Oct 24 2018