1 00:00:01,441 --> 00:00:04,708 Peter Hoejskov: The next pandemic is not a question of if 2 00:00:04,708 --> 00:00:06,293 , but of when. 3 00:00:17,600 --> 00:00:20,586 Alice Allan: Throughout history, pandemics have swept around the 4 00:00:20,586 --> 00:00:23,373 world, leaving devastation in their wake. 5 00:00:23,373 --> 00:00:26,760 What are we doing to prepare for the next one? 6 00:00:26,760 --> 00:00:31,771 Hello, I'm your host, Alice Allen, and in this special 7 00:00:31,830 --> 00:00:35,484 series of Health in Europe, I'll be going behind the scenes at 8 00:00:35,784 --> 00:00:39,552 WHO and some of the European region's major public health 9 00:00:39,719 --> 00:00:44,710 institutions to understand what the most likely causes of future 10 00:00:44,710 --> 00:00:49,107 pandemics could be and what strategies are in place to avert 11 00:00:49,107 --> 00:00:49,308 them. 12 00:00:49,308 --> 00:00:53,981 I'll talk to the experts applying the lessons of previous 13 00:00:53,981 --> 00:00:58,451 pandemics and focus in on the systems in place to spot threats 14 00:00:58,451 --> 00:00:59,973 and reduce their impact. 15 00:00:59,973 --> 00:01:04,751 I'll speak to the legion of public health experts quietly 16 00:01:04,811 --> 00:01:08,805 working away, getting on with the not very glamorous but 17 00:01:08,865 --> 00:01:13,820 incredibly important work of emergency preparedness Experts 18 00:01:14,001 --> 00:01:18,052 in surveillance, genomic sequencing, epidemiology and 19 00:01:18,132 --> 00:01:22,968 more the people who are containing outbreaks and laying 20 00:01:23,007 --> 00:01:27,703 the groundwork to mitigate the effects of pandemics, not if, 21 00:01:28,444 --> 00:01:29,849 but when they occur. 22 00:01:29,849 --> 00:01:39,105 This is Health in Europe, and in this episode we explore H5N1 23 00:01:39,406 --> 00:01:52,516 bird flu my name is peter sosa hoesko. 24 00:01:52,617 --> 00:01:55,540 I work as a technical officer for food safety and zoonotic 25 00:01:55,560 --> 00:02:00,346 diseases in the who regional office for europe, based in in 26 00:02:00,385 --> 00:02:05,132 copenhagen zoonotic diseases have been around forever, but 27 00:02:05,153 --> 00:02:08,503 while their threat has always been there, the virus behind the 28 00:02:08,503 --> 00:02:14,274 Covid-19 pandemic, sars-cov-2, which originated in bats, and, 29 00:02:14,313 --> 00:02:18,449 more recently, the jump of avian flu into cattle, has put them 30 00:02:18,550 --> 00:02:19,774 back in the news. 31 00:02:21,097 --> 00:02:23,526 Peter Hoejskov: So zoonotic diseases are diseases that can 32 00:02:23,868 --> 00:02:25,900 jump from animals to humans. 33 00:02:25,900 --> 00:02:29,087 So basically, a disease that originates in an animal and 34 00:02:29,127 --> 00:02:33,646 transmits to a human, either directly, with direct contact 35 00:02:33,967 --> 00:02:35,391 between animals and humans. 36 00:02:35,391 --> 00:02:40,361 It can be domestic animals, it can be wild animals, or it can 37 00:02:40,382 --> 00:02:43,591 be indirectly as well, through unsafe food, for example. 38 00:02:44,060 --> 00:02:46,967 Alice Allan: Here in Europe we might think sometimes that, oh, 39 00:02:47,109 --> 00:02:50,046 zoonotic diseases, that's something that happens somewhere 40 00:02:50,046 --> 00:02:50,808 else in the world. 41 00:02:50,808 --> 00:02:55,371 Why are zoonotic diseases also relevant in the European region? 42 00:02:56,201 --> 00:02:57,733 Peter Hoejskov: Everywhere in the world, including in the 43 00:02:57,834 --> 00:03:01,930 European region, there is close contacts between humans and 44 00:03:02,210 --> 00:03:02,550 animals. 45 00:03:02,550 --> 00:03:07,347 We have large agricultural productions in the European 46 00:03:07,668 --> 00:03:12,282 region, livestock breeding sites , we have domestic animals. 47 00:03:12,282 --> 00:03:16,411 We interact from now and then with wildlife. 48 00:03:16,411 --> 00:03:20,048 So there is this constant interaction between humans and 49 00:03:20,109 --> 00:03:20,368 animals. 50 00:03:20,368 --> 00:03:23,889 We can't completely separate ourselves from the animal world. 51 00:03:23,889 --> 00:03:27,026 So when we have this interaction there is also a risk 52 00:03:27,026 --> 00:03:29,919 of transmission of diseases between animals and humans. 53 00:03:30,381 --> 00:03:33,908 Alice Allan: Why are we hearing more recently about the threat 54 00:03:34,129 --> 00:03:35,492 of zoonotic diseases? 55 00:03:36,900 --> 00:03:40,844 Peter Hoejskov: We know that the SARS-CoV-2 virus this is the 56 00:03:40,865 --> 00:03:46,631 virus that causes COVID-19 as a disease originated in the animal 57 00:03:46,631 --> 00:03:50,395 population and then, through an intermediate host, ended up in 58 00:03:50,415 --> 00:03:55,286 the human population and with the mutations that viruses can 59 00:03:55,385 --> 00:04:00,354 have, then the transmission between humans can become more 60 00:04:00,395 --> 00:04:04,087 serious, and that was exactly what we saw with the COVID-19 61 00:04:04,508 --> 00:04:04,949 pandemic. 