We’re joining over 30 global health bodies in calling for all research data gathered during the Zika virus outbreak, and future public health emergencies, to be made available as rapidly and openly as possible. It follows a consensus statement arising from a WHO consultation in September 2015, in which leading international stakeholders affirmed that timely and transparent pre-publication sharing of data and results during public health emergencies must become the global norm. The statement is published in full below:
Statement on data sharing in public health emergencies
The arguments for sharing data, and the consequences of not doing so, have been thrown into stark relief by the Ebola and Zika outbreaks.
In the context of a public health emergency of international concern, there is an imperative on all parties to make any information available that might have value in combatting the crisis.
We are committed to working in partnership to ensure that the global response to public health emergencies is informed by the best available research evidence and data, as such:
- Journal signatories will make all content concerning the Zika virus free to access. Any data or preprint deposited for unrestricted dissemination ahead of submission of any paper will not pre-empt its publication in these journals.
- Funder signatories will require researchers undertaking work relevant to public health emergencies to set in place mechanisms to share quality-assured interim and final data as rapidly and widely as possible, including with public health and research communities and the World Health Organisation.
We urge other organisations to make the same commitments.
This commitment is in line with the consensus statement agreed at a WHO expert consultation on data sharing last year whereby researchers are expected to share data at the earliest opportunity, once they are adequately controlled for release and subject to any safeguards required to protect research participants and patients.
Signatories to the Statement
Academy of Medical Sciences, UK
Bill and Melinda Gates Foundation
Biotechnology and Biological Sciences Research Council (BBSRC)
The British Medical Journal (BMJ)
Bulletin of the World Health Organization
Canadian Institutes of Health Research
The Centers for Disease Control and Prevention
Chinese Academy of Sciences
Chinese Centre for Disease Control and Prevention
The Department of Biotechnology, Government of India
The Department for International Development (DFID)
Deutsche Forschungsgemeinschaft (DFG)
The Economic and Social Research Council (ESRC)
Fundação Oswaldo Cruz (Fiocruz)
The Institut Pasteur
Japan Agency for Medical Research and Development (AMED)
The JAMA Network
Médecins Sans Frontières/Doctors Without Borders (MSF)
National Academy of Medicine
National Institutes of Health, USA
National Science Foundation, USA
The New England Journal of Medicine (NEJM)
South African Medical Research Council
UK Medical Research Council
ZonMw – The Netherlands Organisation for Health Research and Development
Our fortnightly round-up of news from the Wellcome Trust community…
Calling the shots
A Hib booster is not necessary for toddlers to extend immunity into later childhood, according to new research carried out at the KEMRI-Wellcome Research Programme in Kilifi, Kenya.
The 15 year study confirms that the spread and infection of the bacteria Haemophilus influenza type b (Hib) – which causes life-threatening infections such as meningitis, sepisis and pneumonia – is under control in Kenya.
The research, published in Lancet Global Health, suggests that bacteria in the environment similar to Hib may provide a natural boost to the immune system, even though the Hib bacterium has stopped circulating in the community.
While most high-income countries offer an additional booster dose of the Hib vaccine, Kenya has followed the World Health Organization’s regime of no booster dose.
Between 2000 and 2014, researchers funded by the Wellcome Trust and Gavi, the vaccine alliance analysed blood samples from over 38,000 children. They found that the vaccine reduced the chances of Hib by 93%.
The researchers also identified that eight years after the vaccine was introduced, 79% of children in the disease risk group (4-35 months) had antibodies at levels indicating long-lasting protection.
Dr Charlie Weller, Vaccine Strategy Lead at the Wellcome Trust, said: “The Hib vaccine is a public health success story for Kenya and a powerful example of the positive impact that long term vaccination programmes can have on the health of a population. By evaluating the vaccine over a long period, the researchers have highlighted that children can have slightly different levels of response to the same vaccine in different countries. We can now use this data to inform the most appropriate vaccine schedule for each country.”
Who do you think you are?
Ancient DNA have revealed that approximately a third of British ancestors were Anglo-Saxon migrants, according to new research published in Nature Communications.
Researchers analysed ancient skeletons, comparing their genomes to modern-day sequences using a new analysis method. They found that Anglo-Saxon migrants were genetically very similar to modern Dutch and Danish, and contribute a significant proportion to the DNA of modern British people.
The skeletons were excavated from burial sites near Cambridge and have been carbon dated, proving they were from the late Iron Age (approximately 50BC) and the Anglo-Saxon era (500-700 AD).
While previous DNA studies – which relied entirely on modern DNA – suggested Anglo-Saxons contribute anything between 10 per cent and 95 per cent to the population, this new technique proves how integrated the people of Britain were.
To accurately distinguish between the genomes of northern European populations, researchers developed a sensitive new method called rarecoal, which can identify subtle genetic traces in individuals using rare genetic variants identified in hundreds of present-day people.
Dr Stephan Schiffels, first author from the Wellcome Trust Sanger Institute, Cambridgeshire and the Max Plank Institute in Germany, said: “By sequencing the DNA from ten skeletons from the late Iron Age and the Anglo-Saxon period, we obtained the first complete ancient genomes from Great Britain. Comparing these ancient genomes with sequences of hundreds of modern European genomes, we estimate that 38 per cent of the ancestors of the English were Anglo-Saxons. This is the first direct estimate of the impact of immigration into Britain from the 5th to 7th Centuries AD and the traces left in modern England.”
Using painkillers in pregnancy could reduce fertility in the next generations, Wellcome Trust-funded research suggests.
The study, conducted in rats, found that when a mother was given painkillers during pregnancy her female offspring had fewer eggs, smaller ovaries and smaller litters of babies compared to those not exposed to the drugs.
Although it is difficult to extrapolate these results to pregnant women, researchers suggest that the similarities between reproductive systems of humans and rats make these findings significant.
Two painkillers were tested in pregnant rats – paracetamol and indomethacin (a prescription-only drug in the same class as ibuprofen and aspirin).
Scientists found that subsequent generations of rats were also impacted by painkillers taken in pregnancy, with females having altered reproductive function.
It is thought that some painkillers might affect the development of germ cells (the cells that create eggs and sperm) while a foetus is in the womb.
Professor Richard Anderson, Elsie Inglis Professor of Clinical Reproductive Science, who co-led the study published in Scientific Reports, said: “These studies involved the use of painkillers over a relatively long period. We now need to explore whether a shorter dose would have a similar effect, and how this information can be usefully translated to human use.”
In other news…
Last week, the World Health Organization declared the Zika virus is a public health emergency of international concern, due to its probable link with microcephaly. We’ve posted an explainer about the disease, and how the Wellcome Trust is working with partners in this area.
The Human Fertilisation and Embryology Authority (HFEA) in the UK approved a research application for new gene editing techniques on human embryos. The research will be led by Dr Kathy Niakan at the Wellcome Trust-funded Francis Crick Institute.
Congratulations to Wellcome Trust-funded researcher Dr Andrew Muinonen-Martin for winning a publication award by La Fondation La Roche-Posay for his work on melanoma.
Congratulations to writer and director Julian Simpson for winning the 2016 Tinniswood Award for his Wellcome Collection-inspired audio drama Fugue State.
Today is International Day of Zero Tolerance for Female Genital Mutilation. To mark the day watch our new audio slideshow which explores the stories behind some of the girls and women who have undergone this procedure or who themselves perform it on others. Find out why one woman voluntarily chose to have this done and what motivates some of the women who continue to perform this on others.
