The Tanner Lectures on Human Values 2009 Brasenose College, Oxford 20-21 February 2009 Meeting the Challenges of the 21 st Century 1 Foreword The Tanner Lectures take place annually at Brasenose College in Oxford; and at a handful of other distinguished seats of learning around the world. This year, the thirtieth academic year following the lectures’ formal inception, was a special one; for it coincided with the 500th year since the founding of the King’s Hall and College of Brasenose. To celebrate this propitious confluence, we were, with the generous support of the Tanner Foundation, delighted to host an especially distinguished, and a singularly numerous and diverse, programme of Lecturers, many with a strong Brasenose connection. As you will see, they addressed and informed us on a varied range of topics; but all brought together under one theme; a pressing one: Meeting the Challenges of the 21st Century. Brasenose is 500 years old, but over the two days of these lectures we looked forward to its continuing role as an academic institution which seeks to help shape and inform the future through the efforts of its men and women. There are many challenges to be met. Professor Roger Cashmore FRS, Principal, Brasenose College, Oxford. 2 Preface The Brasenose 2009 Tanner Lectures took place on 20-21 February 2009, in the Nelson Mandela Lecture Theatre at the Saïd Business School in Oxford. Each of the four sessions was conceived and organised by one or more Fellows of the College in an area of their academic interests: Emerging Infection – William James and Richard Boyd; Terrorism and Security: What have we learnt from Afghanistan and Iraq? – Llewlyn Morgan; Human Rights – Stefan Vogenauer; Environmental Challenges – Giles Wiggs. The Principal, Roger Cashmore, and Emeritus Fellow Harry Judge were also keenly involved in coordinating the lectures. The lectures and discussions were transcribed by students and post-docs working on the areas under discussion: we would like to thank Oliver-James Dyar, Rachael Burke, David Corns, Nicola Palmer, Klem Ryan, Alicia Hinarejos, Caitlin McElroy and Alexandra Conliffe for their efficient and precise work toward producing this record of the lectures. Melanie James, Pat Spight, Merry Donati and Kerrin Honey deserve sincere thanks for their unstinting organisational support. We would also like to thank the Tanner Foundation for their generous support of this special Quincentennial celebratory series of lectures; and also, of course, we should like to thank the Lecturers themselves, for making this such a splendid event. Brief biographical details of the Lecturers may be found in the Appendix. Chris Timpson, Fellow, Brasenose College Oxford, 2009 Tanner Convenor. October 9th 2009 3 Contents Part 1: The Challenge of Emerging Infection 1. Emerging Infections: Is the Past a Guide to the Future? - Robin Weiss 2. Virology in the Jungle: The Global-Local Tension - Jane Cardosa 3. On the Origin of Epidemics - Eddie Holmes 4. Panel Discussion -William James, Jane Cardosa, Eddie Holmes, Harold Jaffe, Paul Klenerman, Tim Peto, Robin Weiss Part 2: Terrorism and International Security: What have we learned from Afghanistan and Iraq? Section 1 Introduction: Llewelyn Morgan and Paddy Docherty 5. Learning to Eat Soup with a Knife - John Nagl 6. The Desert of Death: British Military Intervention in Afghanistan and the Comprehensive Approach -Leo Docherty 7. General Discussion -Paddy Docherty, John Nagl, Leo Docherty Section 2 Introduction: Llewelyn Morgan 8. Afghanistan and Iraq: Panel Discussion -John Bingham, Joanna Buckley, Alan Macdonald, George Noel Clarke, Ana Rodriguez Garcia, Suzan Varga Nagl Part 3: Human Rights in the 21 st Century Section 1 Introduction: Scott Baker 9. Democracy and Human Rights -Vernon Bogdanor 10. Terror, Security and Human Rights -Kate Allen 11. Human Rights Section 1: General Discussion Section 2 Introduction: Nicolas Bratza 12 Values and Rights in Health and Healthcare -Ian Kennedy 13 The Right to Human Enhancement -Julian Savulescu 14 Human Rights Section 2: General Discussion 4 Part 4: Environmental Challenges in a Warming World Introduction: David Shukman 15. Environmental Challenges in a Warming World: I -Robert Watson 16. Environmental Challenges in a Warming Word: II -David King 17. Coal: The Dirtiest Word in the English Language -George Monbiot 18. Environmental Challenges in a Warming World: Consumption, Costs and Responsibilities -Dieter Helm 19: Environmental Challenges: Panel Discussion -David Shukman, Dieter Helm, David King, George Monbiot, Robert Watson Appendix: Notes on the 2009 Tanner Lecturers at Brasenose College, Oxford 5 Part 1: THE CHALLENGE OF EMERGING INFECTION 6 1 Emerging Infections: Is the Past a Guide to the Future? Robin Weiss University College London “Life is lived forwards, but understood backwards” S øren Kierkegaard. It may seem perverse to address the challenges of the 21st Century by examining past pandemics and their effects on human values. Yet several lessons can be drawn that are relevant to our situation