62 00:04:04,949 --> 00:04:08,830 So I think that of course increases the interest and 63 00:04:09,031 --> 00:04:12,543 triggers the attention of we need to be better prepared for 64 00:04:12,804 --> 00:04:14,408 the next potential pandemic. 65 00:04:14,408 --> 00:04:17,499 We don't know when it will happen, but we know it's very 66 00:04:17,559 --> 00:04:18,581 likely to happen. 67 00:04:18,581 --> 00:04:23,230 We also know that a lot of the new infectious diseases that we 68 00:04:23,290 --> 00:04:25,233 see in humans originate in animals. 69 00:04:25,720 --> 00:04:29,045 Alice Allan: Is there anything about our modern way of life 70 00:04:29,708 --> 00:04:33,274 that is increasing the risk of zoonotic transmission? 71 00:04:34,300 --> 00:04:39,274 Peter Hoejskov: Yes, with more urbanisation we get closer 72 00:04:39,514 --> 00:04:41,639 interaction with the animal population. 73 00:04:41,639 --> 00:04:47,432 We see climate change as a factor as well that affects how 74 00:04:48,021 --> 00:04:50,326 the viruses survive and how they mutate. 75 00:04:50,326 --> 00:04:54,880 We see changes in the agricultural practices, the way 76 00:04:54,940 --> 00:04:58,190 we breed animals more intensive livestock breeding. 77 00:04:58,819 --> 00:05:00,086 Alice Allan: Tell me about One Health. 78 00:05:01,341 --> 00:05:04,346 Peter Hoejskov: One Health is an approach, it's a way of working 79 00:05:04,346 --> 00:05:09,021 , seeing these health threats and the health challenges that 80 00:05:09,041 --> 00:05:12,430 we are facing in a much more holistic and a more systematic 81 00:05:12,490 --> 00:05:17,711 way, realising that we cannot prevent and prepare for 82 00:05:17,752 --> 00:05:20,540 pandemics in the human health sector alone. 83 00:05:20,540 --> 00:05:25,110 We need to also work across sectors, across disciplines. 84 00:05:25,110 --> 00:05:29,324 We need to work with colleagues in other organizations or at 85 00:05:29,384 --> 00:05:31,088 country level with other ministries. 86 00:05:31,088 --> 00:05:36,444 So a very close collaboration, sharing of information, joint 87 00:05:36,504 --> 00:05:40,572 risk assessments across the vituary services, agricultural 88 00:05:40,612 --> 00:05:43,326 sector, environment sector and human health. 89 00:05:43,326 --> 00:05:45,572 And that's exactly what One Health is all about. 90 00:05:45,572 --> 00:05:50,180 It is to see health as one across these different domains 91 00:05:50,540 --> 00:05:54,689 and encouraging closer interaction, closer coordination 92 00:05:54,689 --> 00:05:58,165 and sharing of information so we can be better prepared and 93 00:05:58,387 --> 00:06:00,031 act fast if we need to. 94 00:06:00,180 --> 00:06:03,043 We have a formalized partnership with what we call the 95 00:06:03,084 --> 00:06:07,185 Quartipartite Organizations, so that's the Food and agriculture 96 00:06:07,225 --> 00:06:10,422 organization of the United Nations, it's the World 97 00:06:10,482 --> 00:06:14,468 Organization for Animal Health, boha, and it's the United 98 00:06:14,528 --> 00:06:18,055 Nations Environment Program, unep and then WHO. 99 00:06:18,055 --> 00:06:19,687 So we work very closely together. 100 00:06:19,687 --> 00:06:25,009 We have also developed joint guidance material for countries 101 00:06:25,589 --> 00:06:28,495 on how they can operationalize the One Health approach 102 00:06:29,100 --> 00:06:32,418 Basically, what are some of the tools, what are some of the 103 00:06:32,458 --> 00:06:36,649 techniques and how can they better implement and work across 104 00:06:36,649 --> 00:06:40,105 sectors at a country level, because One Health is not at the 105 00:06:40,105 --> 00:06:42,891 global level, only of organizations working together. 106 00:06:42,891 --> 00:06:46,262 It comes all the way down to communities and we know the next 107 00:06:46,262 --> 00:06:50,622 pandemic is also going to start in a community somewhere, so we 108 00:06:50,622 --> 00:06:53,149 need to be better prepared at community level. 109 00:06:53,149 --> 00:06:57,223 So One Health is at all levels and across various sectors and 110 00:06:57,242 --> 00:06:57,704 disciplines. 111 00:07:12,536 --> 00:07:15,639 Alice Allan: Nicola Lewis is director of the Worldwide 112 00:07:15,838 --> 00:07:19,629 Influenza Centre at the Francis Crick Institute in London. 113 00:07:19,629 --> 00:07:24,903 It's a WHO collaborating centre and one of its key functions is 114 00:07:24,903 --> 00:07:28,869 to track strains of influenza that are circulating among 115 00:07:28,990 --> 00:07:33,036 animals and humans to understand how it's changing. 116 00:07:34,940 --> 00:07:37,386 Nicola Lewis: So flu is fascinating and I think one of 117 00:07:37,425 --> 00:07:41,392 the aspects of flu that is fascinating is it's continuously 118 00:07:41,392 --> 00:07:41,935 evolving. 