May 24, 2024 • 27 mins
In this episode, we are putting a special focus on the H5N1 bird flu. We explore the ongoing efforts to prepare for future pandemics by speaking with experts like Peter Sousa Hoejskov, who explains the constant risk of zoonotic diseases jumping from animals to humans, and Maria van Kerkhove, who emphasizes the importance of global surveillance and preparedness in the face of potential influenza pandemics. The discussion sheds light on how close human-animal interactions, even in regions like Europe, keep the threat of these diseases ever-present.
The insightful contributions from leading scientists provide a comprehensive understanding of why we must remain vigilant and proactive. Tune in to Health in Europe with host Alice Allan to discover what’s being done to protect us all from the next pandemic - not if but when.
(Interviews for this podcast were recorded in early May 2024)
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Peter Hoejskov (00:01):
The next pandemic is not a question of if
, but of when.
Alice Allan (00:17):
Throughout history, pandemics have swept around the
world, leaving devastation intheir wake.
What are we doing to preparefor the next one?
Hello, I'm your host, AliceAllen, and in this special
series of Health in Europe, I'llbe going behind the scenes at
WHO and some of the Europeanregion's major public health
(00:39):
institutions to understand whatthe most likely causes of future
pandemics could be and whatstrategies are in place to avert
them.
I'll talk to the expertsapplying the lessons of previous
pandemics and focus in on thesystems in place to spot threats
and reduce their impact.
(00:59):
I'll speak to the legion ofpublic health experts quietly
working away, getting on withthe not very glamorous but
incredibly important work ofemergency preparedness Experts
in surveillance, genomicsequencing, epidemiology and
more the people who arecontaining outbreaks and laying
(01:23):
the groundwork to mitigate theeffects of pandemics, not if,
but when they occur.
This is Health in Europe, andin this episode we explore H5N1
bird flu my name is peter sosahoesko.
(01:52):
I work as a technical officerfor food safety and zoonotic
diseases in the who regionaloffice for europe, based in in
copenhagen zoonotic diseaseshave been around forever, but
while their threat has alwaysbeen there, the virus behind the
Covid-19 pandemic, sars-cov-2,which originated in bats, and,
(02:14):
more recently, the jump of avianflu into cattle, has put them
back in the news.
Peter Hoejskov (02:21):
So zoonotic diseases are diseases that can
jump from animals to humans.
So basically, a disease thatoriginates in an animal and
transmits to a human, eitherdirectly, with direct contact
between animals and humans.
It can be domestic animals, itcan be wild animals, or it can
be indirectly as well, throughunsafe food, for example.
Alice Allan (02:44):
Here in Europe we might think sometimes that, oh,
zoonotic diseases, that'ssomething that happens somewhere
else in the world.
Why are zoonotic diseases alsorelevant in the European region?
Peter Hoejskov (02:56):
Everywhere in the world, including in the
European region, there is closecontacts between humans and
animals.
We have large agriculturalproductions in the European
region, livestock breeding sites, we have domestic animals.
We interact from now and thenwith wildlife.
(03:16):
So there is this constantinteraction between humans and
animals.
We can't completely separateourselves from the animal world.
So when we have thisinteraction there is also a risk
of transmission of diseasesbetween animals and humans.
Alice Allan (03:30):
Why are we hearing more recently about the threat
of zoonotic diseases?
Peter Hoejskov (03:36):
We know that the SARS-CoV-2 virus this is the
virus that causes COVID-19 as adisease originated in the animal
population and then, through anintermediate host, ended up in
the human population and withthe mutations that viruses can
have, then the transmissionbetween humans can become more
(04:00):
serious, and that was exactlywhat we saw with the COVID-19
pandemic.
So I think that of courseincreases the interest and
triggers the attention of weneed to be better prepared for
the next potential pandemic.
We don't know when it willhappen, but we know it's very
likely to happen.
We also know that a lot of thenew infectious diseases that we
(04:23):
see in humans originate inanimals.
Alice Allan (04:25):
Is there anything about our modern way of life
that is increasing the risk ofzoonotic transmission?
Peter Hoejskov (04:34):
Yes, with more urbanisation we get closer
interaction with the animalpopulation.
We see climate change as afactor as well that affects how
the viruses survive and how theymutate.
We see changes in theagricultural practices, the way
(04:54):
we breed animals more intensivelivestock breeding.
Alice Allan (04:58):
Tell me about One Health.
Peter Hoejskov (05:01):
One Health is an approach, it's a way of working
, seeing these health threatsand the health challenges that
we are facing in a much moreholistic and a more systematic
way, realising that we cannotprevent and prepare for
pandemics in the human healthsector alone.
We need to also work acrosssectors, across disciplines.
(05:25):
We need to work with colleaguesin other organizations or at
country level with otherministries.
So a very close collaboration,sharing of information, joint
risk assessments across thevituary services, agricultural
sector, environment sector andhuman health.
And that's exactly what OneHealth is all about.
(05:45):
It is to see health as oneacross these different domains
and encouraging closerinteraction, closer coordination
and sharing of information sowe can be better prepared and
act fast if we need to.
We have a formalized partnershipwith what we call the
Quartipartite Organizations, sothat's the Food and agriculture
(06:07):
organization of the UnitedNations, it's the World
Organization for Animal Health,boha, and it's the United
Nations Environment Program,unep and then WHO.
So we work very closelytogether.