Female genital mutilation (FGM) is the intentional alteration or injury to the female genital organs for non-medical reasons. It offers no medical benefit and yet in spite of being illegal in many countries is still widely practiced today. It is often performed on young girls and children for a variety of social, cultural and religious reasons and is internationally recognised as a violation of the human rights of girls and women.
Our audio slideshow is narrated by and features the work of Nancy Durrell McKenna, an award winning photographer and filmmaker, and long-standing contributor to Wellcome Images. She is Founder Director of the charity SafeHands for Mothers who work to improve maternal and newborn health by using the power of visual imagery to inform communities and educate frontline healthcare workers. In the audio slideshow meet Beatrice, a young woman in Uganda who has chosen to undergo FGM after moving into her husband’s community. Hear what motivated her to make this perhaps surprising decision. Also meet Medina, a traditional circumciser in Djibouti who explains why she continues to provide this service to the women in her community.
Approximately 140 million girls and women are currently living with the effects of FGM as the practice continues globally in parts of Africa, Asia and the Middle East and among diaspora communities. Long-term complications include incontinence, infertility, psychological trauma and the need for later surgeries.
To see more of Nancy’s images or to licence any of these photographs, see her collection on Wellcome Images.
Wellcome Images is one of the world’s richest and most unusual collections, with themes ranging from medical and social history to contemporary healthcare and biomedical science. All our images are available in digital form so please click the link above if you would like to use any of the pictures that feature in this post, or to quickly find related ones. Many are free to use non-commercially under the terms of a Creative Commons licence and full details of the specific licence for each image are provided.
A new exhibition opened at Wellcome Collection this week. ‘States of Mind: Tracing the Edges of Consciousness’ explores our understanding of the conscious experience from different perspectives. Calum Wiggins, a graduate trainee at the Wellcome Trust, has picked out a painting from the exhibition as our Image of the Week.
Henry Wellcome was an avid collector. Not content with gathering objects already in existence, he would also commission artworks to fill gaps in his collection. Wellcome wanted to have a representation of each of the important moments in this history of medicine and this watercolour was one of many painted by Richard Tennant Cooper at his request.
The disconcerting scene is the artist’s interpretation of the effects of chloroform on the human body. Demons armed with both surgical and musical instruments surround the man, holding him still and stimulating his senses.
Painted in the early 20th century, the largest demon sat on the man’s chest is reminiscent of the incubus sat on the woman in Henry Fuseli’s painting, ‘The Nightmare’, from 1781. In Fuseli’s best-known work the presence of the incubus is believed to represent sleep paralysis; with the demon’s weight preventing the woman from moving. A preparatory drawing for ‘The Nightmare’ is on show in ‘States of Mind’ too.
Another comparison that can be seen with Cooper’s painting in the exhibition is with Aya Ben Ron’s ‘Still Under Treatment’. Filmed in 2005, it captures patients being administered anaesthetic and slipping into unconsciousness. The demons are replaced by the doctors and nurses controlling the patients’ states of consciousness and manipulating their bodies once the drugs have taken hold.
Cooper’s watercolour shows the fears which surrounded anaesthesia at the time it was created. Although ‘Still Under Treatment’ demonstrates the mystery still associated with this aspect of medicine, nowadays our understanding of anaesthetics and their effect of the body are helping us to better understand our wider conscious experience.
‘States of Mind: Tracing the Edges of Consciousness’ at Wellcome Collection will be open until 16 October and is free to visit. It will feature a series of changing installations, beginning with Imogen Stidworthy’s The Whisper Heard. You can join the conversation on Twitter using #StatesOfMind and add to our collective consciousness.
Image: An unconscious naked man lying on a table being attacked by little demons armed with surgical instruments; representing the effects of chloroform on the human body. R Cooper. Wellcome Library, London.
It’s a Leap Year – what will you do with your extra day this February? Why not check out one of these fantastic Wellcome Trust supported events?
Nobody’s Home – UK tour – 12th February-28th May
Set in a bathroom, Nobody’s Home follows a soldier’s journey through his own mind, as he struggles with the monsters of his past to finally come home. Theatre Temoin and Grafted Cede present a striking exploration of PTSD in a modern retelling of Homer’s Odyssey, funded through the People Awards. The next tour date is at Bridport Arts Centre in West Dorset on 12th February.
The Encounter – Barbican – 12th February-6th March
In 1969, photographer Loren McIntyre became hopelessly lost in a remote part of the Brazilian rainforest, testing his perception of the world and the limits of human consciousness. Threading scenes of his own life with details of McIntyre’s journey, Simon McBurney incorporates objects and sound effects into this solo performance to evoke a rainforest landscape. Transmitted direct to the audience through provided headphones, the show questions our perceptions of time, communication and our own consciousness. Supported by a Small Arts Award.
The Misfit Analysis – VAULT Festival, London – 2nd-6th March
After a sell-out run at Edinburgh Festival Fringe and appearances on BBC 1, The Misfit Analysis comes to London. Cian Binchy has taught all the actors on The Curious Incident of the Dog in the Night Time how to be autistic. Journeying through his mischievous mind, Cian takes us through a world of wheelchairs and blow up dolls in an unconventional exploration of an autistic mind. Supported by a People Award.
Meta – Canada Water Cultural Space, London – 8th-9th March
This Forum Theatre show was developed with students from the borough of Tower Hamlets. Neuroscientific findings are shared through physical theatre, video projection and sound design giving an insight into what happens to our brain (and the rest of us) as we grow up. Funded through the Large Arts Awards.
RUFF – Barbican – 14th-16th April
Performance artist Peggy Shaw ruminates on life before and after the stroke she had in 2011, delivering a freewheeling monologue with deadpan humour and arresting honesty. There are dark spots and blanks in her memory now. Yet in paying tribute to the family, friends and performers who have inspired and kept her company over the years, she reflects on what is lost and equally celebrates the space left behind for new insight. Funded by a People Award.
What’s in Your Head? – Southbank Centre – 6th February
Explore how the pioneering new area of neuroscience has unlocked our understanding of what’s in our head. Poet and Wellcome Engagement Fellow Lavinia Greenlaw joins consultant neurologist Dr Suzanne O’Sullivan; Dr Dean Burnett, author of The Guardian’s ‘Brain Flapping’ column and forthcoming book The Idiot Brain; and consultant psychiatrist Dr Sukhwinder S Shergill for a talk as part of Southbank Centre’s ‘Changing Minds’ festival.
Passing Encounters: The dead body and the public realm – UCL Institute of Archeology – 6th February
Passing Encounters brings together artists, historians, sociologists and forensic anthropologists to discuss their work on the science, philosophy and representations of the human corpse and decay.
Curated by French & Mottershead as part of their Afterlife Small Arts Award.
An Evening of Lust, Sex and Brains – Book Club, London – 8th February
Join Guerilla Science for a multisensory exploration of human attraction. Discover how your senses, brain and body react when you meet a special someone and investigate the science behind those magical moments. Guerilla Science are supported by a Society Award.
SMASHfest UK – Deptford – 18th-20th February
The science and arts festival returns to Deptford, featuring performance, art, multi-platform digital media and trans-media storytelling developed in partnership with major cultural and scientific institutions. The full programme will be announced soon. Supported by a People Award.
