Viral discussion: Epidemics experts sound off on the future of infection control

Image of flu virus, which experts think will eventually lead to future epidemics
Is the next flu pandemic around the corner?

During the 1918 influenza pandemic, the average life expectancy in the U.S. dropped below 40 years old. Today, public health and medical professionals need to be actively preparing for the next great pandemic, according to leaders of the Massachusetts Medical Society, The New England Journal of Medicine and Microsoft founder Bill Gates, who delivered the keynote address at a Boston-based meeting on April 27 called Epidemics Going Viral: Innovation vs. Nature. Here’s recap of what we heard from various panelists.

The five key drivers of epidemics are population growth/urbanization, travel, animals, environmental/climate changes and conflicts/natural disasters, according to Harvey Fineberg, MD, PhD, President of the Gordon and Betty Moore Foundation and former president of the Institute of Medicine. When it comes to predicting and preventing the next epidemic, Fineberg believes that data from a social media platform like Twitter isn’t going to help identify the next big outbreak.

But John Brownstein, PhD, an epidemiologist and Chief Innovation Officer at Boston Children’s Hospital, disagreed with that idea.

“I believe it’s possible for Twitter to find the next microbe,” Brownstein said. “This information comes in real time and at global scale.” Attendees who were live tweeting with the hashtag #epidemicsgoviral were quick to highlight this difference of opinion.

Uber flu shot, “a cool millennial thing to do”

Anne Schuchat, MD, deputy director of the Centers of Disease Control, busted the myth that non-vaccination rates are rising. She explained that media stories about anti-vaccination supporters can make it seem as though vaccination rates are falling when they actually aren’t.

“Less than one percent of kids aren’t vaccinated in the U.S.,” Schuchat said.

But some vaccinations, like the annual flu shot, still have big gaps to close. Brownstein described how a partnership with Uber — dispatching flu vaccines and nurses to people’s homes — was able to influence people to get their first-ever flu shot.

In addition to convenience, Schuchat thinks cultural context was also at play. She suggested that millennials feel invincible and don’t care much about preventative measures, but that getting a flu shot from Uber seemed like a “cool millennial thing to do.” Using Uber to deliver flu shots could therefore be a good way of tapping into that demographic.

Putting the public back in public health

Brownstein cited other ways that digital technology is influencing disease surveillance. For example, a wearable thermometer is providing new streams of digital health data, integrated with an online health educational tool called Thermia.

At Boston Children’s, Brownstein’s HealthMap team uses social media and online news sources to track infectious diseases globally and in real time. While it’s very effective and capable of tracking disease faster than some government health bureaus, Brownstein says crowdsourcing data online is even more powerful.

Flu Near You, for example, an online service developed by the HealthMap team, uses artificial intelligence to interpret self-reported instances of potential flu symptoms. Brownstein says it is helping to keep people out of the emergency room and providing incredible diagnostic accuracy.

“We’re putting the public back in public health,” Brownstein said.

The last thing the world needs

Thomas Frieden, MD, MPH, former CDC director and NYC health commissioner, said that timely disease detection often doesn’t extend to people on the lower end of the socioeconomic scale, who are at a higher risk of having an undiagnosed infection.

Frieden also said a bridge exists between innovators and medical practitioners, who are immersed in the daily challenges of public health. He hopes that a shift from a reactive, market-based approach to a proactive, government-based approach to handling epidemics will enable better preparedness for the next outbreak.

On the subject of on-the-ground challenges of trying to conduct research during an epidemic in progress, such as the West Africa Ebola outbreak in 2014, Kathryn Maitland, MBBS, PhD, FRS, a professor of pediatric tropical infectious disease at the Imperial College London, discussed her firsthand experience. While providing pediatric care in Africa, where she had to navigate getting consent and deferred consent situations where the parents might not be present or alive to consent to care.

Jeremy Farrar, PhD, director of the London-based Wellcome Trust, had good things to say about historical U.S. involvement in overseas epidemics.  “The U.S. has led the world and it’s a better place because of it,” Farrar said. “The last thing the world needs is for you to withdraw.”

Universal flu vaccine challenge

During his keynote address, Bill Gates, a self-proclaimed optimist, delivered an uncharacteristically dire warning. The world is not ready for the massive airborne pandemic that will inevitably occur, according to Gates.

“The only way to be prepared for the next pandemic is to prepare in the same serious way that the military prepares for war,” Gates said.

Toward that goal, Gates announced a new Grand Challenge from the Bill and Melinda Gates Foundation, a $12 million investment in research, to develop a universal flu vaccine within the next ten years. He hopes the challenge will “encourage bold thinking by the world’s best scientists across disciplines, including those new to the field.”

The announcement was met with cheers, applause from live attendees, and a blast of social media activity.

Fittingly, the event wrapped up with a simple but meaningful directive to attendees: “Travel safely and try not to spread germs along the way.”

Want more soundbytes from Epidemics Going Viral? Check out the stream of live tweets cast by its attendees.