We have also developed jointguidance material for countries
on how they can operationalizethe One Health approach
(06:29):
Basically, what are some of thetools, what are some of the
techniques and how can theybetter implement and work across
sectors at a country level,because One Health is not at the
global level, only oforganizations working together.
It comes all the way down tocommunities and we know the next
pandemic is also going to startin a community somewhere, so we
(06:50):
need to be better prepared atcommunity level.
So One Health is at all levelsand across various sectors and
disciplines.
Alice Allan (07:12):
Nicola Lewis is director of the Worldwide
Influenza Centre at the FrancisCrick Institute in London.
It's a WHO collaborating centreand one of its key functions is
to track strains of influenzathat are circulating among
animals and humans to understandhow it's changing.
Nicola Lewis (07:34):
So flu is fascinating and I think one of
the aspects of flu that isfascinating is it's continuously
evolving.
It's changing the whole time.
Is it's continuously evolving?
It's changing the whole time.
It's a virus that, when itreplicates in a particular host,
makes mistakes, and it makesmistakes in its genome, and that
means that it's able toconstantly evolve, and some of
(07:56):
this evolution means that it'sable to escape prior immunity
that we might have to aparticular flu virus.
So we're merely facing achallenge constantly to try and
keep up with this changingevolution.
Flu viruses are also fascinatingbecause they can do something
else in terms of changingconstantly.
They can undergo what we callreassortment, and this happens
(08:18):
when two different flu virusesinfect a person or infect a pig
at the same time and theyshuffle their genetic material
so that the progeny flu virusthat comes out of the pig or
other human is actuallydifferent.
And this process ofreassortment is also a way that
flu viruses evolve.
Now we know that flu virusesare particularly tricky to
(08:42):
understand from this point ofview, because this whole
evolutionary process means thatwe have to stay abreast of this
evolution to understand wherethe next threat might come from.
Alice Allan (08:53):
Big scientific advances have been made in the
last hundred years aboutunderstanding viruses and
tracking them.
How close are we to being ableto keep up with flu?
Nicola Lewis (09:03):
I think we're getting much, much better at
trying to keep up with theevolution of these pathogens.
I certainly think that newtechnologies are coming along
all the time and we make themost of those, particularly in
the influenza field.
But because flu changesconstantly, it constantly
presents a new challenge to us.
So we certainly can't drop ourguard with flu viruses, and I
(09:27):
think there is one certainty,and that is that there will be
another flu pandemic in thefuture.
Alice Allan (09:33):
Can you think of a particular moment when flu has
done something that has shockedor surprised you?
One of those moments whenyou've gone gosh wow, flu.
That was interesting.
Nicola Lewis (09:46):
I think one of the major surprises has been quite
recently, actually with the H5highly pathogenic viruses that
have been circulating in birdpopulations, and we've been
facing a massive challenge withthese viruses since about 1997.
But in about mid-2020, wesuddenly saw a radical shift in
the way that these viruses wereevolving.
(10:08):
All of a sudden, rather thanbeing confined to particular
geographic regions, they managedto switch back into wild birds,
they managed to infect manymore wild bird hosts and then
they managed to spread globallyto the extent that since 2020,
they've spread not justthroughout Eurasia, not just
(10:29):
through into Europe, into Africa, but they've also hopped over
the Atlantic and have now spreadright the way down North
America, south America, and havejust turned up in Antarctica.
We have never seen this kind ofsituation with a highly
pathogenic H5 virus before, andI certainly think that if you'd
(10:49):
asked me in 2019, this would nothave been the picture I would
have conjured up in my mindabout what bird flu could do.
Alice Allan (10:58):
How are scientists responding to this new behaviour
?
Nicola Lewis (11:02):
As researchers, we are very committed to
understanding what has changedwith the virus, but also what we
can do to help populations ofanimals, and indeed the human
population, be prepared to beable to counteract these
infections, to be able tomitigate them and to essentially
(11:23):
prepare for a potentialpandemic from these viruses.
So there are a number ofdifferent initiatives that we
undertake to keep up with theseviruses.
The first is to sample theseviruses in animal populations to
characterise them, to sequencethem, to antigenically
characterise them, to understandwhat they look like in these
(11:43):
animal populations, in birdpopulations, but also when
they've spilled over intoterrestrial mammal populations
around the world.
And the next part of this is tounderstand what these viruses
look like relative to what wecall candidate vaccine viruses.
And these are viruses that theWHO network, the Global
(12:05):
Influenza Surveillance ResponseNetwork, worldwide we take these
viruses and we try tounderstand the similarity to
potential candidate vaccineviruses we might have to use
were there to be a humanpandemic.
And so, twice a year, the WHOcollaborating centres that are
part of this GIST-Risk GlobalInfluenza Surveillance and
(12:27):
Response Network come togethertwice a year and we have a very
important job to do twice a year.
One is to make recommendationfor seasonal influenza viruses
and for the vaccine strains, butthe other is to look at the
viruses that are circulating inanimal populations and to think
about what we need to preparefor, what kind of candidate
(12:48):
vaccine viruses we might need tohave in our armoury to help us,
were there to be a pandemictomorrow in our armoury to help
us, were there to be a pandemictomorrow In the European region.
Alice Allan (13:03):
detections of H5N1 have been made in farmed fur
animals in Finland and Spain,and also in domestic cats in
Poland.
Aisling Vaughan is anepidemiologist who works for WHO
Europe in the High ThreatPathogens team.
I started by asking her whatthe team had learned from
working on these outbreaks.