Curing Perfect Lab – 68 Middle Street, Brighton – 19th February
Curing Perfect is an interactive online graphic novel which challenges users to think about the nature of perfection. What would a world of perfection look like and what role do gene and stem cell biology have in this? Have a go at some playful tests at this drop in event and join in the online game. The event is part of the Brighton Science Festival and is supported by a Small Arts Award. Curing Perfect is a trans media arts project that fully involves learning disabled people in the creative process.
Timeless – London shop tba – 29th February-5th March
Timeless is a fictional beauty brand and learning experience, created in response to growing public interest in social egg freezing. Popping-up in a busy London shop to engage people with the topic of fertility and how egg freezing may impact the world of work, relationships and wider society, Timeless will bring the medical and social issues around this sensitive subject to life through the language and products of a beauty store. Funded by a People Award.
A.R. Hopwood’s False Memory Archive Anthology – available on Amazon
“My Dad feels like he remembers the great smogs in London in 52 but he wasn’t born until 1958. I feel like I remember Live Aid 85 but I wasn’t born until August 1985 – one month afterwards!” Since 2012 the artist and Wellcome Engagement Fellow Al Hopwood has been collecting ‘false’ and ‘non-believed’ memories from the public as part of his national touring exhibition and events series, The False Memory Archive. This anthology features reflections on the archive from renowned psychologists Professor Elizabeth Loftus and Professor Christopher French.
Letting in the Light – The Grove, Stratford – until 24th March
As part of their People Award, Daily Life Ltd presents an exhibition of work by thirty-five artists, illuminating our understanding of the experience of mental distress. The exhibition is made up of artworks selected through an open call process and features artists with personal experience of mental health issues. The works are presented in the hope of brightening up the dark winter months with wit, beauty, insight and creativity.
Daria Martin: At the Threshold – Maureen Paley galley, Bethnal Green – 30th January-13th March
At The Threshold is the second of three short films by Daria Martin and is inspired by Martin’s research into a form of heightened physical sensitivity called mirror-touch synaesthesia. It uses the 1950’s film genre of melodrama to frame a domestic drama involving a synaesthetic boy and his mother, whose enmeshed relationship is shaken by a third party. Funded by a Small Arts award.
Silent Signal – QUAD, Derby – 6th February-6th March
A newly commissioned exhibition funded through a Large Arts Award, featuring six new animations. Each is produced through a two-year collaboration between an artist and a scientist, that explore the signals that enable our bodies to operate and adapt to fight disease. View a trailer here.
The Demiurge – HOME Gallery, Manchester – 6th February-10th April
AL and AL’s new film The Demiurge is inspired by Francis Crick’s Panspermia theory on the origins of life. Starring actress Sophie Linfield, the film is funded through the Small Arts Awards and is part of the Incidents of Travel in the Multiverse exhibition.
Under the Microscope – Great Ormond Street Hospital – 10th February-10th April
Over 12 months artist Sofie Layton has been working in partnership with GOSH to explore how children and families interpret medical information and understand disease. The Small Arts Award-funded project culminates in a series of installations and artworks developed by Sofie, displayed in the Octav Botnar Wing of GOSH and at the Institute of Child Health.
Brain Zone – Centre for Life, Newcastle – from 25th March
This new Capital Award funded zone at the Centre for Life will feature new exhibits and activities around how the brain works and how it controls so many of your body’s functions. There will also be opportunities to take part in experiments to help scientists with their research.
Wellcome Collection Events
States of Mind: Tracing the edges of consciousness – 4 February – 16 October
This evolving exhibition will examine perspectives from artists, psychologists, philosophers and neuroscientists to interrogate our understanding of the conscious experience.
Exploring phenomena such as somnambulism, mesmerism, and disorders of memory and consciousness, the exhibition will examine ideas about the nature of consciousness, and in particular what can happen when our typical conscious experience is interrupted, damaged or undermined.
States of Mind: Tracing the edges of consciousness will feature a series of changing installations. The first one will be The Whisper Heard by Imogen Stidworthy, from 4 February until 24 April. Find out more about this and future installations.
Tibet’s Secret Temple: Body, mind and meditation in Tantric Buddhism – until 28 February
Tibet’s Secret Temple explores Tibetan Buddhist yogic and meditational practice and their connections to physical and mental wellbeing.
This exhibition is inspired by an exquisite series of 17th-century murals from a private meditation chamber for Tibet’s Dalai Lamas in Lhasa’s Lukhang Temple. By bringing the mural images together with a unique set of objects, Tibet’s Secret Temple uncovers previously unseen stories behind the ancient, esoteric and once-secret practices illustrated in the Lukhang murals and shows their relevance to the expanding and wide-ranging contemporary interest in meditative wellbeing.
Friday Late Spectacular: Feeling Emotional – Friday 5 Feb, 19.00–23.00
Express your funny feelings through laughter therapy, witness a ‘toddler’ robot modelling human emotional development, experience live performances, design your own emoji, or attend one of our evening talks.
Body of Essays – Monday 29 Feb, 18.30–20.30
Body of Essays invites five writers to ruminate on a different organ of the body. Each will read their own 15-minute essay, being recorded for broadcast as part of BBC Radio 3’s series The Essay.
Packed Lunch: Insomnia – Wednesday 24 Feb, 13.00–14.00
Many people experience insomnia at some point in their lives. Güliz Özcan hopes to unravel the role of amyloid β, a critical protein in Alzheimer’s disease, in the sleep–wake cycle. Hear more about the latest research into what makes us sleepy.
Saturday Studio: Life Drawing – Saturday 27 Feb, 14.00–15.00, 15.00–16.00, 16.00–17.00
Aged 14-19? Drop by to try out or develop your skills at drawing the human body in our life drawing sessions led by London Drawing. All materials will be provided and there will be a nude life model.
Level Up Human – various venues – 17th February-7th April
Join Simon Watt and guests for the live recording of an exciting new podcast series at the following venues, funded by a People Award – check the venue links nearer the time for more details.
Brighton Science Festival – 17th February: with guests Robin Ince, Kat Arney and Jules Howard
Smashfest London – 18th February: guests TBC
Northern Ireland Science Festival – 25th February: guests TBC
Royal Institution – 11th March: guests TBC
Edinburgh Science Festival – 7th April: with guests Susan Morrison, Aubrey de Grey
Death: The Human Experience – Bristol Museum & Art Galley – until March 2016
Hundreds of diverse objects – from a Ghanaian fantasy coffin to a Victorian mourning dress – reveal captivating stories from across the world, from the earliest human societies to modern day.
A programme of events will be running alongside the exhibition:
Death: Is it your right to choose? – 23rd January-13th March: An installation of a room at the Dignitas flat near Zurich and surrounding displays relating to Assisted Dying.
Death Professionals in Conversation – 5th February, 5.30-7.30pm: A funeral celebrant, a crematorium manager, a palliative care doctor and a mortuary manager will answer your questions about their work in an informal discussion about life and death.
What is a Good Death? – 20th February, 2-3.30pm: The husband and friend of Maggie Roebuck, who ended her life in Switzerland two years ago, discuss her story.
Radical Life Extension: When being 300 is the new 40 – 27th February, 2-3pm: John Troyer, Director for the Centre for Death and Society explores the contemporary politics and bioethics of an extending lifespan and having a body that might never ‘die’.
Death Fair – 5th March, 10am-5pm: A day of activities including a shroud wrapping demo, a will making workshop and a history of death guided walk.
The outbreak of Zika virus in the Americas and possible link to microcephaly has caused international concern, with the WHO declaring a Public Health Emergency of International Concern. Our Zika virus explainer outlined what we know about the virus, and where gaps in our understanding lie. In this blog post we look at different research programmes the Wellcome Trust is involved in which may help to bring the outbreak under control.