119 00:07:41,935 --> 00:07:43,865 It's changing the whole time. 120 00:07:43,865 --> 00:07:45,411 Is it's continuously evolving? 121 00:07:45,411 --> 00:07:47,019 It's changing the whole time. 122 00:07:47,019 --> 00:07:49,014 It's a virus that, when it replicates in a particular host, 123 00:07:49,014 --> 00:07:52,783 makes mistakes, and it makes mistakes in its genome, and that 124 00:07:52,783 --> 00:07:56,509 means that it's able to constantly evolve, and some of 125 00:07:56,550 --> 00:08:00,043 this evolution means that it's able to escape prior immunity 126 00:08:00,125 --> 00:08:02,386 that we might have to a particular flu virus. 127 00:08:02,386 --> 00:08:05,922 So we're merely facing a challenge constantly to try and 128 00:08:05,963 --> 00:08:07,809 keep up with this changing evolution. 129 00:08:08,639 --> 00:08:11,846 Flu viruses are also fascinating because they can do something 130 00:08:11,966 --> 00:08:14,449 else in terms of changing constantly. 131 00:08:14,449 --> 00:08:18,505 They can undergo what we call reassortment, and this happens 132 00:08:18,586 --> 00:08:23,127 when two different flu viruses infect a person or infect a pig 133 00:08:23,168 --> 00:08:27,259 at the same time and they shuffle their genetic material 134 00:08:27,822 --> 00:08:31,714 so that the progeny flu virus that comes out of the pig or 135 00:08:31,754 --> 00:08:33,200 other human is actually different. 136 00:08:33,200 --> 00:08:36,527 And this process of reassortment is also a way that 137 00:08:36,586 --> 00:08:37,869 flu viruses evolve. 138 00:08:37,869 --> 00:08:42,826 Now we know that flu viruses are particularly tricky to 139 00:08:42,886 --> 00:08:45,032 understand from this point of view, because this whole 140 00:08:45,179 --> 00:08:49,349 evolutionary process means that we have to stay abreast of this 141 00:08:49,450 --> 00:08:52,645 evolution to understand where the next threat might come from. 142 00:08:53,128 --> 00:08:55,537 Alice Allan: Big scientific advances have been made in the 143 00:08:55,597 --> 00:08:58,625 last hundred years about understanding viruses and 144 00:08:58,684 --> 00:08:59,307 tracking them. 145 00:08:59,307 --> 00:09:02,880 How close are we to being able to keep up with flu? 146 00:09:03,361 --> 00:09:06,106 Nicola Lewis: I think we're getting much, much better at 147 00:09:06,447 --> 00:09:09,995 trying to keep up with the evolution of these pathogens. 148 00:09:09,995 --> 00:09:14,067 I certainly think that new technologies are coming along 149 00:09:14,206 --> 00:09:16,912 all the time and we make the most of those, particularly in 150 00:09:16,951 --> 00:09:17,974 the influenza field. 151 00:09:17,974 --> 00:09:21,687 But because flu changes constantly, it constantly 152 00:09:21,727 --> 00:09:23,131 presents a new challenge to us. 153 00:09:23,131 --> 00:09:27,788 So we certainly can't drop our guard with flu viruses, and I 154 00:09:27,828 --> 00:09:31,320 think there is one certainty, and that is that there will be 155 00:09:31,380 --> 00:09:33,105 another flu pandemic in the future. 156 00:09:33,907 --> 00:09:37,042 Alice Allan: Can you think of a particular moment when flu has 157 00:09:37,201 --> 00:09:40,149 done something that has shocked or surprised you? 158 00:09:40,149 --> 00:09:44,427 One of those moments when you've gone gosh wow, flu. 159 00:09:44,427 --> 00:09:45,711 That was interesting. 160 00:09:46,460 --> 00:09:49,875 Nicola Lewis: I think one of the major surprises has been quite 161 00:09:49,917 --> 00:09:53,807 recently, actually with the H5 highly pathogenic viruses that 162 00:09:53,827 --> 00:09:56,780 have been circulating in bird populations, and we've been 163 00:09:56,801 --> 00:10:00,371 facing a massive challenge with these viruses since about 1997. 164 00:10:00,371 --> 00:10:06,370 But in about mid-2020, we suddenly saw a radical shift in 165 00:10:06,390 --> 00:10:08,181 the way that these viruses were evolving. 166 00:10:08,181 --> 00:10:12,149 All of a sudden, rather than being confined to particular 167 00:10:12,211 --> 00:10:16,184 geographic regions, they managed to switch back into wild birds, 168 00:10:16,184 --> 00:10:20,721 they managed to infect many more wild bird hosts and then 169 00:10:20,740 --> 00:10:25,946 they managed to spread globally to the extent that since 2020, 170 00:10:26,005 --> 00:10:29,549 they've spread not just throughout Eurasia, not just 171 00:10:29,710 --> 00:10:33,333 through into Europe, into Africa , but they've also hopped over 172 00:10:33,374 --> 00:10:36,277 the Atlantic and have now spread right the way down North 173 00:10:36,317 --> 00:10:39,399 America, south America, and have just turned up in Antarctica. 