Aisling Vaughn (13:19):
I think what we learned from these events in
Europe most recently was that astrong foundation of trust
amongst stakeholders is reallyreally important.
It enables rapid informationexchange, it allows for
coordinated multi-sectoralefforts and it really drives
(13:42):
decisive actions to effectivelyprevent any further viral spread
and then, of course, safeguardboth human and animal health.
Alice Allan (13:52):
How do you assess the current risk of H5N1 to
humans, particularly in thelight of the recent detections
in cattle in the US?
Aisling Vaughn (14:02):
So it's important to remember that this
virus mostly affects wild birdsand domestic birds.
It rarely affects humans andthere's really no evidence yet
that this virus has acquired theability to spread well from
person to person.
And despite the high number ofclade 2344B outbreaks we've seen
(14:25):
, and the detections in animalsand as well the human exposures
to this virus at thehuman-animal interface,
relatively few infections haveactually been reported to date,
which is reassuring.
So, overall, since thebeginning of 2021, 28 detections
of H5N1 in humans have beenreported to WHO, including the
(14:50):
most recent case who hadexposure to dairy cattle.
So, of all of the H5N1 casesreported in Europe and North
America, they have beenasymptomatic or mild.
So, for example, the mostrecent case in the US reported
conjunctivitis as their onlysymptom.
All H5N1 cases so far have beensporadic infections.
(15:13):
They've occurred through director indirect contact with
infected birds or infectedmammals or environments such as
live poultry markets or otherpremises with infected animals,
and among these cases, therehave been no reported human to
human transmission and, in fact,there have been no reported
human human transmission of H5N1since 2007.
(15:37):
So, based on everything we know, based on all the information
available, who assesses thecurrent overall public health
risk posed by H5N1 to be low,and for those with exposure to
infected birds or animals orcontaminated environments, the
risk of infection is consideredlow to moderate.
(15:58):
But these viruses arecontinually evolving and
spreading in birds and animals,so continuous real-time
monitoring is needed.
Maria van Kerkhove (16:14):
I think with almost certainty we will have
another flu pandemic in ourlifetime.
Alice Allan (16:19):
Dr Maria Van Kerkhoff is the Acting Interim
Director of the WHO's Departmentof Epidemic and Pandemic
Preparedness and Prevention.
She also leads on COVID-19emergency management and she's
technical lead of the WHO HealthEmergencies Programme.
She started her career workingon avian influenza 20 years ago.
Maria van Kerkhove (16:43):
I became interested in viruses, pathogens
, when I was in college and whenI was doing my PhD at London
School of Hygiene and TropicalMedicine.
And as part of my PhD work Iwas based in Cambodia and I was
working with Institute PasteurCambodia on H5N1, on avian
influenza, and at the time therewere six or seven human cases
(17:06):
in Cambodia.
So it was relatively new andwhat we were doing there with
colleagues across the Ministryof Health, the Ministry of
Agriculture, institute Pasteur,where we're doing these outbreak
investigations, and I wasfascinated with outbreak
investigation it wasmultidisciplinary, it was all
One Health before it was evencalled One Health, you know and
it was really just earlydetection and early action to
(17:28):
prevent onward spread.
So we were doing all thesecomplex, comprehensive
investigations in the field.
Oh my gosh, I absolutely lovedit.
Alice Allan (17:38):
Why are we hearing so much about H5N1 recently?
Maria van Kerkhove (17:41):
So there's a lot of attention right now to
avian influenza and there's amassive epizootic across the
world.
It has expanded greatly in thelast couple of years.
This is particular on H5N1, butnot only H5N1.
We see in wild birds, we see indomestic poultry, we see in
spillover into mammals,including humans.
(18:04):
But this is being detected innew countries Right now.
There's been quite a lot ofattention on H5N1 in dairy cows,
in dairy cattle in the US, andyou know it is unfortunate that
the world starts to payattention when you see this in
high-income countries.
But we will use this attentionto draw awareness to one the
(18:27):
global influenza andsurveillance response system
that's been in place for 70years.
Who did not wake up to flu.
We've been working on this forquite a long time because we
know there's seasonal influenza,there's a potential for
pandemic influenza and there'sall these novel subtypes of
avian influenza.
And we work with the PIPframework of looking at how do
we have better capacities incountries for these types of
(18:48):
detection, but also how do weshare viruses with our global
lab network, our nationalinfluenza centres, our WHO
collaborating centres toidentify certain viruses that
should be thought of forvaccines.
Alice Allan (19:05):
The PIP framework is WHO's Pandemic Influenza
Preparedness Framework.
Maria van Kerkhove (19:11):
So we have these candidate vaccine viruses,
including many H5N1 vaccines,which prompt us already to have
H5N1 vaccines, which prompt usalready to have H5N1 vaccines in
development.
Now I do want to contextualizethis that since 2017, we've only
had 28 human cases of avianinfluenza and we have not seen
human-to-human transmission.
We're constantly lookingbecause our worry is that these
(19:34):
viruses can be more adapted fortransmission.
We have not seen that yet, butwe are concerned.
The more opportunity this virushas to circulate, the more
opportunities we see forinfection in different species,
and these viruses can combinethe genetic components of it,
can combine and potentiallycause a new virus of influenza
(19:57):
that could be highlytransmissible.
That's what happened in 2009.
So we're constantly thinkingabout this.
Not just thinking, but takingaction to be better prepared.
What we want to do is prevent,prevent, prevent.
There are some treatments forinfluenza.
