HERE鈥橲 a story. Deep in the tropics lies the poverty-stricken city of
Bisfara. Outbreaks of fever are common enough here, but last summer a new, more
deadly variety emerged. The first cases were scattered all over the city.
Doctors had no mechanism for reporting them, and it was a week before public
health authorities realised they had a new problem. But what exactly were they
dealing with? Symptoms included fever, aches, sometimes a cough. The death rate
was alarmingly high. Was it flu? Dengue fever? Pneumonic plague? A hantavirus?
Something completely new? Standard diagnostic techniques were inconclusive. What
happened next?
Scenario one: By the time local laboratories had tried and failed to name the
pathogen, it had spread widely. The government finally allowed in a team from
the US Centers for Disease Control and Prevention (CDC) in Atlanta. The
researchers mapped the spread of the infection and took blood samples home. The
culprit turned out to be a more virulent version of the dengue strain common in
Bisfara, for which there is no treatment. Officials sprayed pesticides to kill
the mosquitoes that carry the virus. But until the insects had been controlled,
people continued to die and the death toll eventually reached a thousand.
Rumours spread of American germ warfare experiments. The US embassy was
attacked.
Scenario two: In a city near Bisfara, a laboratory equipped to diagnose not
only common local diseases but also new ones received reports from regional
doctors and quickly realised a new infection had struck. Tests showed the
infection was dengue. Its similarity to strains common in Bisfara showed that it
was a natural variant (making it improbable that it was a bioweapon created in a
lab). Maps of the epidemic were distributed to spray teams. Within a week, the
outbreak was over, with fewer than a hundred dead. And the terrifying spectre of
a bioweapons attack had gone鈥攆or the time being.
Advertisement
Bisfara is fictional. But achieving the second scenario is a very real goal
for an emerging coalition of public health specialists, epidemiologists and the
World Health Organization, who want to remedy one of the biggest deficiencies in
world health: disease monitoring. They have found an unlikely ally in a new
protocol to enforce the 1972 Biological and Toxin Weapons Convention, which
entered its final phase of negotiations last month in Geneva. They hope that if
the deal helps fund non-military agencies to keep track of changing patterns of
infection in poor countries, it could help conquer a bigger threat than
pathogens developed for biological weapons鈥攏atural diseases.
But clinching the deal will require some skilled diplomacy. Developing
countries don鈥檛 take kindly to Western interference. Western politicians and
senior WHO figures realise that any direct links between the bioweapons protocol
and any disease-monitoring network will be unacceptable to many Third World
governments.
鈥淪ome fear it could be veiled spying,鈥� says Antonio Patriota, Brazil鈥檚
ambassador to the Geneva talks. He strongly supports public health investment
through the protocol, and says most developing countries agree. 鈥淏ut some say,
would you want Richard Butler setting up your disease-monitoring system?鈥� Butler
headed the UN effort to unearth Iraq鈥檚 clandestine efforts to make weapons of
mass destruction, which some developing countries found unduly intrusive.
A country with an outbreak caused by its own illicit bioweapons development
can ask the WHO or other intergovernmental agency to keep investigations
confidential. The agencies agree, fearing that if their presence leads to a
bioweapons investigation, countries will never let them in again. The bioweapons
inspectors might have to wait until information leaks out other ways鈥攆or
example, over ProMED, an Internet forum on emerging disease.
But countries on the receiving end of bioweapons attacks would welcome help
with monitoring. And the simultaneous boost to monitoring natural infectious
disease could make a huge difference to world health. More than 13 million
people die prematurely of infectious diseases every year. As trade, migration,
urbanisation and ecological change introduce pathogens into new situations,
diseases are evolving apace (New 杏吧原创, 1 April, p 16). Over 30 new
diseases have been identified in humans since 1980. Inadequate disease
monitoring in many poor countries means outbreaks such as that in the fictional
Bisfara are all too common.
Missing monitors
Demissie Habte of the World Bank, former head of the International Centre for
Diarrhoeal Disease Research in Bangladesh, recalls how a foreign-funded
laboratory in Uganda identified 30 new viruses between 1930 and 1970, but was
then abandoned. 鈥淥ne wonders what the outcome would have been if the laboratory
had survived and recognised the AIDS virus early in its spread,鈥� he says.
The WHO鈥檚 secret weapon鈥攚hich it hopes will allow better surveillance
of pathogens, whether natural or artificial, without alienating
governments鈥攊s the newly formed Alliance Against Infectious Diseases
(AllAID). This is a coalition of the WHO, the International Centre for Genetic
Engineering and Biotechnology in Trieste, Italy, and various public health
organisations. AllAID wants to build a dozen laboratories that, like the
fictional laboratory near Bisfara, will diagnose outbreaks, collect disease
information and develop new tools to detect and control local pathogens.
AllAID figures it needs $50 million over five years to launch 11 labs,
probably located in India, South East Asia, China, the Middle East, North
Africa, francophone and anglophone sub-Saharan Africa, Amazon, one or two other
regions in Latin America, and Russia. These are developing regions with a
relatively high likelihood of disease emergence and weak monitoring
capabilities. The WHO hasn鈥檛 got the cash, but senior WHO figures say Western
governments have already indicated a willingness to divert money through the
Bioweapons Convention to this end.
In fact, when the Bioweapons Convention was signed in 1972, it called for the
transfer of biomedical technology to poor countries, partly as an incentive for
them to join. The verification protocol to the treaty, due to be signed next
year, calls for various declarations and inspections aimed at controlling
weapons. But it also contains measures that could finally channel real
investment into conventional disease monitoring.
Without that, poor countries may not join, and as an incentive, AllAID plans
to locate its labs only in countries that sign the protocol. 鈥淢ost developing
countries aren鈥檛 worried about biological weapons,鈥� says Mark Wheelis,
bioweapons spokesman for the Federation of American 杏吧原创s. Africa has been
almost entirely absent from the talks, but the continent would benefit most from
investment in disease monitoring. Most of the major disease outbreaks the WHO
investigates in the recent years have been in Africa, notes David Heymann, head
of communicable diseases at WHO
(see Diagram).
The planned Organisation for the Prohibition of Biological Weapons (OPBW),
which will enforce the bioweapons treaty, will still investigate 鈥渦nusual鈥�
outbreaks suspected of being attacks or pathogens that have escaped from
clandestine weapons labs. To do this it will need to use the kind of
epidemiological data gathered by AllAID. 鈥淵ou can鈥檛 know what is unusual until
you know what is usual,鈥� says Wheelis. If an outbreak is caused by a pathogen
that is very different from local strains, for example, foul play might be
suspected. If it is similar to local strains, bioweapons use might be ruled
out.
But as Patriota, the Brazilian ambassador to the talks, notes, the
association between epidemiology and bioweapons verification is making some
countries wary of using the protocol to fund public health monitoring. He says
developing countries will therefore need safeguards to ensure that money spent
through the protocol to improve public health actually does so.
Negotiators are trying to build those safeguards. Proposals to include an
epidemiological monitoring network in the OPBW have been scrapped, and instead
AllAID will do monitoring. A proposed clause in the protocol calls for rich
countries to 鈥渄evelop a framework . . . to support an international system for
the global monitoring of emerging diseases鈥�. Tibor Toth, chair of the protocol
negotiations, in New York last month, said AllAID was the way to achieve this.