Understanding the health consequences of microcephaly
Since October there have been approximately 4,000 babies born in Brazil with abnormally small heads – a condition called microcephaly. While a definitive link is not yet proven, the evidence is growing that the increase in reported cases of microcephaly is being caused by mothers contracting the Zika virus at some stage during pregnancy.
Work funded by the Brazilian government is already underway to try to figure out how Zika may be causing these birth abnormalities and at what stage of pregnancy women are most vulnerable. As part of this work, the Wellcome Trust has funded Professor Laura Rodrigues from the London School of Hygiene and Tropical medicine to follow a cohort of newborn babies to see how they develop during the first two years of life. They will carry out assessments of development, brain scans and other measures to try and build a picture of how this newly identified type of microcephaly affects the health of the children as they grow up, for example through potential learning difficulties.
The outcomes of the research will help the Brazilian Ministry of Health, health providers in Brazil and other Zika-affected countries to understand the true burden of microcephaly and develop appropriate support services for children with the condition. The work may lead to preventative strategies to protect pregnant women in future.
Controlling the mosquitoes that spread the virus
Without a vaccine or treatment for Zika on the immediate horizon, one of the most promising options for controlling the spread of the virus in the medium term is by curtailing the Aedes mosquito that transmits the virus. The Aedes mosquito is exquisitely adapted to urban living and is notoriously difficult to control, however there are a number of innovative approaches in development that could have an impact.
We are in active discussion with research teams, partner funders and the governments of the region to assess whether the following interventions could have a role in bringing the epidemic under control:
A biotech firm called Oxitec, which the Wellcome Trust funded for several years, has developed a genetically modified version of the male Aedes aegypti mosquito, which produces sterile offspring. Field trials have shown that controlled release of these mosquitoes into to a specified area can dramatically reduce or even eliminate the mosquito population, thereforeremoving the vector that carries harmful viruses.
- We have funded another mosquito control programme called Eliminate Dengue, which uses naturally occurring bacteria called wolbachia to curb the spread of infection. Wolbachia prevents the dengue virus from growing properly inside the insect meaning it cannot be passed between people. As the mosquitoes breed, they pass on the bacteria through their eggs so that it soon spreads throughout the population.Field trials of the wolbachia mosquitoes began in Australia in 2011 and have now been carried out in four other countries, including in Brazil. Experts are hopeful that wolbachia may help curb the spread of the Zika virus, though further research is needed to test this theory and to determine the best way to deploy wolbachia across entire cities.
- We also recently funded Professor Luke Alphey from the Pirbright Institute to investigate other methods for controlling the spread of viral infections by mosquitos, using synthetic biology techniques, though these are not yet in field trials.
Senior Research Fellow Professor Simon Hay and colleagues at the Wellcome Trust Centre for Human Genetics recently published new maps detailing the global distribution of the Aedes mosquitoes. It shows that the geographical spread of Aedes is now the widest it’s ever been, with the mosquitoes present in all continents including North America and parts of Europe. This information will help to determine the areas that may be affected by Zika if the virus continues to spread.
We are also in touch with the Wellcome Trust programmes around the world to make sure they are equipped to conduct surveillance for Zika in their regions in case of spread beyond the Americas.
Making the world safer against emerging infectious diseases
As with Ebola, Zika virus has demonstrated our vulnerability to emerging infectious diseases with the potential to cause pandemics. We have contributed to several high profile reports published in the wake of Ebola that have outlined the important changes to global health systems to address these gaps.
Most recently, the report of the Commission on Creating a Global Health Risk Framework for the Future by the National Academies of Medicine USA concluded that an investment of less $4.5bn a year would make the world more resilient to the threat of infectious disease.
The Wellcome Trust was a co-sponsor of the report, and is advocating several important reforms of global health systems, including:
- Establishing a permanent, independent WHO body with the authority and agility to coordinate the global response to infectious disease outbreaks.
- Efforts to fully integrate research and development into the 21st century emergency response, for example by conducting safety testing of promising drugs and treatments and agreeing clinical trial protocols in advance of an outbreak.
- Strengthening the public health systems and research infrastructure as the first line of defence against potential pandemics, particularly within low and middle-income countries.
We are very involved with many partners around the world to ensure that the response and the critical research work are very clearly coordinated. We have not opened an emergency funding call for Zika proposals, as we did with Ebola, but we will be watching the development of the epidemic as it progresses, working very closely with our partners and will keep this under constant review.
If you would like to contact us about a research proposal please email our science funding division on firstname.lastname@example.org
The World Health Organisation (WHO) today declared the Zika virus outbreak in South and Central American a Public Health Emergency of International Concern (PHEIC). It is the first time since the Ebola outbreak that began in 2014 that the WHO has declared this status, and only the fourth time in its history.
A coordinated international response will now see resources concentrated on disease surveillance, mosquito control and research in an attempt to control the spread of infection in the Americas and beyond. But how did a virus that many people had never heard of until a few weeks ago so quickly become a global health concern and what efforts are needed to tackle it?
What is Zika?
The Zika virus was first discovered in a rhesus monkey from the Zika forest, Uganda in 1947. There were very few significant outbreaks of the disease reported before 2007 and since then there have been relatively small outbreaks reported in the Western Pacific, the Americas and Africa, all causing very mild illness and limited epidemics.
Zika belongs to the same family tree of viruses as Yellow Fever, Dengue and West Nile fever – known collectively as Flaviviridae. It is transmitted by Aedes mosquitoes which are present in large numbers in tropical regions including South and Central America, Africa, South East Asia and the Western Pacific.
There has been at least one documented case of sexual transmission of Zika, but these events are expected to be very rare and almost all transmission in the present outbreak is thought to be through being bitten by an infected Aedes mosquito. Given the geographical spread of the Aedes mosquito it’s possible, but not certain, that the virus will spread to all of these regions if efforts to contain it are not successful.
It is thought that the vast majority of people who contract Zika have no symptoms at all or experience only a very mild illness with a fever, rash and aching joints. However, evidence from the current outbreak in South America is beginning to suggest that infection with Zika may cause serious complications during pregnancy.
Microcephaly and other complications
In early 2016, reports began to emerge from Brazil of an unusually high number of babies born with abnormally small heads – a condition called microcephaly. There have been around 4,000 cases reported since October 2015, compared with the few hundred a year that Brazil normally experiences. Health authorities investigating this unexplained increase noticed that the spike in cases overlapped with the areas experiencing the Zika outbreak, suggesting a possible link between the virus and microcephaly. However, although the evidence is growing, this has not yet been proven definitively.
An outbreak in 2013 in French Polynesia also coincided with an unusual increase in Guillain-Barré syndrome – a rare condition where the body’s immune system attacks parts of the nervous system causing muscle weakness and problems with coordination. El Salvador has also reported a similar rise in cases of the syndrome since its first confirmed case of Zika in 2015. Efforts are ongoing to look back at the French Polynesian outbreak to investigate a possible link between Zika and Guillain-Barré.
Because there were no recorded large-scale outbreaks of Zika prior to 2007, there are currently many unanswered questions about the virus, how it causes disease in people and the possible complications including for pregnant women. Research is needed to address these questions and also to establish:
- The link between Zika infection and microcephaly and, if proven how this process occurs, how many pregnancies are affected and when during pregnancy is the most dangerous time to contract the virus.