We have vaccination, so there'sa seasonal vaccine campaign
every year.
We urge people to get not onlyCOVID vaccines but also
(20:20):
influenza vaccines, and thereare H5N1 vaccines in development
, should we need them.
Alice Allan (20:26):
This recent species jump into cattle.
What's WHO or what are yourpartner agencies doing to
understand that development andany potential risks to humans?
Maria van Kerkhove (20:39):
Yeah, quite a bit actually.
So what we're trying to do isenhance the surveillance.
We have a global surveillancesystem in humans as part of our
GISRIS system, which is lookingat sentinel sites, so patients
that are going into hospitals.
Some are non-hospital sites.
We're working with FAO and WOHAon surveillance in animals, so
in wild birds, in poultry, inlivestock, and now that we're
(21:03):
seeing infections in certainspecies we want to make sure
that those species are testedmore systematically.
So not just dairy cattle in theUS, but we would ask more
globally for surveillance toinclude these animals, but not
only in the animals themselvesbut looking in the products of
those animals, like milk andmilk products.
So there's a lot of work thathas to happen there to
(21:25):
understand the extent ofcirculation.
We advise that sequencing beconducted and shared because
there's a lot that we can gainin our understanding of
transmission and circulationwith the sequence information.
So I don't have the fullpicture, but that's just because
the work is ongoing as we aretalking about this right now.
(21:45):
We also are very activelyengaging with our WHO
collaborating centers, nationalinfluenza centers, to make sure
that samples that need to be inthe right labs to do the right
types of laboratory researchtype studies are ongoing and
that information is shared andwe're constantly doing risk
assessments.
Alice Allan (22:04):
What kind of key factors could contribute to a
species jump to humans for H5N1?
Maria van Kerkhove (22:12):
So one is opportunity right.
So, as these species intermixwith each other, you know, we
have wild birds that are flying,and so there's opportunities
for the virus to spread betweenpoultry and other species, wild
birds and other species andthat's what we think has
happened here, based on thesequencing information.
We're also very carefullylooking at the viruses and
looking at the mutations withinthe viruses and any changes that
(22:35):
would favor mammalianadaptations what they call it
would favor a transmission inmammals.
Now we're seeing some changes,but these are mainly, primarily
poultry viruses and they havenot adapted well to transmit
between people and in mammals,and that's a really important
thing that we're tracking.
(23:03):
We have a lot of reallyfantastic I mean this with the
utmost respect super nerdyscientists, who I adore, around
the world who are looking atthis with us.
So it's not just WHO sittinghere saying what do we think?
What we do is we bring togetherthe best minds in the world as
part of our global influenzasurveillance and response system
.
We do this for COVID as welland for SARS-CoV-2, of what do
these changes in the virusesmean from a public health point
(23:24):
of view?
So that is something that'salso ongoing.
Alice Allan (23:34):
There've been a lot of headlines recently
predicting that the nextpandemic is going to be caused
by an influenza virus that'sjumped from animals to humans.
How do you assess that risk?
Maria van Kerkhove (23:47):
For me, flu is a certainty because it's so
much in circulation.
It's infected many differentspecies.
We have avian influenza and theopportunities for reassortance,
the opportunities for apandemic influenza virus are
high.
That's why we have a wholesystem in place to be prepared
(24:08):
for this.
The challenge is will we seeanother coronavirus pandemic,
given that we had SARS-CoV-2cause, a pandemic for sure.
This is an opportunity.
Question is will we see anarbovirus pandemic?
Now, I'm not saying this toscare people who are listening
to this, but for us it'ssomething that we have to be
prepared for.
So we have to think out of thebox, really prepare for what are
(24:33):
the known threats, but alsothink out of the box, for you
know, really prepare for whatare the known threats, but also
think out of the box, you know,for something different, perhaps
waterborne or whatnot.
So for me, pandemics,unfortunately, are part of what
we will deal with in ourlifetimes.
I don't believe this will bethe last pandemic we will deal
with in our lifetimes.
Alice Allan (24:50):
We know we weren't prepared for the COVID-19
pandemic.
Are we prepared for the nextone?
Maria van Kerkhove (24:57):
Yes and no.
Yes because we do have strongsystems that are in place.
We have learned a lot in thelast four years from COVID.
We have strengthened PCRcapacity, sequencing capacity.
We have stronger communityengagement.
We have many systems that arein place to ensure better
(25:17):
clinical care and infectionprevention and control and good
coordination in our emergencyoperation centers and supply
chain.
No, on the other hand nobecause I think the world's
trust in science you knowthere's been a lot of, there's
been a lot of distrust, um, overthe last couple of years, and
(25:37):
that's something we have to workon.
You can develop the bestinterventions in the world, but
if they're not implemented bycommunities, they're useless.
We still have challenges withequity and access to these
materials and I think you know,in many respects we are better
off and in others we are not.
I'm optimistic.
That's what gets me out of bedevery day, otherwise I wouldn't
(26:00):
be able to do this job.
I'm hopeful with the pandemicagreement that is being
discussed and negotiated rightnow by all of our member states
to get this done.
They want to get this donebecause we have to do.
We can't just have a handshakeand say, oh, we'll do better
next time.
There have to be commitments inplace to ensure that we do
(26:22):
better the next time.
Again, covid-19 did not have tobe as bad as it was, as it is,
and we owe it to our children,our grandchildren, to make sure
that we we keep up these systemsand have that commitment in
place to make sure that we dobetter the next time.
