www.asiabiotech.com Special Feature — Bioterrorism Bioterrorism Interview with Donald Henderson rofessor Donald Henderson is a Johns Hopkins University Distinguished Service Professor Emeritus and Dean Emeritus of the School. He has a joint appointment in the department of Epidemiology. He is also Professor of Medicine and Public PHealth at the University of Pittsburgh School of Medicine. He rejoined the Hopkins faculty in June 1995 after fi ve years of federal government service in which he served initially as Associate Director, Offi ce of Science and Technology Policy, executive offi ce of the President (1991- 1993). He later became the deputy assistant secretary and senior science advisor in the Department of Health and Human Services. From 1977 through August 1990, Dr. Henderson was dean of the Johns Hopkins School of Public Health. He came to Hopkins after directing the World Health Organization’s global smallpox eradication campaign (1966-1977). Dr. Henderson was instrumental in initiating WHO’s global program of immunization, which has vaccinated 80 percent of the world’s children against six major diseases and has as a goal the eradication of poliomyelitis. Professor Henderson is also a resident fellow of the Center for Biosecurity of the University of Pittsburgh Medical Center. He is presently a resident scholar at the Center for Biosecurity of the University of Pittsburgh Medical Center. The Center for Biosecurity was originally founded in 1998 as the Center for Civilian Biodefense Studies at the Johns Hopkins Medical Institutions. The Center was established to increase national and international awareness of the medical and public health threats posed by biological weapons. After the 9/11 attack, Dr. Henderson was appointed as the government’s fi rst Director of the Offi ce of Public Health Emergency Preparedness. He continues to serve as senior science advisor to Secretary Thompson of the Department of Health and Human Services and as Chair of the Secretary’s Council on Public Health Preparedness. 18 APBN • Vol. 10 • No. 1 • 2006 10.1.henderson.indd 18 1/18/06 2:19:56 PM www.asiabiotech.com Special Feature — Bioterrorism Can you highlight the main points of the public lecture you gave in Singapore recently? The important message is that we are facing a very different set of problems in the 21st century. We are spending billions of dollars in trying to develop a vaccine that really is not in the horizon at the moment. We are also developing drugs that we have but these drugs do not cure. The number of diseases like SARs , encephalitis, monkey pox, H5N1 fl u, etc. are rising. There have been so many changes in the world that we have to recognize that we are at war with new emerging diseases. I think the world saw 30 new diseaseas in the past 35 years. These diseases are those we have never seen before. Some of them have emerged from remote areas; these are new agents that existed due to mutation and thus circulate among animals which then infect humans in contact with them. We now realize that there are a lot of diseases that can be transmitted from animals to man. Now, we have to also worry about the possiblity of some people using them as bioterrorism agents. The world is different now is due to a few reasons. Firstly, we have many developed urban areas. These places are changing very rapidly. Many of these large urban areas are in the tropical or subtropical regions. People live very closely in these places and thereby infections is easily transmitted at great speed. Many of these places do not have good sanitation. Thus, different organisms grow and have the potential of spreading as it never did before . Secondly, we are also traveling a great deal. The volume of air travel is growing immensely everyday. Now, the distance between two points on Earth is not more than 36 hours. The borders between countries are remarkably diminished now. In some poor areas, where resources are limited, many people are working very hard. These places do not have enough facilities or equipment. There is a case where hospitals in the rural part of the world have only fi ve syringes and sterilization is a problem. A number of hemorragic fever spread among the people there and, as a result, many died . This is the problem of hospitals in some areas of the world that has limited resources. Another problem we face is antibiotic resistance. The antibiotic that are effective before may not be effective when the organism mutate and develop resistance. One other problem is globalization and modernization. With modernization, we begin to process food in bulk. Producing food in huge amounts in factories has become a normal practise. In doing so, when contamination takes place, many people will be affected due to the large amount of food manufactured. This tremendous growth in food processing is a problem that we never had before. We are moving around the world at such a great pace now, it is hard to control the number of cattle or poultry we can rear. Agriculture in a large scale may cause infection of a large amount of animals. This in turn APBN • Vol. 10 • No. 1 • 2006 19 10.1.henderson.indd 19 1/18/06 2:19:58 PM www.asiabiotech.com Special Feature — Bioterrorism affects human. As we look at all these problems; overcrowding, ease of transport, large scale food processing etc, we have to also bear in mind another emerging problem—bioterrorism. In the past, people used to think that bioterrorism is bad and that no one would resolve to that because they are afraid the same terrible thing might happen to them. But now, it is different. Bioterrorism is a relatively new problem. As far as the US is concerned, there was not much concern about bioterrorism until about ten years ago. A few episodes took place. One episode is the religious cult from Japan that eleased the Sarin gas. They were also actively trying to aerolize anthrax and botulinum toxin not only in the US but also in Tokyo city. They had the intent to cause major destruction. Here is a group that does not have any connection with any state (totally independent), yet they are trying their best to use these bioterrorism agents. In another case, there was a release of anthrax in envelops. There was only 10 grams of anthrax in fi ve envelops. A small amount but it caused tremendous turmoil in the country. People all over the country were paranoid. There were buildings being evacuated. Thousands of letters were being processed not only in the US but also in other countries, in the midst of people’s fear that they might be attacked. We have not found the person who did it, but we are almost certain that this person still have more anthrax with him. There was a great deal of anxiety at that time. Now, we face another problem—H5N1 virus. The virus appeared in Hong Kong in 1997. The Hong Kong authorities killed billions of chickens due to this virus. However, recently, at the start of this year we see similar cases again. The question really is “Is it going to affect us humans”? I think from the standpoint of looking at all these, we began doing what we should have done long ago. We began to recognize we are really going to have a brand new strain of fl u virus. In 1957, a brand new strain evolved. As you know, back in history, we are looking at about two to three new strains every century. There has been a major change in the virus and we can expect a pandemic again. What happened recently in Cambodia, Thailand, Vietnam brought home the message that this is a problem that we cannot stop totally. We have to be prepared. We are going to prepare hospitals in case some people ever get infected with H5N1. Even if the virus does not spread, it could happen 10 years or 20 years later. But when we look back at what happened in 1918. That was a ferocious epidemic that killed millions. Most of the people who died were in their 20s, these people are supposed to have healthy immune systems to fi ght the infections. If we have antibiotics then, these people would not have died. However, looking at the case studies, many of them died within two or three days. This means that they died too fast and there was not even a secondary immune response that can take place. It was clearly viral pneumonia that blew out of proportion and killed many people. Now, we hope we can do much better with antibiotics. I am not sure if we can do any better then we used to be. A fl u like the one in 1918 can be as big a 20 APBN • Vol. 10 • No. 1 • 2006 10.1.henderson.indd 20 1/18/06 2:20:00 PM www.asiabiotech.com Special Feature — Bioterrorism problem to us now as then. We begin to understand that notwithstanding the progress we have made in the biomedical science, we are by no means prepared to deal with this sort of problem which can result in a global catastrophe. Well, we can try coming up with a vaccine quickly. But we are using the same method of vaccine production as what we were using 50 years ago! Instead of using modern tissue cell culture, we are still using eggs. We should be using the tissue cell culture method. There has been talk about it 25 years ago but most pharmaceutical companies do not want to change due to cost problem.