Navigating the Aftermath of Epidemics

The symptoms and implications of disease often reach far beyond the individual, carrying consequences for communities, countries, and sometimes the whole world. There are broad social, psychological, economic, and political ramifications when societies are struck by epidemics. Over the past few years, newspaper headlines and Twitter feeds have been filled with stories of Zika, Ebola, and malaria devastating entire communities. We have found ourselves bewildered by the unknown implications of these viruses, confronted with drug resistance, and in need of accessible and affordable diagnostic tools. This year at TEDMED 2017 we will hear from Speakers and Hive Innovators who are facing the challenges of epidemics head-on.

Ebola Survivors Clinic staff

As a rookie physician, Soka Moses helped lead his community through the bleakest days of the Ebola epidemic as Clinical Director of the Ministry of Defense Ebola Treatment Center in Monrovia, Liberia. Soka and his staff treated over 600 patients, risking their own infection and death. After saving hundreds of lives, Soka has now turned his attention to Ebola survivors. According to WHO, Liberia is home to 5,000 survivors, many of whom lost their families to the disease. That is not all that they have lost, as both patients and health care providers who have come in contact with the sick face severe social stigma that isolates them from their communities. Physically, Ebola survivors experience symptoms such as joint pain, dizziness, blurred vision, and the inability to concentrate to such severity that it precludes them from working. The unmet need to care for these patients prompted Soka to take on a new role as Director of the Ebola Survivors Clinic at Redemption Hospital in Monrovia, where he helps survivors reclaim their lives. While there are currently no cases of Ebola infection in Liberia, the effects still linger, and a recent outbreak of Ebola in the Democratic Republic of Congo is a reminder that continued prevention, detection, and response efforts are essential to ensure outbreaks do not turn into epidemics. To that end, Liberia and the United States are partnering to perform clinical research studies at Redemption Hospital and other sites across the country in order to ascertain the long-term ramifications of Ebola virus disease.

Like Soka, retina specialist Camila Ventura is working alongside her patients as they discover the still unknown, long-term consequences of a virus. Camila, who comes from a family of ophthalmologists in Recife, Brazil, works with patients and families affected by Congenital Zika Syndrome. Camila found herself on the front lines of the Zika epidemic after reporting ocular findings in babies with the Zika virus. While the number of cases of Zika infection in Brazil, the Caribbean, and the United States are down this year, US cities near the Mexico border—where infection data is limited and the rainy season has begun—are being cautious. One case of the Zika virus, likely spread from a mosquito, was recently reported in Hidalgo County, Texas.

There’s a new understanding of how infants with Congenital Zika Syndrome can present with a broad spectrum of symptoms, including visual impairments. Camila is actively gathering information on the visual impacts of this virus, closely following her infant patients to uncover the mechanisms behind their unique symptoms and the best treatment options for them. Her team partners with families of babies with Congenital Zika Syndrome to navigate the unknown prognosis and long-term consequences of this virus.

Zika can be a challenge to diagnose because there are so few copies of the virus in a patient’s body, which means that it requires a highly sensitive test. This year at TEDMED, we will hear from Omar Abudayyeh of SHERLOCK, who will take the stage during the Audacious session alongside 19 other innovators who are transforming health and medicine. At SHERLOCK, Omar and his colleagues found a new application for CRISPR technology, using it to detect and diagnose biologic material rather than to edit genomes. The team designed a way to detect viruses, bacteria, and cancer at attomolar levels, allowing for highly accurate diagnosis in incredibly small amounts of sample. The result is a simple and inexpensive diagnostic tool that can be rapidly used—vital when time is of the essence.

The Anopheles mosquito, which transmits malaria

While viruses like Ebola and Zika have presented the global health community with new and unexpected challenges in terms of our ability to offer timely diagnosis and treatment, our world has long been familiar with the suffering caused by malaria. Malaria remains a leading cause of death in developing countries, where young children and pregnant women are at greatest risk of infection. Physician and professor Nick White studies this disease from Mahidol University in Bangkok, Thailand. In 1981, Nick and his colleagues happened upon a Chinese scientific journal describing the antimalarial properties of an herb called qinghao. They performed large-scale studies, treating adults and children infected with malaria with derivatives of qinghao, commonly known as artemisinin. Artemisinin combined with a conventional antimalarial, or artemisinin-based combination therapy (ACT), quickly proved to significantly decrease malaria morbidity and mortality worldwide. Despite the effectiveness of the treatment, Nick and his team faced significant challenges convincing policy makers to adopt it, but found success after another party published an incendiary article in The Lancet. Now, this successful treatment of malaria faces new challenges, as artemisinin resistance has repeatedly emerged in Southeast Asia. In the past few years, Nick and his team have made advances in exploring the options available to eradicate these resistant strains.