Alice Allan (26:41):
In future episodes I'll talk to experts who are
tracking disease outbreaks,trying to understand them better
and preparing for futurepandemics Not if, but when they
happen.
Health in Europe is produced bythe World Health Organization.
(27:03):
Music for this episode is byBen Howells, Richard Duttonall
and Gareth Thomas.
Sound engineering is by DavidBarrett.
My name's Alice Allen.
Thanks for listening, Thank you.
The next pandemic is not a question of if
, but of when.
Alice Allan (00:17):
Throughout history, pandemics have swept around the
world, leaving devastation intheir wake.
What are we doing to preparefor the next one?
Hello, I'm your host, AliceAllen, and in this special
series of Health in Europe, I'llbe going behind the scenes at
WHO and some of the Europeanregion's major public health
(00:39):
institutions to understand whatthe most likely causes of future
pandemics could be and whatstrategies are in place to avert
them.
I'll talk to the expertsapplying the lessons of previous
pandemics and focus in on thesystems in place to spot threats
and reduce their impact.
(00:59):
I'll speak to the legion ofpublic health experts quietly
working away, getting on withthe not very glamorous but
incredibly important work ofemergency preparedness Experts
in surveillance, genomicsequencing, epidemiology and
more the people who arecontaining outbreaks and laying
(01:23):
the groundwork to mitigate theeffects of pandemics, not if,
but when they occur.
This is Health in Europe, andin this episode we explore H5N1
bird flu my name is peter sosahoesko.
(01:52):
I work as a technical officerfor food safety and zoonotic
diseases in the who regionaloffice for europe, based in in
copenhagen zoonotic diseaseshave been around forever, but
while their threat has alwaysbeen there, the virus behind the
Covid-19 pandemic, sars-cov-2,which originated in bats, and,
(02:14):
more recently, the jump of avianflu into cattle, has put them
back in the news.
Peter Hoejskov (02:21):
So zoonotic diseases are diseases that can
jump from animals to humans.
So basically, a disease thatoriginates in an animal and
transmits to a human, eitherdirectly, with direct contact
between animals and humans.
It can be domestic animals, itcan be wild animals, or it can
be indirectly as well, throughunsafe food, for example.
Alice Allan (02:44):
Here in Europe we might think sometimes that, oh,
zoonotic diseases, that'ssomething that happens somewhere
else in the world.
Why are zoonotic diseases alsorelevant in the European region?
Peter Hoejskov (02:56):
Everywhere in the world, including in the
European region, there is closecontacts between humans and
animals.
We have large agriculturalproductions in the European
region, livestock breeding sites, we have domestic animals.
We interact from now and thenwith wildlife.
(03:16):
So there is this constantinteraction between humans and
animals.
We can't completely separateourselves from the animal world.
So when we have thisinteraction there is also a risk
of transmission of diseasesbetween animals and humans.
Alice Allan (03:30):
Why are we hearing more recently about the threat
of zoonotic diseases?
Peter Hoejskov (03:36):
We know that the SARS-CoV-2 virus this is the
virus that causes COVID-19 as adisease originated in the animal
population and then, through anintermediate host, ended up in
the human population and withthe mutations that viruses can
have, then the transmissionbetween humans can become more
(04:00):
serious, and that was exactlywhat we saw with the COVID-19
pandemic.
So I think that of courseincreases the interest and
triggers the attention of weneed to be better prepared for
the next potential pandemic.
We don't know when it willhappen, but we know it's very
likely to happen.
We also know that a lot of thenew infectious diseases that we
(04:23):
see in humans originate inanimals.
Alice Allan (04:25):
Is there anything about our modern way of life
that is increasing the risk ofzoonotic transmission?
Peter Hoejskov (04:34):
Yes, with more urbanisation we get closer
interaction with the animalpopulation.
We see climate change as afactor as well that affects how
the viruses survive and how theymutate.
We see changes in theagricultural practices, the way
(04:54):
we breed animals more intensivelivestock breeding.
Alice Allan (04:58):
Tell me about One Health.
Peter Hoejskov (05:01):
One Health is an approach, it's a way of working
, seeing these health threatsand the health challenges that
we are facing in a much moreholistic and a more systematic
way, realising that we cannotprevent and prepare for
pandemics in the human healthsector alone.
We need to also work acrosssectors, across disciplines.
(05:25):
We need to work with colleaguesin other organizations or at
country level with otherministries.
So a very close collaboration,sharing of information, joint
risk assessments across thevituary services, agricultural
sector, environment sector andhuman health.
And that's exactly what OneHealth is all about.
(05:45):
It is to see health as oneacross these different domains
and encouraging closerinteraction, closer coordination
and sharing of information sowe can be better prepared and
act fast if we need to.
We have a formalized partnershipwith what we call the
Quartipartite Organizations, sothat's the Food and agriculture
(06:07):
organization of the UnitedNations, it's the World
Organization for Animal Health,boha, and it's the United
Nations Environment Program,unep and then WHO.
So we work very closelytogether.
We have also developed jointguidance material for countries
on how they can operationalizethe One Health approach
(06:29):
Basically, what are some of thetools, what are some of the
techniques and how can theybetter implement and work across
sectors at a country level,because One Health is not at the
global level, only oforganizations working together.
It comes all the way down tocommunities and we know the next
pandemic is also going to startin a community somewhere, so we
(06:50):
need to be better prepared atcommunity level.
So One Health is at all levelsand across various sectors and
disciplines.