174 00:10:39,399 --> 00:10:45,431 We have never seen this kind of situation with a highly 175 00:10:45,471 --> 00:10:49,822 pathogenic H5 virus before, and I certainly think that if you'd 176 00:10:49,923 --> 00:10:54,190 asked me in 2019, this would not have been the picture I would 177 00:10:54,210 --> 00:10:57,315 have conjured up in my mind about what bird flu could do. 178 00:10:58,301 --> 00:11:01,346 Alice Allan: How are scientists responding to this new behaviour 179 00:11:01,346 --> 00:11:01,346 ? 180 00:11:02,008 --> 00:11:05,735 Nicola Lewis: As researchers, we are very committed to 181 00:11:05,796 --> 00:11:09,986 understanding what has changed with the virus, but also what we 182 00:11:09,986 --> 00:11:14,039 can do to help populations of animals, and indeed the human 183 00:11:14,159 --> 00:11:18,568 population, be prepared to be able to counteract these 184 00:11:18,649 --> 00:11:23,125 infections, to be able to mitigate them and to essentially 185 00:11:23,125 --> 00:11:26,332 prepare for a potential pandemic from these viruses. 186 00:11:26,860 --> 00:11:29,626 So there are a number of different initiatives that we 187 00:11:29,967 --> 00:11:32,013 undertake to keep up with these viruses. 188 00:11:32,100 --> 00:11:36,375 The first is to sample these viruses in animal populations to 189 00:11:36,375 --> 00:11:40,024 characterise them, to sequence them, to antigenically 190 00:11:40,065 --> 00:11:43,493 characterise them, to understand what they look like in these 191 00:11:43,559 --> 00:11:47,825 animal populations, in bird populations, but also when 192 00:11:47,845 --> 00:11:50,912 they've spilled over into terrestrial mammal populations 193 00:11:50,971 --> 00:11:51,692 around the world. 194 00:11:52,539 --> 00:11:55,567 And the next part of this is to understand what these viruses 195 00:11:55,687 --> 00:12:00,764 look like relative to what we call candidate vaccine viruses. 196 00:12:00,764 --> 00:12:05,836 And these are viruses that the WHO network, the Global 197 00:12:05,878 --> 00:12:10,067 Influenza Surveillance Response Network, worldwide we take these 198 00:12:10,067 --> 00:12:13,553 viruses and we try to understand the similarity to 199 00:12:13,639 --> 00:12:17,568 potential candidate vaccine viruses we might have to use 200 00:12:17,710 --> 00:12:19,133 were there to be a human pandemic. 201 00:12:19,133 --> 00:12:24,212 And so, twice a year, the WHO collaborating centres that are 202 00:12:24,253 --> 00:12:27,201 part of this GIST-Risk Global Influenza Surveillance and 203 00:12:27,302 --> 00:12:31,493 Response Network come together twice a year and we have a very 204 00:12:31,552 --> 00:12:33,480 important job to do twice a year . 205 00:12:33,480 --> 00:12:37,283 One is to make recommendation for seasonal influenza viruses 206 00:12:37,946 --> 00:12:41,514 and for the vaccine strains, but the other is to look at the 207 00:12:41,595 --> 00:12:44,860 viruses that are circulating in animal populations and to think 208 00:12:44,921 --> 00:12:48,131 about what we need to prepare for, what kind of candidate 209 00:12:48,152 --> 00:12:52,720 vaccine viruses we might need to have in our armoury to help us, 210 00:12:52,720 --> 00:12:56,106 were there to be a pandemic tomorrow in our armoury to help 211 00:12:56,126 --> 00:13:03,631 us, were there to be a pandemic tomorrow In the European region. 212 00:13:03,652 --> 00:13:04,933 Alice Allan: detections of H5N1 have been made in farmed fur 213 00:13:04,953 --> 00:13:07,099 animals in Finland and Spain, and also in domestic cats in 214 00:13:07,119 --> 00:13:07,239 Poland. 215 00:13:07,239 --> 00:13:10,832 Aisling Vaughan is an epidemiologist who works for WHO 216 00:13:10,832 --> 00:13:13,681 Europe in the High Threat Pathogens team. 217 00:13:13,681 --> 00:13:17,530 I started by asking her what the team had learned from 218 00:13:17,571 --> 00:13:18,994 working on these outbreaks. 219 00:13:19,676 --> 00:13:24,125 Aisling Vaughn: I think what we learned from these events in 220 00:13:25,287 --> 00:13:30,515 Europe most recently was that a strong foundation of trust 221 00:13:30,716 --> 00:13:34,400 amongst stakeholders is really really important. 222 00:13:34,400 --> 00:13:38,312 It enables rapid information exchange, it allows for 223 00:13:38,371 --> 00:13:42,722 coordinated multi-sectoral efforts and it really drives 224 00:13:42,863 --> 00:13:47,234 decisive actions to effectively prevent any further viral spread 225 00:13:47,234 --> 00:13:51,263 and then, of course, safeguard both human and animal health. 226 00:13:52,029 --> 00:13:55,197 Alice Allan: How do you assess the current risk of H5N1 to 227 00:13:55,256 --> 00:13:59,335 humans, particularly in the light of the recent detections 228 00:13:59,434 --> 00:14:00,599 in cattle in the US? 229 00:14:02,364 --> 00:14:04,009 Aisling Vaughn: So it's important to remember that this 230 00:14:04,068 --> 00:14:08,658 virus mostly affects wild birds and domestic birds. 231 00:14:08,658 --> 00:14:13,152 It rarely affects humans and there's really no evidence yet 232 00:14:13,491 --> 00:14:18,221 that this virus has acquired the ability to spread well from 233 00:14:18,261 --> 00:14:19,163 person to person. 