- The actual number of Zika cases and the geographical spread. This is likely to be difficult as there is no reliable diagnostic test for previous Zika infection and many of the asymptomatic cases go unreported.
- Whether something has changed, either in the virus or in the mosquito, or in their interaction, which has led to the sudden rise in the number of cases.
- If people who have been infected with Zika go on to have long-term immunity to the virus. This will be important for determining whether a vaccine approach is likely to be successful in controlling the spread of the virus.
- How best to control the Aedes mosquito.
Prospects for a vaccine
With Ebola, we were in a relatively advantageous position as several promising vaccine and treatment candidates had already been developed and tested in animals. This allowed scientists involved in the Ebola response to quickly set up human clinical trials of promising drugs and vaccines in the worst affected countries.
Our knowledge of the Zika virus is at a much earlier stage and the fact that the condition appears to be most dangerous for pregnant women makes the prospect of developing preventative vaccines far more challenging.
For ethical reasons, pregnant women are often excluded from taking part in clinical trials of new medical products until their safety has been assessed over many years and in many different populations. Therefore, although vaccine prototypes for dengue and West Nile fever could be adapted towards Zika, and that work has started, assessing these vaccines will be difficult.
Finding a treatment for Zika would perhaps be even more problematic, given that there has been limited success in developing drugs that work well against acute viral infections and the same issues of testing medicines on pregnant women would also arise.
One of the most effective methods for containing Zika in the medium term is likely to be through controlling populations of Aedes mosquitoes that spread the infection. This may be through traditional preventative measures such as wearing long sleeves, removing standing water where the insects like to lay eggs and ‘fogging’ residential areas with insecticide.
There are also some interesting new methods that involve modifying mosquitoes in a laboratory to inhibit their ability to carry and spread disease. Methods include genetically altering male mosquitoes so that they produce sterile young and infecting the insects with naturally occurring bacteria that stop the virus growing. Field trials of these approaches are already underway in several countries, including Brazil.
Check this blog tomorrow for a post about what the Wellcome Trust is doing to support efforts into Zika virus research.
For further reading on the Zika virus, the Centre for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota has put together a comprehensive list of resources and literature.
This week, there has been growing concern over the outbreak of the Zika virus in Brazil. Now detected in over 20 countries, the World Health Organization will convene an emergency committee to discuss the spread of the disease. The virus has been linked to birth defects, notably microcephaly (abnormal smallness of the head), so pregnant women are most at risk. Here, we take a look at the mosquito that carries the Zika virus…
Our image this week shows the Aedes aegypti mosquito, a vector that can transmit tropical diseases including dengue, chikunguna, yellow fever, West Nile fever, and Zika.
Aedes aegypti are now present on all continents except Antarctica. Originating in Africa as primarily a forest species, the mosquito has spread with globalisation and trade, and has adapted to urban environments.
Surprisingly, these mosquitoes don’t fly very far – on average about 400 metres during their adult lifespan, according to WHO. Partially as a result of drought in Brazil, Aedes aegypti have been able to breed within households as more people are storing large containers of water indoors.
So how can these mosquitoes transmit diseases like Zika? An infected female Aedes aegypti passes on the virus after biting an infected person and then biting another, uninfected person.
Female mosquitos use protein from human blood to help their eggs develop. The eggs can hatch into larvae in less than a day, and this larvae then takes around four days to develop into pupae. Adult mosquitoes will emerge two days after that. Once an adult mosquito has bitten a person and extracted blood, it lays its’ eggs. And the cycle starts again.
While Aedes aegypti are adept at transmitting the Zika virus, there are ways we can attempt to halt the spread. The Wellcome Trust-funded company Oxitec have developed an innovative solution to control Aedes aegypti. By releasing genetically modified male mosquitoes whose offspring will die before they become mature adults, the number of mosquitoes could be dramatically reduced.
After the World Economic Forum’s Annual Meeting in Davos last week, drug-resistant infection remains high on the international agenda. Earlier this month, we posted an explainer giving a broad overview of the scale of the problem. In this post, our director Dr Jeremy Farrar discusses the urgent need to act on drug-resistant infection, first published on the World Economic Forum blog.
Like so many breakthroughs, it happened almost by accident. In the late 1940s, fishermen near Lederle Laboratories, in New York state, noticed that the trout they were catching were getting bigger. Word reached a biochemist called Thomas Jukes, who thought it might have something to do with the run-off from Lederle’s latest miracle product – an antibiotic called aureomycin.
So he and his colleague Robert Stokstad tried an experiment. They took some newborn chicks, and fed one group on a liver extract, designed to cure anaemia. Another was given aureomycin.
The results were startling: the birds given the antibiotic didn’t just survive, but put on weight with extraordinary rapidity. When this discovery was officially announced in 1950, the New York Times proclaimed that aureomycin’s “hitherto unsuspected nutritional powers” would have “enormous long-range significance for the survival of the human race”.
In the 65 years since, antibiotics have cured millions of people of infectious diseases, as well as filling billions of stomachs by helping chickens, pigs and cattle get ever larger. But their use in gargantuan quantities, with poor controls, has left us facing a new threat: drug-resistant bacteria.
The independent Review on Antimicrobial Resistance, backed by the UK government and the Wellcome Trust and headed by the economist Jim O’Neill, estimates that by 2050, infections that are untreatable with antibiotics could cost the global economy $100 trillion and kill 10 million people a year. And when it comes to fighting them, our cupboard is almost bare: we have developed no new classes of antibiotics for 25 years. This is a problem that rivals climate change.
One solution is to increase the supply of new drugs. We have failed here not for want of ingenuity, but for want of incentives. It is difficult, often even impossible, for any antibiotic to make money in the current system. These are low-priced drugs taken for short periods of time, but use at the volumes needed to turn a profit is exactly what builds resistance. The O’Neill review has recommended new funding mechanisms to stimulate antibiotic development that I hope will be taken forward in Davos this week. But we must tackle demand as well as supply.
Some 70 per cent of medically important antibiotics in the US are given not to people but to animals. The global proportion used in agriculture is hard to calculate, but the O’Neill review estimates it is at least half. As evidence mounts of a link between agricultural antibiotic use and resistant infections in people, it is clear that we are taking unacceptable risks. Antibiotic use for growth promotion should be banned: there are acceptable alternatives, as a ban in Denmark has shown. Where antibiotics are needed to treat sick animals, these should be restricted to classes that have no human medical use.
Go on as we are, and we will jeopardise more critical drugs like Colistin, a last-resort treatment against bacteria that have become resistant against other antibiotics. Colistin is used widely in agriculture, and in November, it was revealed that E. coli bacteria in China, in both pigs and people, have acquired resistance to it. The same gene has now been found in E. coli in Europe. We are recklessly losing something we should have taken great care to protect.
As we tackle agricultural misuse of antibiotics, we must also take on overuse in human medicine. One key to that is better public engagement. Last year, Wellcome carried out a wide-ranging study of UK public attitudes to antibiotics. It showed that people see them almost as magic pills: a prescription, whatever your actual illness, is evidence that you’re really suffering. So powerful is this effect, according to research from King’s College London, that doctors who limit antibiotic prescriptions receive worse ratings from patients.
This is fed by a lack of awareness of antibiotic resistance. Our research revealed that many people simply don’t understand what those words mean. Most interpret it as their own bodies becoming resistant to the drugs, which is one reason they stop taking them too early — a major contributing factor to the development of resistance.