Alice Allan (07:12):
Nicola Lewis is director of the Worldwide
Influenza Centre at the FrancisCrick Institute in London.
It's a WHO collaborating centreand one of its key functions is
to track strains of influenzathat are circulating among
animals and humans to understandhow it's changing.
Nicola Lewis (07:34):
So flu is fascinating and I think one of
the aspects of flu that isfascinating is it's continuously
evolving.
It's changing the whole time.
Is it's continuously evolving?
It's changing the whole time.
It's a virus that, when itreplicates in a particular host,
makes mistakes, and it makesmistakes in its genome, and that
means that it's able toconstantly evolve, and some of
(07:56):
this evolution means that it'sable to escape prior immunity
that we might have to aparticular flu virus.
So we're merely facing achallenge constantly to try and
keep up with this changingevolution.
Flu viruses are also fascinatingbecause they can do something
else in terms of changingconstantly.
They can undergo what we callreassortment, and this happens
(08:18):
when two different flu virusesinfect a person or infect a pig
at the same time and theyshuffle their genetic material
so that the progeny flu virusthat comes out of the pig or
other human is actuallydifferent.
And this process ofreassortment is also a way that
flu viruses evolve.
Now we know that flu virusesare particularly tricky to
(08:42):
understand from this point ofview, because this whole
evolutionary process means thatwe have to stay abreast of this
evolution to understand wherethe next threat might come from.
Alice Allan (08:53):
Big scientific advances have been made in the
last hundred years aboutunderstanding viruses and
tracking them.
How close are we to being ableto keep up with flu?
Nicola Lewis (09:03):
I think we're getting much, much better at
trying to keep up with theevolution of these pathogens.
I certainly think that newtechnologies are coming along
all the time and we make themost of those, particularly in
the influenza field.
But because flu changesconstantly, it constantly
presents a new challenge to us.
So we certainly can't drop ourguard with flu viruses, and I
(09:27):
think there is one certainty,and that is that there will be
another flu pandemic in thefuture.
Alice Allan (09:33):
Can you think of a particular moment when flu has
done something that has shockedor surprised you?
One of those moments whenyou've gone gosh wow, flu.
That was interesting.
Nicola Lewis (09:46):
I think one of the major surprises has been quite
recently, actually with the H5highly pathogenic viruses that
have been circulating in birdpopulations, and we've been
facing a massive challenge withthese viruses since about 1997.
But in about mid-2020, wesuddenly saw a radical shift in
the way that these viruses wereevolving.
(10:08):
All of a sudden, rather thanbeing confined to particular
geographic regions, they managedto switch back into wild birds,
they managed to infect manymore wild bird hosts and then
they managed to spread globallyto the extent that since 2020,
they've spread not justthroughout Eurasia, not just
(10:29):
through into Europe, into Africa, but they've also hopped over
the Atlantic and have now spreadright the way down North
America, south America, and havejust turned up in Antarctica.
We have never seen this kind ofsituation with a highly
pathogenic H5 virus before, andI certainly think that if you'd
(10:49):
asked me in 2019, this would nothave been the picture I would
have conjured up in my mindabout what bird flu could do.
Alice Allan (10:58):
How are scientists responding to this new behaviour
?
Nicola Lewis (11:02):
As researchers, we are very committed to
understanding what has changedwith the virus, but also what we
can do to help populations ofanimals, and indeed the human
population, be prepared to beable to counteract these
infections, to be able tomitigate them and to essentially
(11:23):
prepare for a potentialpandemic from these viruses.
So there are a number ofdifferent initiatives that we
undertake to keep up with theseviruses.
The first is to sample theseviruses in animal populations to
characterise them, to sequencethem, to antigenically
characterise them, to understandwhat they look like in these
(11:43):
animal populations, in birdpopulations, but also when
they've spilled over intoterrestrial mammal populations
around the world.
And the next part of this is tounderstand what these viruses
look like relative to what wecall candidate vaccine viruses.
And these are viruses that theWHO network, the Global
(12:05):
Influenza Surveillance ResponseNetwork, worldwide we take these
viruses and we try tounderstand the similarity to
potential candidate vaccineviruses we might have to use
were there to be a humanpandemic.
And so, twice a year, the WHOcollaborating centres that are
part of this GIST-Risk GlobalInfluenza Surveillance and
(12:27):
Response Network come togethertwice a year and we have a very
important job to do twice a year.
One is to make recommendationfor seasonal influenza viruses
and for the vaccine strains, butthe other is to look at the
viruses that are circulating inanimal populations and to think
about what we need to preparefor, what kind of candidate
(12:48):
vaccine viruses we might need tohave in our armoury to help us,
were there to be a pandemictomorrow in our armoury to help
us, were there to be a pandemictomorrow In the European region.
Alice Allan (13:03):
detections of H5N1 have been made in farmed fur
animals in Finland and Spain,and also in domestic cats in
Poland.
Aisling Vaughan is anepidemiologist who works for WHO
Europe in the High ThreatPathogens team.
I started by asking her whatthe team had learned from
working on these outbreaks.
Aisling Vaughn (13:19):
I think what we learned from these events in
Europe most recently was that astrong foundation of trust
amongst stakeholders is reallyreally important.
It enables rapid informationexchange, it allows for
coordinated multi-sectoralefforts and it really drives
(13:42):
decisive actions to effectivelyprevent any further viral spread
and then, of course, safeguardboth human and animal health.
Alice Allan (13:52):
How do you assess the current risk of H5N1 to
humans, particularly in thelight of the recent detections
in cattle in the US?