Together, these Speakers and Innovators demonstrate diligence and ingenuity as they bravely tackle the overwhelming challenges surrounding epidemics. Whether by navigating the unknown effects of disease alongside patients or developing new ways to diagnose and treat pathogens, their work inspires hope. We invite you to join us at TEDMED this November to hear them share their remarkable stories.

Killing them softly: Andrew Read’s tactics would stop mosquitoes without resistance

Andrew Read is firing some of science’s latest salvos in the fight against malaria, including a resistance-proof green pesticide

Vector-borne diseases (VBDs)  – deadly viruses and bacteria born by mosquitoes, ticks and fleas – have been gloomy landmarks on the pages of human history, particularly after massive scourges like the fifth-century Plague of Justinian wiped out some 25 to 100 million people in the Eastern Roman Empire and heralded the beginning of the Dark Ages in Europe. And #justonebite from a disease-carrying insect, as the World Health Organization (WHO) Twitter campaign for World Health Day reminds us, is all it takes to contract one.

Mosquito eggs hatching in water. Image: Shutterstock

Mosquito eggs hatching in water. Image: Shutterstock

Malaria kills some 627,000 people each year; in 2012, about 460,000 of them are children who died before their fifth birthday – that’s one child death per minute.  Dengue is otherwise known as “bone-break fever,” due to its wracking effects. Chikungunya, a virus spreading rapidly in the Caribbean, brings headache, joint pain and rashes. No wonder just thinking about these gives us the shivers, a fact Bill Gates drove home when he released a jar of mosquitoes into the room at his TED talk in 2009, saying, “Not only poor people should experience this.”

This unsettling move was prescient; we normally think of these diseases as problems only in poor nations like many in Africa, but thanks to globalization and climate changes they’re getting closer to or diving more deeply into the U.S. Someday, West Nile virus, dengue and perhaps Chikungunya may become facts of life here.

Many of these are killers without a cure, so humans have set our wits to defeating them one way or another.  We’ve tried pesticides; environmental control; shields like clothing and bed nets. TEDMED 2012 speaker Andrew Read, biologist and Director of the Center for Infectious Disease Dynamics at Penn State University, has other ideas: He’s attacking viruses where they live, inside a mosquito’s body.

Read is working with Mathew Thomas, a fellow entomologist, to grow a pathogenic fungus that infiltrates a mosquito’s organs, eventually killing it before the malaria parasite it may harbor matures enough to become contagious, a period of about 12 days. The fungus, which shows no harm to humans, can be sprayed on walls, floors and standing water inside a home.

The fungus aims to be an evolution-proof insecticide. Indoor spraying is still a cornerstone of malaria control, but mosquitoes eventually breed resistance to strains of pesticides if they’re killed immediately, and we don’t have that many new chemical options with which to attack them. Plus, killing all of the world’s mosquitoes could have unforeseen ecological consequences. Instead, Read’s formula kills the bugs more slowly, so that the female has time to lay eggs before expiring.

Read has devoted the majority of his career discovering how infectious diseases evolve, particularly the malaria parasite. As he discussed at TEDMED 2012, there are two ways to combat resistance:  a “drugs-bugs” arms race, in which the bugs are already slowly winning; or evolutionary management, trying to shape the bug populations of the future, which which we’ve done a lousy job so far, he says, in part because many scientists don’t fully understand evolutionary biology.

“If we’re really serious, we’ve got to start measuring things, like the selective forces happening when we hit these bugs. We need to think if we can retard or even stop the evolution that undermines our marvelous technology.

“When we attack life, life evolves back. We are picking  a fight with natural selection, and natural selection is one of the most powerful forces in the universe. Going into a fight without Darwin is like going to the moon without Newton,” Read said in his talk.

Nevertheless, his solution hasn’t yet gone to trial. Funding for his efforts and similar ones is scarce, Read says, adding, “Killing bugs is just not sexy.” The global research and development budget is small in proportion to the severity of malaria’s harms. Of that, the vast majority goes toward tinkering with chemical solutions to kill the messengers, while only about 4 percent goes toward actual vector control; that may change, Read says, as resistance continues to build, as it is in some areas, including West Africa.

If diseases in Chikungunya do spread into the U.S., and there is political pressure for a greener, non-chemical solution, ideas like his may gain more traction. One sign:  His colleague Matthew Thomas is working on a fungal agent to kill bedbugs — an idea that’s already received much attention as their numbers grow in the U.S.

Stacy Lu