234 00:14:19,163 --> 00:14:25,480 And despite the high number of clade 2344B outbreaks we've seen 235 00:14:25,480 --> 00:14:29,673 , and the detections in animals and as well the human exposures 236 00:14:29,833 --> 00:14:33,322 to this virus at the human-animal interface, 237 00:14:33,990 --> 00:14:37,532 relatively few infections have actually been reported to date, 238 00:14:37,613 --> 00:14:38,554 which is reassuring. 239 00:14:38,554 --> 00:14:44,774 So, overall, since the beginning of 2021, 28 detections 240 00:14:44,774 --> 00:14:50,109 of H5N1 in humans have been reported to WHO, including the 241 00:14:50,129 --> 00:14:52,793 most recent case who had exposure to dairy cattle. 242 00:14:52,793 --> 00:14:57,484 So, of all of the H5N1 cases reported in Europe and North 243 00:14:57,570 --> 00:15:01,278 America, they have been asymptomatic or mild. 244 00:15:01,278 --> 00:15:04,630 So, for example, the most recent case in the US reported 245 00:15:04,671 --> 00:15:07,315 conjunctivitis as their only symptom. 246 00:15:08,197 --> 00:15:13,725 All H5N1 cases so far have been sporadic infections. 247 00:15:13,725 --> 00:15:17,754 They've occurred through direct or indirect contact with 248 00:15:17,794 --> 00:15:22,061 infected birds or infected mammals or environments such as 249 00:15:22,140 --> 00:15:25,125 live poultry markets or other premises with infected animals, 250 00:15:26,510 --> 00:15:28,898 and among these cases, there have been no reported human to 251 00:15:28,957 --> 00:15:32,955 human transmission and, in fact, there have been no reported 252 00:15:32,995 --> 00:15:37,264 human human transmission of H5N1 since 2007. 253 00:15:37,264 --> 00:15:41,440 So, based on everything we know , based on all the information 254 00:15:41,639 --> 00:15:45,395 available, who assesses the current overall public health 255 00:15:45,456 --> 00:15:51,575 risk posed by H5N1 to be low, and for those with exposure to 256 00:15:51,635 --> 00:15:54,830 infected birds or animals or contaminated environments, the 257 00:15:54,870 --> 00:15:58,461 risk of infection is considered low to moderate. 258 00:15:58,461 --> 00:16:03,777 But these viruses are continually evolving and 259 00:16:03,836 --> 00:16:07,962 spreading in birds and animals, so continuous real-time 260 00:16:08,003 --> 00:16:09,625 monitoring is needed. 261 00:16:14,611 --> 00:16:16,616 Maria van Kerkhove: I think with almost certainty we will have 262 00:16:16,657 --> 00:16:18,341 another flu pandemic in our lifetime. 263 00:16:19,971 --> 00:16:22,616 Alice Allan: Dr Maria Van Kerkhoff is the Acting Interim 264 00:16:22,636 --> 00:16:27,072 Director of the WHO's Department of Epidemic and Pandemic 265 00:16:27,192 --> 00:16:28,999 Preparedness and Prevention. 266 00:16:28,999 --> 00:16:33,835 She also leads on COVID-19 emergency management and she's 267 00:16:33,895 --> 00:16:37,530 technical lead of the WHO Health Emergencies Programme. 268 00:16:37,530 --> 00:16:42,763 She started her career working on avian influenza 20 years ago. 269 00:16:43,850 --> 00:16:46,655 Maria van Kerkhove: I became interested in viruses, pathogens 270 00:16:46,655 --> 00:16:52,011 , when I was in college and when I was doing my PhD at London 271 00:16:52,033 --> 00:16:53,416 School of Hygiene and Tropical Medicine. 272 00:16:53,416 --> 00:16:57,995 And as part of my PhD work I was based in Cambodia and I was 273 00:16:58,014 --> 00:17:02,524 working with Institute Pasteur Cambodia on H5N1, on avian 274 00:17:02,570 --> 00:17:06,097 influenza, and at the time there were six or seven human cases 275 00:17:06,398 --> 00:17:07,079 in Cambodia. 276 00:17:07,079 --> 00:17:10,857 So it was relatively new and what we were doing there with 277 00:17:11,058 --> 00:17:13,390 colleagues across the Ministry of Health, the Ministry of 278 00:17:13,450 --> 00:17:16,452 Agriculture, institute Pasteur, where we're doing these outbreak 279 00:17:16,452 --> 00:17:19,576 investigations, and I was fascinated with outbreak 280 00:17:19,615 --> 00:17:22,839 investigation it was multidisciplinary, it was all 281 00:17:22,940 --> 00:17:25,501 One Health before it was even called One Health, you know and 282 00:17:25,521 --> 00:17:28,625 it was really just early detection and early action to 283 00:17:28,684 --> 00:17:29,665 prevent onward spread. 284 00:17:29,665 --> 00:17:33,414 So we were doing all these complex, comprehensive 285 00:17:33,476 --> 00:17:34,739 investigations in the field. 286 00:17:34,739 --> 00:17:37,031 Oh my gosh, I absolutely loved it. 287 00:17:38,234 --> 00:17:41,442 Alice Allan: Why are we hearing so much about H5N1 recently? 288 00:17:41,950 --> 00:17:43,634 Maria van Kerkhove: So there's a lot of attention right now to 289 00:17:43,714 --> 00:17:47,771 avian influenza and there's a massive epizootic across the 290 00:17:47,832 --> 00:17:48,211 world. 291 00:17:48,211 --> 00:17:52,238 It has expanded greatly in the last couple of years. 