It’s the same when we talk about the scale of the problem. I warned above that drug-resistant infections could cost us millions of lives and trillions of dollars, that it is a challenge comparable to climate change. Such phrases may get heads nodding at Davos, but they are mostly ignored by the general public. When we use such grand language, our research showed, people assume that we’re exaggerating, or that scientists will fix things, or that the problem lies far in the future.
We need to communicate better. Rather than talking about “antibiotic resistance”, we should say “drug-resistant infections”: we found that putting the focus on the bacteria, not the patient, improves understanding. We should also illustrate the problem through specific, familiar and contemporary threats: the idea that E.coli, tuberculosis or salmonella will become harder to treat, or that Caesareans, chemotherapy or hip replacements will become difficult to conduct.
The WHO considers drug-resistant infection to be the greatest challenge in infectious disease. It is already killing hundreds of thousands of people in developed and developing nations. But we know what needs to be done: increase the supply of new antibiotics, and cut the demand for existing ones, by restricting their use in agriculture and doing a better job of explaining the problem.
Thomas Jukes believed that antibiotics were an astonishing force for good. He was right, even if their “nutritional powers” have proved double-edged. We must value these remarkable drugs, and deploy them with due care and attention, if we are not to squander their continuing potential to save and improve lives.
Our fortnightly round-up of news from the Wellcome Trust community…
The frontline treatment for typhoid is no longer effective due to drug resistance, according to a Wellcome Trust-funded study published in The Lancet Infectious Diseases.
The research revealed that fluoroquinolone antibiotics, which have commonly been used to treat typhoid for many years, have been over-prescribed and are no longer the recommended treatment for individuals with typhoid fever in Nepal, and possibly in the rest of South Asia.
The study found that – for the first time – the bacteria Salmonella Typhi has become resistant to advanced fluoroquinolones, making the treatment ineffective.
Conducted in Nepal, the trial had to be stopped early due to concerns over safety, as there was a high clinical failure rate of some antibiotics in patients with typhoid.
The researchers also discovered that a large proportion of individuals who have symptoms indicating they have uncomplicated typhoid fever are actually likely to have an alternative diagnosis.
Dr Buddha Basnyat, senior author of the study and head of the Oxford University Clinical Research Unit in Nepal said, “The findings from this study are sobering. Typhoid is becoming more difficult and confusing to treat and we must now more seriously consider public health measures such as vaccination to protect against typhoid.”
Wake up call for deadly disease
The study, funded by the Wellcome Trust and conducted by the Mahidol Oxford Tropical Medicine Research Unit, is the first to provide an evidence-based estimate of the global extent of melioidosis, which is caused by a bacterium found in soil and water in South and Southeast Asia and northern Australia.
Researchers predict that melioidosis is present in almost 80 countries, including 34 that have never reported the disease. Health workers and policy makers are encouraged to give the disease a higher priority as the spread of melioidosis is on the rise.
Melioidosis – which is contracted through the skin, lungs or by drinking contaminated water – is difficult to diagnose since it mimics other diseases. High-risk groups for the disease include patients with diabetes mellitus, chronic kidney disease and excessive alcohol intake. The bacterium is also resistant to many antimicrobials, and insufficient treatment could lead to fatality rates of over 70%.
Dr Direk Limmathurotsakul, study co-author and Head of Microbiology at MORU said, “Although melioidosis has been recognised for more than 100 years, awareness of it is still low even among medical and laboratory staff in confirmed endemic areas. We predict that the burden of this disease is likely to increase in the future because the incidence of diabetes mellitus is increasing and the movements of people and animals could lead to the establishment of new endemic areas.”
Predicting cancer’s growth
A mathematical rule may predict how a cancer will grow, according to researchers at The Institute of Cancer Research.
The study, published in Nature Genetics, suggests that by applying mathematical formulas to tumour biopsies, doctors could make clinical decisions about how an individual patient’s cancer will change and what treatments should be used.
The mathematical model predicted that in many tumours, all important cancer genes were already present early on, and any new mutations inside the tumour act as ‘passengers’ with no additional effect.
While the model indicated bowel, stomach and some lung cancers closely followed a path set out by a theoretical model, it could not as accurately predict the path of some other cancers like brain and pancreatic tumours. Scientists suggest that in these cases, pressures on resource and space might lead to natural selection playing a greater role in the spread of mutations.
Study co-leader Dr Trevor Graham, Head of the Evolution and Cancer laboratory at the Barts Cancer Institute at QMUL, said, “We often think of cancers as being the chaotic and uncontrolled growth of cells within the body. But counter to this intuition, our study shows how cancer evolution is in fact often highly ordered and can even be explained by a straightforward mathematical rule. We can attempt to bend it in our favour to improve patient outcomes.”
In other news…
An Ebola legacy lab has been set up in Sierra Leone to improve resilience to future epidemics. The lab is a collaboration between the University of Makeni and the University of Cambridge, with funding from the Wellcome Trust.
Congratulations to Professor Francois Nosten, Head of the Shoklo Malaria Research Unit at the Wellcome Trust’s major overseas programme in Thailand, who was awarded l’Orde de la Légion d’honneur (Legion of Honour) for his work fighting malaria for over three decades. You can read about his work in our long-form online publication, Mosaic.
The House of Commons International Development Committee has published a report on ‘Ebola: Responses to a public health emergency’. Jeremy Farrar was a witness and gave evidence at the committee session.
Each week we are reminded of the global threat of the latest ‘superbug’ or highly drug-resistant infection. MRSA is the culprit that probably first springs to mind, but increasingly infections that are often overlooked are joining this ‘super’ category. Our Image this week is of ‘Super-gonorrhoea’, one of the newest bugs on the block, with several outbreaks of this untreatable strain in the north of England at the end of last year. Amy Luck, a graduate trainee at the Wellcome Trust, tells us more…
Gonorrhoea. Not a topic that we usually want to discuss but – forced into the public eye over the last few years – this sexually transmitted ‘superbug’ is becoming more and more prevalent with several highly drug-resistant outbreaks over the last year. Good old penicillin has been used to treat this common infection for over 70 years and 80% of cases still respond to this treatment today in the UK, according to a recent review on Antimicrobial Resistance.
However, due to the 20% that don’t respond to penicillin, doctors prescribe almost all of their patients a treatment that is the ‘last line’ of defence available for gonorrhoea- a combination of two different drugs. Due to this overuse there is a strong selective pressure on these two drugs and a superbug-strain of gonorrhoea has emerged in the UK.
The way that we diagnose bacterial infections hasn’t changed since the 1940s. The Review on Antimicrobial Resistance calls for new, rapid diagnostics to stop unnecessary antibiotic use and tackle superbugs. The outdated method of ‘guessing’ if and what infection a patient may have has led to the over-prescription of antibiotics and increased the incidence of more common infections developing resistance to our antibiotics.
If there was a rapid test to diagnose drug susceptibility or the type of infection that an individual had, tailored drugs could be administered. This would allow patients to be treated with the correct drug the first time, reducing unnecessary antibiotic use and the likelihood of resistance.
At the end of 2015, a little bit of Kenya came to the Wellcome Trust in the form of eight members of staff from the African Academy of Sciences (AAS) who are based in Nairobi. They have established the Alliance for Accelerating Excellence in Science in Africa (AESA), the research funding unit and think tank that seeks to shift the centre of gravity for African science to Africa. In this post, Programme Manager Alphonse Neba describes the grants management and finance training he and colleagues received, and his reflections on returning home…
When I was asked to write a blog about our visit to London and grants management training at the Wellcome Trust, I had no clue where and how to start, as blogging is a new experience for me. But as I reflected on the trip and the training, I realised there were some key lessons I could share.
