Mouse airway epithelial cultures

2006 meeting - Public health threats

Local public health threats can have unanticipated consequences elsewhere that necessitate collaboration by a huge range of interested parties and determined efforts by national governments to implement proposals for joint action. The implications of regional outbreaks of bird flu are obvious to all but the abject conditions of the poorest of the poor in many developing countries also have immense significance as a source of disaffection and potential instability.

Waiting for a pandemic

The history of human civilisation is littered with tales of dramatic epidemics that devastated communities with no resistance to a novel rampant microbe. Of all the microbial threats capable of spreading quickly that we know, the influenza virus is currently the one most capable of generating alarm. The familiar endemic form of the disease while unpleasant lacks the horrific qualities of smallpox or plague but nonetheless three times in the last century pandemics have swept around the planet causing substantial loss of life. When the first of these pandemics emerged in 1918, its origin was unknown.

Fifteen years elapsed before the cause was established as a novel virus here at the National Institute for Medical Research. It soon became apparent that the virus has a remarkable capacity to evolve rapidly into new forms capable of evading our immune response. In the 1970s we learnt that the virus has an almost unique genetic organisation based on eight separate strands of RNA (not DNA) which make the virus very adept at "reassorting" the genetic material of other strains of the virus to combine their worst features.

The epicentre of these sudden genetic shifts has usually been in the Far East where the flu viruses of aquatic birds and poultry seem to recombine with their human equivalents. A well-rehearsed contingency plan exists to deal with possible pandemics. These have performed well during earlier scares but the virology community is constantly exploring new ways of protecting the public.

Growing up in India and Ethiopia : reflections on the Millennium Development Goals

In 2000 world leaders (at the instigation of the United Nations) pledged to improve the plight of the developing world by means of eight Millennium Development Goals, amongst which was a proposal to halve child and maternal mortality by 2015 against a benchmark set in 1990. How were the public supposed to respond to such ambitious and unprecedented proposals?

As a Winston Churchill Travelling Fellow during the winter of 2006 I travelled in India and Ethiopia and had the opportunity to find out for myself what makes early life so precarious in the developing world.

In Ethiopia one in six children and in India one in fourteen will die before they are five years old and in both countries one half of all children will have stunted growth. In Britain in 1906 infant mortality was similar to Ethiopia today - and had been very much higher - but it has halved in every subsequent 25 - year interval through innumerable preventive interventions.

The question we should ponder is how the British experience can be recapitulated. Most infant and maternal deaths in the developing world are avoidable in principle by improvements in hygiene and nutrition but progress is slow for many reasons including profoundly difficult anthropological issues reflecting the low status of women in the poorest strata of society. Safe water supplies and miracles of sanitary engineering are obvious requirements but as with British industrial slums of 1906, health activists are needed on a massive scale to advise and persuade people to adopt better standards of mothercraft.

 

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