292 00:17:52,238 --> 00:17:56,063 This is particular on H5N1, but not only H5N1. 293 00:17:56,063 --> 00:18:00,737 We see in wild birds, we see in domestic poultry, we see in 294 00:18:00,817 --> 00:18:04,646 spillover into mammals, including humans. 295 00:18:04,646 --> 00:18:08,976 But this is being detected in new countries Right now. 296 00:18:09,116 --> 00:18:13,084 There's been quite a lot of attention on H5N1 in dairy cows, 297 00:18:13,084 --> 00:18:18,502 in dairy cattle in the US, and you know it is unfortunate that 298 00:18:18,522 --> 00:18:21,215 the world starts to pay attention when you see this in 299 00:18:21,276 --> 00:18:22,259 high-income countries. 300 00:18:22,259 --> 00:18:27,057 But we will use this attention to draw awareness to one the 301 00:18:27,156 --> 00:18:29,301 global influenza and surveillance response system 302 00:18:29,321 --> 00:18:30,874 that's been in place for 70 years. 303 00:18:30,874 --> 00:18:33,321 Who did not wake up to flu. 304 00:18:33,321 --> 00:18:36,351 We've been working on this for quite a long time because we 305 00:18:36,431 --> 00:18:39,063 know there's seasonal influenza, there's a potential for 306 00:18:39,123 --> 00:18:41,712 pandemic influenza and there's all these novel subtypes of 307 00:18:41,772 --> 00:18:42,575 avian influenza. 308 00:18:42,575 --> 00:18:46,049 And we work with the PIP framework of looking at how do 309 00:18:46,069 --> 00:18:48,296 we have better capacities in countries for these types of 310 00:18:48,336 --> 00:18:54,299 detection, but also how do we share viruses with our global 311 00:18:54,519 --> 00:18:57,949 lab network, our national influenza centres, our WHO 312 00:18:57,989 --> 00:19:01,837 collaborating centres to identify certain viruses that 313 00:19:01,897 --> 00:19:04,462 should be thought of for vaccines. 314 00:19:05,330 --> 00:19:09,400 Alice Allan: The PIP framework is WHO's Pandemic Influenza 315 00:19:09,519 --> 00:19:10,782 Preparedness Framework. 316 00:19:11,349 --> 00:19:13,160 Maria van Kerkhove: So we have these candidate vaccine viruses, 317 00:19:13,160 --> 00:19:15,857 including many H5N1 vaccines, which prompt us already to have 318 00:19:15,877 --> 00:19:19,596 H5N1 vaccines, which prompt us already to have H5N1 vaccines in 319 00:19:19,596 --> 00:19:20,076 development. 320 00:19:20,076 --> 00:19:24,935 Now I do want to contextualize this that since 2017, we've only 321 00:19:24,935 --> 00:19:29,708 had 28 human cases of avian influenza and we have not seen 322 00:19:29,769 --> 00:19:30,991 human-to-human transmission. 323 00:19:30,991 --> 00:19:34,724 We're constantly looking because our worry is that these 324 00:19:34,785 --> 00:19:37,354 viruses can be more adapted for transmission. 325 00:19:37,354 --> 00:19:40,364 We have not seen that yet, but we are concerned. 326 00:19:40,364 --> 00:19:44,494 The more opportunity this virus has to circulate, the more 327 00:19:44,596 --> 00:19:48,002 opportunities we see for infection in different species, 328 00:19:48,589 --> 00:19:52,324 and these viruses can combine the genetic components of it, 329 00:19:52,384 --> 00:19:57,329 can combine and potentially cause a new virus of influenza 330 00:19:57,450 --> 00:19:58,515 that could be highly transmissible. 331 00:19:58,515 --> 00:20:00,041 That's what happened in 2009. 332 00:20:00,041 --> 00:20:02,111 So we're constantly thinking about this. 333 00:20:02,111 --> 00:20:05,238 Not just thinking, but taking action to be better prepared. 334 00:20:05,238 --> 00:20:09,011 What we want to do is prevent, prevent, prevent. 335 00:20:09,011 --> 00:20:12,980 There are some treatments for influenza. 336 00:20:12,980 --> 00:20:16,590 We have vaccination, so there's a seasonal vaccine campaign 337 00:20:16,771 --> 00:20:17,333 every year. 338 00:20:17,333 --> 00:20:20,519 We urge people to get not only COVID vaccines but also 339 00:20:20,760 --> 00:20:25,198 influenza vaccines, and there are H5N1 vaccines in development 340 00:20:25,198 --> 00:20:25,941 , should we need them. 341 00:20:26,430 --> 00:20:29,576 Alice Allan: This recent species jump into cattle. 342 00:20:29,576 --> 00:20:33,703 What's WHO or what are your partner agencies doing to 343 00:20:33,971 --> 00:20:38,732 understand that development and any potential risks to humans? 344 00:20:39,034 --> 00:20:40,416 Maria van Kerkhove: Yeah, quite a bit actually. 345 00:20:40,416 --> 00:20:42,643 So what we're trying to do is enhance the surveillance. 346 00:20:42,643 --> 00:20:46,018 We have a global surveillance system in humans as part of our 347 00:20:46,057 --> 00:20:49,963 GISRIS system, which is looking at sentinel sites, so patients 348 00:20:49,984 --> 00:20:50,950 that are going into hospitals. 349 00:20:50,950 --> 00:20:52,232 Some are non-hospital sites. 