today. One is how infectious disease has always taken the opportunity to follow globalisation. Without the opening of the Central Asian silk route following Genghis Khan's conquests there would have been no Black Death in 14th Century Europe; without the decimation of the New World indigenous population by smallpox and measles in the wake of the Spanish conquistadors in the 16th Century there would have been no market for the trans- Atlantic slave trade. Another lesson is how advances in technology have provided opportunities for novel agents to infect humans. Perhaps the most notable one was the development of agriculture allowing humans to live in sizeable and dense populations that could sustain ongoing cycles of infection. Then, with the domestication of livestock and the adoption of the human environment by 'companion' animals such as dogs and rats, infections in these species were able to cross over and adapt to human-to-human transmission. Although 21st century epidemics like SARS and AIDS tend to originate from exotic animal species, several modern outbreaks can also be attributed to technological change. I shall discuss these with reference to the emergence of Legionnaire’s disease and variant Creutzfeldt-Jakob disease, and why we need to be vigilant over medical advances such as xenotransplantation. ‘Emerging’ infections can be divided into three categories: truly novel diseases like AIDS and SARS, old diseases caused by newly discovered pathogens like hepatitis C virus, and re-emerging infections. I shall argue that some of the most serious threats to public health are posed by the re-emergence of old infections like malaria, tuberculosis, dengue and cholera. Novel infections like H5N1 influenza virus and SARS coronavirus caused only a few hundred human deaths, yet owing to fear incurred by their novelty and high mortality rate, they have cost approximately $80-100 billion, as noted by Jane Cardosa in her Tanner Lecture. So the social and economic consequences of the early 21st century outbreaks bear little relation to the actual burden of infectious disease (Box 1). [Box 1] Newly emerging knowledge about previously unknown yet ancient infections has been a remarkable advance of modern research. Helicobacter pylori is a bacterium adapted to living in the acid conditions of the stomach. It causes peptic and duodenal ulcers as well as stomach 7 cancer. Thanks to the identification of H. pylori, ulcers can cured with a single course of inexpensive antibiotics in contrast to the previous treatment for the chronic symptoms of the ulcers themselves. H. pylori, HIV and human papilloma virus types 16 and 18 – which cause cervical cancer – were each identified in 1983 and the importance of these discoveries has recently been recognised by the award of Nobel Prizes 1. Thanks to advances in molecular cloning technology, twelve more novel human viruses have been discovered during the past 20 years. For example, Kaposi sarcoma herpesvirus was identified in 1994 and causes a tumour with a dramatically increased incidence in immunosuppressed transplant patients and in AIDS. In the last two years alone three new human polyoma viruses have been found, one of them oncogenic. That is extraordinary, for you would have thought we would know what was inside humans by now. It is likely that, like stomach ulcers, other diseases which were not previously thought to be transmissible (perhaps other cancers and some forms of neurological disease) will turn out to have an infectious agent as a factor in their complex aetiology. In terms of human values, emerging infections in plants and animals can be just as devastating as human infections. The potato blight in Ireland in 1845 led to starvation and mass emigration. In 2001, the foot-and-mouth disease outbreak among cattle and sheep in the UK cost £ billions to the economy 2. Diseases of crops and livestock present easier targets for bioterrorists than those in humans, though to my mind, natural catastrophes remain the greater threat. In his Tanner Lecture, Eddie Holmes discusses the identification of a previously unknown pathogen in beehives suffering from colony collapse disorder. Flowering plants and pollinating insects co- evolved and remain co-dependent; without honey bees and bumble bees, there will be no food supply. The thinking behind the Tanner lectures on emerging infections and those on the environment could be joined up 3,4 . HUMANKIND’S COLLECTION OF VIRUSES AND INFECTIONS Imagine visiting a 500 year old Oxford College like Brasenose and looking at the portraits in the Hall. Some of these will be true ‘family heirlooms’ that have been handed down from generation to generation 4. Others may be temporary exhibits on loan for a fixed term, and some will be new acquisitions which are here to stay. So it is with human viruses (Box 2). The family heirlooms with a long co-evolutionary history have co-speciated with the host and include many DNA viruses. The ‘temporary exhibits’ are the zoonoses, which are often RNA viruses that come from distantly related animals.