We are all very grateful to the Wellcome Trust and the African Academy of Sciences for making this trip and training a reality. The African Academy of Sciences takes its partnerships and responsibilities with the Wellcome Trust and its other funding partners very seriously.
Our arrival at Heathrow airport in London was not uneventful:
“What brings you to London?” the immigration officer at Heathrow asked one of my colleagues.
“I am attending a training course in grants management at the Wellcome Trust,” my colleague responded.
“Is Wellcome spelled with a single ‘l’ or a double ‘l’?” the immigration officer continued.
The response “with a double ‘l’” was sufficient to let my colleague through the immigration formalities.
His grilling, and subsequent “pass mark”, appeared to us like the proverbial elephant passing through the eye of a needle for those of us still in the queue. Needless to say, none of us was sent back.
When we arrived at the Wellcome Trust offices and began the carefully thought-out and comprehensive training, it soon became evident how attention to detail was important not only as far as security checks at Heathrow airport was concerned, but as an indispensable skill, cutting deeply across the broad spectrum of grants management processes, procedures and activities of the Wellcome Trust.
Kudos to Wellcome Trust staff Emma Ralph, Nidhee Jadeja, Sophie Mathewson, Amy Luck, Rob Coutts, Harriet Hall and all the facilitators for anticipating our needs as a new and lean grants management outfit.
Getting to grips with grants management
The practical and hands-on components of the course were fantastic. Designing scheme sheets, playing with Grant Tracker (the Wellcome Trust’s system for managing grant applications), identifying reviewers, drafting and giving feedback to applicants were all simply empowering.
Other highlights were the training on organising and managing funding committees, attending and observing live funding committees at work, and visiting other relevant s events around London which almost made some of us begin to think and feel we were bonafide employees of the Trust.
And finally, being able to return with a bounty of relevant materials and other tools back to Kenya for future reference was the cherry on the pie and simply sublime.
Returning home and looking ahead
All in all, our trip provided a unique learning experience and perspective on grants management. The deep insights provided by facilitators during discussions on some intractable grants management issues and experiences were also invaluable.
We felt like members of a surgical operation team, watching, learning and assisting the lead surgeons successfully undertake a delicate brain operation. Coincidentally, from the room we were working in we observed surgeons and medical teams performing operations in the hospital which is across the road from the Wellcome Trust.
For me, the history of the Wellcome Trust provides a strong strategic lesson on possible fund-raising initiatives for science and health research on the African continent.
I am certain my colleagues would agree that we left the Trust feeling fully equipped, emboldened and having a deeper understanding of grants management.
I am also certain that we left the Trust with no illusions about the challenges that lay ahead in our determination to be the new centre of gravity on the African continent for science funding and developing health strategies for the continent.
More information about the DELTAS Africa funding scheme which will be handed over to AESA colleagues later this year is available on the Wellcome Trust website.
The World Economic Forum’s annual meeting in Davos, Switzerland is taking place this week, from 20-23 January. Known simply as ‘Davos’, the meeting is an opportunity for business and political leaders to meet and debate the big issues facing the world – from climate change and rising interest rates to the war in Syria. One of the items on the agenda this year is the crisis confronting modern medicine in the shape of drug-resistant infections. Here, we re-post an entry by Mark Henderson, Head of Communications at the Wellcome Trust, originally published on the World Economic Forum’s blog Agenda, which explains what drug-resistant infection is and why it’s such a pressing issue for all of us…
Infectious diseases are caused by bacteria, viruses, parasites or funguses getting into our bodies. Once inside, they can cause damage directly or by generating a response from our own immune system that causes collateral damage while trying to get rid of the infection. This can lead to anything from a sore throat to septicemia.
Over the past 70 years or so, we have discovered drugs that augment our body’s immune response to infections. Antibiotics, for example, kill bacteria, or at least stop them growing – some are general and kill lots of different species of bacteria; others are more specific. But bacteria are always evolving. An antibiotic targets a particular characteristic of the infectious bacteria, so by specifically killing all bacteria that have this characteristic, any that happen not to have it gain an advantage and are left free to multiply and spread. This creates a population of resistant bacteria that cannot be killed by that antibiotic.
Drugs used to treat infections are called antimicrobials, so this type of drug resistance is also called antimicrobial resistance, or AMR. Antibiotic resistance is the same thing, but specific to antibiotics. However, the term drug-resistant infections makes it clearer that it is the infectious species which is resistant to the drug, not the patient.
Why are drug-resistant infections a problem?
There are already strains of tuberculosis that are resistant to most – even all – our drugs. Without drug treatments, tuberculosis kills about 45% of patients, and nearly everyone who is HIV positive. Gonorrhoea, a sexually transmitted infection, used to be treated with penicillin but, as recent outbreaks in the UK have shown, the bacteria that cause it have developed resistance to all but one antibiotic, and even that is starting to become less effective. Untreated, gonorrhoea can lead to infertility and inflammatory disease. Drug resistance makes infections more serious, harder to treat, and a bigger threat to our lives.
Who is at risk?
We are all at risk if infections that are currently easily treated become resistant to the small number of drugs we can still use. For some infections, it might mean just an extra day or two of feeling ill, but it could also increase the risk of death, especially for vulnerable patients like young children. Drug-resistant infections already directly cause an estimated 700,000 deaths each year. it’s expected that will rise to 10 million a year by 2050. If nothing changes by then, this scale of human suffering and premature deaths will have set the world’s GDP back by as much as 3.5%.
But we also use these drugs to help control infections during and after surgery, including organ transplants, hip replacements and caesarian sections. As more infections become resistant to our drugs, even routine operations will become riskier.
Can’t we just make new drugs?
One way to get around the emergence of drug resistance is to keep inventing new drugs that exploit different weaknesses of the infectious species. But the rate of development of new antibiotics (and drugs for treating viral and parasitic infections) has slowed since the “golden age” of the second half of the 20th century, exacerbating a problem that has been known about since the discovery of penicillin in 1928.
Current business models do not incentivize the development of new antibiotics. Development costs are high, and are very hard to recoup because the drugs cannot generally be sold either at high prices or in high volumes. When a new antibiotic does reach the market, medical stewardship requires it to be used sparingly and only when absolutely necessary to delay resistance from developing, but reimbursement models do not currently reward this.
To reinvigorate the development of new drugs for infections, we need to make the discovery and invention of antibiotics a game that everyone is incentivised to play, in universities, pharmaceutical companies, government research labs or anywhere else.
What else can we do to counter drug-resistant infections?
We need to look after the drugs we already have. This means using them properly – saving antibiotics for bacterial infections they can treat, and not using them to “treat” viral infections like the flu and the common cold. Misusing antibiotics like this essentially breeds drug resistance among the bacteria that normally live in our bodies – even though these bacteria are harmless, they can pass resistance on to other, more dangerous species. The same is true if people don’t finish their course of antibiotics, or when antibiotics are used in agriculture as growth factors or preventive treatments – it all breeds stronger, more dangerous bacteria.
So we also need better diagnostic tools to tell doctors exactly what is the cause of their patient’s infection so they can prescribe the most appropriate and effective drug. And, as potential and actual patients, we all need to understand how to make the best use of the drugs we are given to treat infections.
Should we invest more in alternatives to drugs?