350 00:20:52,232 --> 00:20:58,693 We're working with FAO and WOHA on surveillance in animals, so 351 00:20:58,933 --> 00:21:03,787 in wild birds, in poultry, in livestock, and now that we're 352 00:21:03,847 --> 00:21:07,856 seeing infections in certain species we want to make sure 353 00:21:07,876 --> 00:21:10,522 that those species are tested more systematically. 354 00:21:11,211 --> 00:21:14,477 So not just dairy cattle in the US, but we would ask more 355 00:21:14,518 --> 00:21:18,471 globally for surveillance to include these animals, but not 356 00:21:18,531 --> 00:21:20,856 only in the animals themselves but looking in the products of 357 00:21:20,896 --> 00:21:23,222 those animals, like milk and milk products. 358 00:21:23,222 --> 00:21:25,674 So there's a lot of work that has to happen there to 359 00:21:25,756 --> 00:21:27,580 understand the extent of circulation. 360 00:21:27,580 --> 00:21:33,452 We advise that sequencing be conducted and shared because 361 00:21:33,472 --> 00:21:35,769 there's a lot that we can gain in our understanding of 362 00:21:35,810 --> 00:21:39,538 transmission and circulation with the sequence information. 363 00:21:39,538 --> 00:21:43,133 So I don't have the full picture, but that's just because 364 00:21:43,133 --> 00:21:45,881 the work is ongoing as we are talking about this right now. 365 00:21:45,881 --> 00:21:50,022 We also are very actively engaging with our WHO 366 00:21:50,042 --> 00:21:53,472 collaborating centers, national influenza centers, to make sure 367 00:21:53,574 --> 00:21:56,730 that samples that need to be in the right labs to do the right 368 00:21:56,810 --> 00:22:01,181 types of laboratory research type studies are ongoing and 369 00:22:01,201 --> 00:22:03,913 that information is shared and we're constantly doing risk 370 00:22:03,953 --> 00:22:04,455 assessments. 371 00:22:04,797 --> 00:22:07,667 Alice Allan: What kind of key factors could contribute to a 372 00:22:07,768 --> 00:22:11,015 species jump to humans for H5N1? 373 00:22:12,156 --> 00:22:14,079 Maria van Kerkhove: So one is opportunity right. 374 00:22:14,180 --> 00:22:16,950 So, as these species intermix with each other, you know, we 375 00:22:16,970 --> 00:22:19,978 have wild birds that are flying, and so there's opportunities 376 00:22:20,077 --> 00:22:23,479 for the virus to spread between poultry and other species, wild 377 00:22:23,519 --> 00:22:25,749 birds and other species and that's what we think has 378 00:22:25,788 --> 00:22:28,559 happened here, based on the sequencing information. 379 00:22:28,961 --> 00:22:31,751 We're also very carefully looking at the viruses and 380 00:22:31,771 --> 00:22:35,760 looking at the mutations within the viruses and any changes that 381 00:22:35,760 --> 00:22:40,619 would favor mammalian adaptations what they call it 382 00:22:41,903 --> 00:22:44,230 would favor a transmission in mammals. 383 00:22:44,230 --> 00:22:47,698 Now we're seeing some changes, but these are mainly, primarily 384 00:22:47,778 --> 00:22:51,673 poultry viruses and they have not adapted well to transmit 385 00:22:51,753 --> 00:22:54,901 between people and in mammals, and that's a really important 386 00:22:54,941 --> 00:23:03,790 thing that we're tracking. 387 00:23:03,790 --> 00:23:05,174 We have a lot of really fantastic I mean this with the 388 00:23:05,194 --> 00:23:06,579 utmost respect super nerdy scientists, who I adore, around 389 00:23:06,599 --> 00:23:08,385 the world who are looking at this with us. 390 00:23:08,385 --> 00:23:11,396 So it's not just WHO sitting here saying what do we think? 391 00:23:11,396 --> 00:23:14,951 What we do is we bring together the best minds in the world as 392 00:23:15,031 --> 00:23:17,538 part of our global influenza surveillance and response system 393 00:23:17,538 --> 00:23:17,538 . 394 00:23:17,538 --> 00:23:20,954 We do this for COVID as well and for SARS-CoV-2, of what do 395 00:23:20,994 --> 00:23:24,373 these changes in the viruses mean from a public health point 396 00:23:24,393 --> 00:23:24,634 of view? 397 00:23:24,634 --> 00:23:26,559 So that is something that's also ongoing. 398 00:23:34,869 --> 00:23:37,013 Alice Allan: There've been a lot of headlines recently 399 00:23:37,094 --> 00:23:40,378 predicting that the next pandemic is going to be caused 400 00:23:40,439 --> 00:23:44,125 by an influenza virus that's jumped from animals to humans. 401 00:23:44,125 --> 00:23:46,096 How do you assess that risk? 402 00:23:47,532 --> 00:23:51,922 Maria van Kerkhove: For me, flu is a certainty because it's so 403 00:23:52,001 --> 00:23:53,124 much in circulation. 404 00:23:53,124 --> 00:23:56,477 It's infected many different species. 405 00:23:56,477 --> 00:24:00,515 We have avian influenza and the opportunities for reassortance, 406 00:24:00,515 --> 00:24:04,411 the opportunities for a pandemic influenza virus are 407 00:24:04,431 --> 00:24:04,651 high. 408 00:24:04,651 --> 00:24:08,660 That's why we have a whole system in place to be prepared 409 00:24:08,680 --> 00:24:08,920 for this. 410 00:24:08,920 --> 00:24:12,835 The challenge is will we see another coronavirus pandemic, 411 00:24:13,656 --> 00:24:17,251 given that we had SARS-CoV-2 cause, a pandemic for sure. 412 00:24:17,251 --> 00:24:18,637 This is an opportunity. 