Aisling Vaughn (14:02):
So it's important to remember that this
virus mostly affects wild birdsand domestic birds.
It rarely affects humans andthere's really no evidence yet
that this virus has acquired theability to spread well from
person to person.
And despite the high number ofclade 2344B outbreaks we've seen
(14:25):
, and the detections in animalsand as well the human exposures
to this virus at thehuman-animal interface,
relatively few infections haveactually been reported to date,
which is reassuring.
So, overall, since thebeginning of 2021, 28 detections
of H5N1 in humans have beenreported to WHO, including the
(14:50):
most recent case who hadexposure to dairy cattle.
So, of all of the H5N1 casesreported in Europe and North
America, they have beenasymptomatic or mild.
So, for example, the mostrecent case in the US reported
conjunctivitis as their onlysymptom.
All H5N1 cases so far have beensporadic infections.
(15:13):
They've occurred through director indirect contact with
infected birds or infectedmammals or environments such as
live poultry markets or otherpremises with infected animals,
and among these cases, therehave been no reported human to
human transmission and, in fact,there have been no reported
human human transmission of H5N1since 2007.
(15:37):
So, based on everything we know, based on all the information
available, who assesses thecurrent overall public health
risk posed by H5N1 to be low,and for those with exposure to
infected birds or animals orcontaminated environments, the
risk of infection is consideredlow to moderate.
(15:58):
But these viruses arecontinually evolving and
spreading in birds and animals,so continuous real-time
monitoring is needed.
Maria van Kerkhove (16:14):
I think with almost certainty we will have
another flu pandemic in ourlifetime.
Alice Allan (16:19):
Dr Maria Van Kerkhoff is the Acting Interim
Director of the WHO's Departmentof Epidemic and Pandemic
Preparedness and Prevention.
She also leads on COVID-19emergency management and she's
technical lead of the WHO HealthEmergencies Programme.
She started her career workingon avian influenza 20 years ago.
Maria van Kerkhove (16:43):
I became interested in viruses, pathogens
, when I was in college and whenI was doing my PhD at London
School of Hygiene and TropicalMedicine.
And as part of my PhD work Iwas based in Cambodia and I was
working with Institute PasteurCambodia on H5N1, on avian
influenza, and at the time therewere six or seven human cases
(17:06):
in Cambodia.
So it was relatively new andwhat we were doing there with
colleagues across the Ministryof Health, the Ministry of
Agriculture, institute Pasteur,where we're doing these outbreak
investigations, and I wasfascinated with outbreak
investigation it wasmultidisciplinary, it was all
One Health before it was evencalled One Health, you know and
it was really just earlydetection and early action to
(17:28):
prevent onward spread.
So we were doing all thesecomplex, comprehensive
investigations in the field.
Oh my gosh, I absolutely lovedit.
Alice Allan (17:38):
Why are we hearing so much about H5N1 recently?
Maria van Kerkhove (17:41):
So there's a lot of attention right now to
avian influenza and there's amassive epizootic across the
world.
It has expanded greatly in thelast couple of years.
This is particular on H5N1, butnot only H5N1.
We see in wild birds, we see indomestic poultry, we see in
spillover into mammals,including humans.
(18:04):
But this is being detected innew countries Right now.
There's been quite a lot ofattention on H5N1 in dairy cows,
in dairy cattle in the US, andyou know it is unfortunate that
the world starts to payattention when you see this in
high-income countries.
But we will use this attentionto draw awareness to one the
(18:27):
global influenza andsurveillance response system
that's been in place for 70years.
Who did not wake up to flu.
We've been working on this forquite a long time because we
know there's seasonal influenza,there's a potential for
pandemic influenza and there'sall these novel subtypes of
avian influenza.
And we work with the PIPframework of looking at how do
we have better capacities incountries for these types of
(18:48):
detection, but also how do weshare viruses with our global
lab network, our nationalinfluenza centres, our WHO
collaborating centres toidentify certain viruses that
should be thought of forvaccines.
Alice Allan (19:05):
The PIP framework is WHO's Pandemic Influenza
Preparedness Framework.
Maria van Kerkhove (19:11):
So we have these candidate vaccine viruses,
including many H5N1 vaccines,which prompt us already to have
H5N1 vaccines, which prompt usalready to have H5N1 vaccines in
development.
Now I do want to contextualizethis that since 2017, we've only
had 28 human cases of avianinfluenza and we have not seen
human-to-human transmission.
We're constantly lookingbecause our worry is that these
(19:34):
viruses can be more adapted fortransmission.
We have not seen that yet, butwe are concerned.
The more opportunity this virushas to circulate, the more
opportunities we see forinfection in different species,
and these viruses can combinethe genetic components of it,
can combine and potentiallycause a new virus of influenza
(19:57):
that could be highlytransmissible.
That's what happened in 2009.
So we're constantly thinkingabout this.
Not just thinking, but takingaction to be better prepared.
What we want to do is prevent,prevent, prevent.
There are some treatments forinfluenza.
We have vaccination, so there'sa seasonal vaccine campaign
every year.
We urge people to get not onlyCOVID vaccines but also
(20:20):
influenza vaccines, and thereare H5N1 vaccines in development
, should we need them.
Alice Allan (20:26):
This recent species jump into cattle.
What's WHO or what are yourpartner agencies doing to
understand that development andany potential risks to humans?
Maria van Kerkhove (20:39):
Yeah, quite a bit actually.