Drugs are not the only tools we have to tackle infections. Improving access to clean water is helping to eradicate endemic Guinea worm disease in the absence of any drugs. For other diseases, we have effective vaccines that prevent illness and can help to stop the spread of the infection. One way to reduce the impact of drug resistance would be to develop vaccines for more infections, and to use the vaccines we have to systematically control or eliminate those diseases. However, there are still several infections for which we do not have vaccines, and drug treatment is the only effective response.
Who is responsible for responding to drug-resistant infections?
Infectious diseases are a public health issue. Drug-resistant infections span political borders and require coordinated action from authorities around the world. But we must all take on some responsibility for understanding the problem – which will always be with us as long as we use drugs to treat infections – and the simple things we can do to avoid making it worse.
If you liked this you may also like our blog post on why the issue of drug-resistant infection is often misunderstood. To find out more about what the Wellcome Trust is doing about drug-resistant infection visit the policy pages on our website.
Our image this week is a visualisation of antibodies being activated by the Ebola vaccine.
Ebola has featured heavily in the news this week, as the World Health Organization announced on Thursday that the epidemic was over in West Africa. While it is promising that known chains of transmission had ended, flare-ups of the disease were expected, and one has already been reported in Sierra Leone. This highlights the fragility of the situation, and the importance of continuing to develop new vaccines and treatments.
Commissioned for the Wellcome Trust Annual Review, photographer Catherin Losing and set designer Sarah Parker were tasked with the challenge of depicting an Ebola vaccine at work inside the body. They placed a set of tiny blobs of glycerine on glass and laid them on the floor, taking the photograph from above. They used the convex of the blobs to bring the shape of the ebola virus into focus like little wide-angle lenses, and used ‘Y’ shapes to represent the antibodies being activated by the vaccine in the body.
The Ebola vaccine known as VSV-ZEBOV, co-funded by the Wellcome Trust, was announced as being up to 100 per cent effective in a clinical trial in Guinea in August 2015. Carrying out both a safety and efficacy trial for the vaccine within eight months took an astonishing collaborative effort, but it was not quick enough for the thousands of people who died of Ebola in the outbreak.
A report published this week by the US National Academy of Medicine – and co-sponsored by the Wellcome Trust – stressed that the global community must be better prepared for future pandemic threats. The report highlighted that the equivalent of 60 cents a year for everyone in the world could make us a lot safer against epidemic and pandemic threats.
Image Credit: Photography: Catherine Losing, Set design: Sarah Parker. (C) the image makers
As the world continues to learn difficult lessons from the Ebola crisis and the failures that occurred during the response, a landmark report published today spells out what must be done to increase our resilience to such outbreaks in future. Here, Wellcome Trust Director Dr Jeremy Farrar examines the main recommendations from the Global Health Risk Framework Commission, convened by the National Academy of Medicine in the US, and the steps that should be taken to increase the world’s resilience against epidemic and pandemic threats…
Few global events can inflict death, ill-health, economic disruption and social upheaval with the reliability of infectious disease.
The 1918 flu pandemic killed more than 50 million people, and HIV/Aids has claimed 35 million lives and counting. Even smaller outbreaks with much lower death tolls, such as SARS in 2003 and Ebola in 2014-15, can destabilise nations and destroy prosperity. The latest modelling estimates the likely cost of pandemics this century at more than $6 trillion, or $60 billion a year.
It will never be possible to eliminate these risks completely: it is the nature of evolution that new infectious agents will emerge, and that old ones will evade our efforts to control them. Yet in a world where military spending touches $2 trillion a year, we have systematically under-invested in preventing, preparing for and containing dangerous outbreaks of infectious disease. The evidence is plain from inadequate responses to the defining outbreaks of the past 15 years – SARS, swine flu, the MERS coronavirus, and most recently, Ebola.
As the failures and lessons of the Ebola epidemic are assessed by the international community, it is becoming increasingly clear how this under-investment should best be addressed. The costs of greater health security, too, need be nothing like as steep as is commonly imagined.
This week, the Global Health Risk Framework (GHRF) commission, convened by the US National Academy of Medicine, concluded that extra global spending of just $4.5 billion each year – about 60 cents for every person on the planet — would build substantially greater resilience against epidemic and pandemic threats. That is less than the world’s cellphone users spend each year on new ringtones.
A growing consensus
The GHRF report, together with Dame Barbara Stocking’s review of the Ebola crisis for the World Health Organisation, and an independent report led by the London School of Hygiene and Tropical Medicine, Harvard University and the Lancet, also underpins a growing consensus on how extra resources should best be spent, and on the accompanying structures needed to deliver a resilient world health system. The conclusions can be grouped into three sets of measures that would together create greater health security for all.
The first cornerstone of global defence is strong regional and national capacity to monitor, detect and respond to emerging and endemic infectious diseases. In too many countries, especially those with low incomes and weak states, this essential infrastructure is missing – as it was in the three West African countries where Ebola struck. As the GHRF recommends, we need standards for core capacity, and financing mechanisms in place so this can be delivered.
All countries must contribute to this investment, of around $3.4 billion a year, but the rich nations that will bear higher costs should not think of these simply as altruistic aid. It is also in their naked self-interest. As the spread of SARS to Canada showed, pathogens do not much care about national borders – global defences against pandemics are as strong as their weakest links. In the worst case, over-investment in this health infrastructure will deliver great improvements in the fight against endemic killers such as malaria, tuberculosis and HIV, with limited benefits for pandemic defence. In the best, it could head off an emerging threat before it goes global.
The second essential step is reform of the WHO, to give it the institutional capacity and resources to lead preparedness for and response to infectious disease emergencies. The WHO, commendably, has already begun this process, establishing a programme to oversee this vital function and a contingency fund to pay for it. The GHRF rightly recommends extending this approach, to create a permanent Center for Health Emergency Preparedness and Response that would lead and co-ordinate defences and action against pandemic threats. This should have sustainable funding – which will mean increased WHO subscriptions, especially from richer member states — and a strong independent board.
Accelerating research and development
Finally, we need urgently to upgrade the tools at our disposal for preventing and treating emerging infections. This will involve substantial investment in drugs, vaccines and diagnostics, as well as in strategies for understanding and engaging with affected communities, where market incentives alone will not drive research and development. We cannot afford a repeat of the situation with Ebola – candidate vaccines existed when the outbreak was confirmed, but had not completed the necessary safety testing to begin effectiveness trials immediately and contribute to containing the epidemic.
To catalyse this, the WHO should establish an independent expert panel charged with accelerating this vital R&D. It would help prioritise the most urgent needs and identify the most scientifically promising candidates, oversee the development and sharing of protocols for trials, and ensure supply and equitable access, all with the unique authority and legitimacy of the WHO.
The resulting framework would help to guide investments by national governments, industry and philanthropy – the WHO should not make spending decisions, but is uniquely well placed to play a critical co-ordinating and convening role. This panel could also link up parallel efforts designed to support R&D in more specialised fields such as drug-resistant infections and vaccines, which will be discussed in Davos next week. The GHRF recommends global investment of at least $1bn a year, for at least 15 years.
Humanity cannot prevent the emergence of infectious threats like Ebola, but if we make eminently affordable investments, and some very achievable institutional reforms, we can certainly limit the damage to life, health and prosperity that they can inflict.
The full report, entitled The Neglected Dimension of Global Security, is available to download from the National Academy of Medicine website. You can also read the Wellcome Trust press release for more information.