413 00:24:18,637 --> 00:24:22,259 Question is will we see an arbovirus pandemic? 414 00:24:22,259 --> 00:24:24,833 Now, I'm not saying this to scare people who are listening 415 00:24:24,894 --> 00:24:27,936 to this, but for us it's something that we have to be 416 00:24:27,977 --> 00:24:28,439 prepared for. 417 00:24:28,439 --> 00:24:33,474 So we have to think out of the box, really prepare for what are 418 00:24:33,474 --> 00:24:36,396 the known threats, but also think out of the box, for you 419 00:24:36,416 --> 00:24:37,902 know, really prepare for what are the known threats, but also 420 00:24:37,922 --> 00:24:39,287 think out of the box, you know, for something different, perhaps 421 00:24:39,287 --> 00:24:39,748 waterborne or whatnot. 422 00:24:39,748 --> 00:24:44,618 So for me, pandemics, unfortunately, are part of what 423 00:24:44,699 --> 00:24:46,061 we will deal with in our lifetimes. 424 00:24:46,061 --> 00:24:48,893 I don't believe this will be the last pandemic we will deal 425 00:24:48,933 --> 00:24:49,815 with in our lifetimes. 426 00:24:50,215 --> 00:24:53,201 Alice Allan: We know we weren't prepared for the COVID-19 427 00:24:53,381 --> 00:24:53,981 pandemic. 428 00:24:53,981 --> 00:24:55,845 Are we prepared for the next one? 429 00:24:57,130 --> 00:24:57,750 Maria van Kerkhove: Yes and no. 430 00:24:57,750 --> 00:25:02,460 Yes because we do have strong systems that are in place. 431 00:25:02,460 --> 00:25:05,893 We have learned a lot in the last four years from COVID. 432 00:25:05,893 --> 00:25:10,603 We have strengthened PCR capacity, sequencing capacity. 433 00:25:10,603 --> 00:25:12,471 We have stronger community engagement. 434 00:25:12,471 --> 00:25:17,258 We have many systems that are in place to ensure better 435 00:25:17,317 --> 00:25:20,362 clinical care and infection prevention and control and good 436 00:25:20,402 --> 00:25:23,266 coordination in our emergency operation centers and supply 437 00:25:23,346 --> 00:25:23,586 chain. 438 00:25:23,586 --> 00:25:30,018 No, on the other hand no because I think the world's 439 00:25:30,157 --> 00:25:34,222 trust in science you know there's been a lot of, there's 440 00:25:34,242 --> 00:25:37,616 been a lot of distrust, um, over the last couple of years, and 441 00:25:37,656 --> 00:25:38,923 that's something we have to work on. 442 00:25:38,923 --> 00:25:40,611 You can develop the best interventions in the world, but 443 00:25:40,811 --> 00:25:43,018 if they're not implemented by communities, they're useless. 444 00:25:43,018 --> 00:25:47,596 We still have challenges with equity and access to these 445 00:25:47,635 --> 00:25:52,951 materials and I think you know, in many respects we are better 446 00:25:53,090 --> 00:25:54,452 off and in others we are not. 447 00:25:54,893 --> 00:25:56,595 I'm optimistic. 448 00:25:56,595 --> 00:26:00,719 That's what gets me out of bed every day, otherwise I wouldn't 449 00:26:00,739 --> 00:26:01,820 be able to do this job. 450 00:26:01,820 --> 00:26:04,743 I'm hopeful with the pandemic agreement that is being 451 00:26:04,784 --> 00:26:07,586 discussed and negotiated right now by all of our member states 452 00:26:16,089 --> 00:26:16,451 to get this done. 453 00:26:16,451 --> 00:26:17,535 They want to get this done because we have to do. 454 00:26:17,535 --> 00:26:18,779 We can't just have a handshake and say, oh, we'll do better 455 00:26:18,799 --> 00:26:19,039 next time. 456 00:26:19,039 --> 00:26:22,451 There have to be commitments in place to ensure that we do 457 00:26:22,471 --> 00:26:23,272 better the next time. 458 00:26:23,272 --> 00:26:29,104 Again, covid-19 did not have to be as bad as it was, as it is, 459 00:26:30,010 --> 00:26:32,739 and we owe it to our children, our grandchildren, to make sure 460 00:26:32,759 --> 00:26:35,512 that we we keep up these systems and have that commitment in 461 00:26:35,553 --> 00:26:38,317 place to make sure that we do better the next time. 462 00:26:41,643 --> 00:26:44,673 Alice Allan: In future episodes I'll talk to experts who are 463 00:26:44,733 --> 00:26:48,547 tracking disease outbreaks, trying to understand them better 464 00:26:48,547 --> 00:26:53,538 and preparing for future pandemics Not if, but when they 465 00:26:53,597 --> 00:26:53,898 happen. 466 00:26:53,898 --> 00:27:03,192 Health in Europe is produced by the World Health Organization. 467 00:27:03,192 --> 00:27:04,415 Music for this episode is by Ben Howells, Richard Duttonall 468 00:27:04,435 --> 00:27:04,777 and Gareth Thomas. 469 00:27:04,777 --> 00:27:06,621 Sound engineering is by David Barrett. 470 00:27:06,621 --> 00:27:08,330 My name's Alice Allen. 471 00:27:08,330 --> 00:27:20,587 Thanks for listening, Thank you .