So what we're trying to do isenhance the surveillance.
We have a global surveillancesystem in humans as part of our
GISRIS system, which is lookingat sentinel sites, so patients
that are going into hospitals.
Some are non-hospital sites.
We're working with FAO and WOHAon surveillance in animals, so
in wild birds, in poultry, inlivestock, and now that we're
(21:03):
seeing infections in certainspecies we want to make sure
that those species are testedmore systematically.
So not just dairy cattle in theUS, but we would ask more
globally for surveillance toinclude these animals, but not
only in the animals themselvesbut looking in the products of
those animals, like milk andmilk products.
So there's a lot of work thathas to happen there to
(21:25):
understand the extent ofcirculation.
We advise that sequencing beconducted and shared because
there's a lot that we can gainin our understanding of
transmission and circulationwith the sequence information.
So I don't have the fullpicture, but that's just because
the work is ongoing as we aretalking about this right now.
(21:45):
We also are very activelyengaging with our WHO
collaborating centers, nationalinfluenza centers, to make sure
that samples that need to be inthe right labs to do the right
types of laboratory researchtype studies are ongoing and
that information is shared andwe're constantly doing risk
assessments.
Alice Allan (22:04):
What kind of key factors could contribute to a
species jump to humans for H5N1?
Maria van Kerkhove (22:12):
So one is opportunity right.
So, as these species intermixwith each other, you know, we
have wild birds that are flying,and so there's opportunities
for the virus to spread betweenpoultry and other species, wild
birds and other species andthat's what we think has
happened here, based on thesequencing information.
We're also very carefullylooking at the viruses and
looking at the mutations withinthe viruses and any changes that
(22:35):
would favor mammalianadaptations what they call it
would favor a transmission inmammals.
Now we're seeing some changes,but these are mainly, primarily
poultry viruses and they havenot adapted well to transmit
between people and in mammals,and that's a really important
thing that we're tracking.
(23:03):
We have a lot of reallyfantastic I mean this with the
utmost respect super nerdyscientists, who I adore, around
the world who are looking atthis with us.
So it's not just WHO sittinghere saying what do we think?
What we do is we bring togetherthe best minds in the world as
part of our global influenzasurveillance and response system
.
We do this for COVID as welland for SARS-CoV-2, of what do
these changes in the virusesmean from a public health point
(23:24):
of view?
So that is something that'salso ongoing.
Alice Allan (23:34):
There've been a lot of headlines recently
predicting that the nextpandemic is going to be caused
by an influenza virus that'sjumped from animals to humans.
How do you assess that risk?
Maria van Kerkhove (23:47):
For me, flu is a certainty because it's so
much in circulation.
It's infected many differentspecies.
We have avian influenza and theopportunities for reassortance,
the opportunities for apandemic influenza virus are
high.
That's why we have a wholesystem in place to be prepared
(24:08):
for this.
The challenge is will we seeanother coronavirus pandemic,
given that we had SARS-CoV-2cause, a pandemic for sure.
This is an opportunity.
Question is will we see anarbovirus pandemic?
Now, I'm not saying this toscare people who are listening
to this, but for us it'ssomething that we have to be
prepared for.
So we have to think out of thebox, really prepare for what are
(24:33):
the known threats, but alsothink out of the box, for you
know, really prepare for whatare the known threats, but also
think out of the box, you know,for something different, perhaps
waterborne or whatnot.
So for me, pandemics,unfortunately, are part of what
we will deal with in ourlifetimes.
I don't believe this will bethe last pandemic we will deal
with in our lifetimes.
Alice Allan (24:50):
We know we weren't prepared for the COVID-19
pandemic.
Are we prepared for the nextone?
Maria van Kerkhove (24:57):
Yes and no.
Yes because we do have strongsystems that are in place.
We have learned a lot in thelast four years from COVID.
We have strengthened PCRcapacity, sequencing capacity.
We have stronger communityengagement.
We have many systems that arein place to ensure better
(25:17):
clinical care and infectionprevention and control and good
coordination in our emergencyoperation centers and supply
chain.
No, on the other hand nobecause I think the world's
trust in science you knowthere's been a lot of, there's
been a lot of distrust, um, overthe last couple of years, and
(25:37):
that's something we have to workon.
You can develop the bestinterventions in the world, but
if they're not implemented bycommunities, they're useless.
We still have challenges withequity and access to these
materials and I think you know,in many respects we are better
off and in others we are not.
I'm optimistic.
That's what gets me out of bedevery day, otherwise I wouldn't
(26:00):
be able to do this job.
I'm hopeful with the pandemicagreement that is being
discussed and negotiated rightnow by all of our member states
to get this done.
They want to get this donebecause we have to do.
We can't just have a handshakeand say, oh, we'll do better
next time.
There have to be commitments inplace to ensure that we do
(26:22):
better the next time.
Again, covid-19 did not have tobe as bad as it was, as it is,
and we owe it to our children,our grandchildren, to make sure
that we we keep up these systemsand have that commitment in
place to make sure that we dobetter the next time.
Alice Allan (26:41):
In future episodes I'll talk to experts who are
tracking disease outbreaks,trying to understand them better
and preparing for futurepandemics Not if, but when they
happen.
Health in Europe is produced bythe World Health Organization.
(27:03):
Music for this episode is byBen Howells, Richard Duttonall
and Gareth Thomas.
Sound engineering is by DavidBarrett.
My name's Alice Allen.
Thanks for listening, Thank you.
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