Saturday, March 10, 2018

WHO List Of Blueprint Priority Diseases

Credit WHO


Nearly a decade ago, Lloyd's issued a pandemic impact report for the Insurance industry, which we examined in The Lloyds Report: A Closer Look. This was five years after SARS and six months before the arrival of the 2009 pandemic, and at a time when the world was focused primarily on avian H5N1 as a pandemic threat. 

The report stressed five points:
While geared primarily for the insurance and re-insurance industry, the report also provided a `best guess' list of possible pandemic contenders.  Pathogens - in additional to novel influenza - that could conceivably spark a pandemic in the near future.

Their list included:
  • Hendra Virus
  • Nipah Virus
  • Cholera
  • Small Pox
  • Bubonic Plague
  • Tuberculosis
  • Lassa fever
  • Rift Valley fever
  • Marburg virus
  • Ebola virus
  • Bolivian hemorrhagic fever
  • MRSA
  • SARS
    At the time I wrote : "I could add Dengue, Chikungunya, and of course Virus X, the one we don't know about yet, to this list."  Since then, a remarkable number of diseases from the Lloyds list have made substantial public health impacts around the globe, including:
    1. Ebola in West Africa
    2. Bubonic (& Pneumonic) plague in Madagascar
    3. MERS (a SARS-like Coronavirus) in the Middle East
    4. Cholera in Haiti, the Middle East, and Africa
    5. Lassa Fever currently spreading in Nigeria 
    Earlier this year the WHO updated their own list of `priority' diseases, and while it shares many of the items from the Lloyds list, its intent is to highlight `diseases and pathogens to prioritize for research and development'.
    Basically, a list of serious disease threats for which few medical countermeasures currently exist, and not meant to serve as a comprehensive list of possible pandemic or epidemic contenders. 
    Missing, for example, are novel influenza, TB, HIV/AIDS, etc, as they explained in their first list which was released in 2015:
    Other diseases with epidemic potential - such as HIV/AIDS, Tuberculosis, Malaria, Avian influenza and Dengue - were not included in the list because there are major disease control and research networks for these infections, and an existing pipeline for improved interventions.
    Some excerpts from the 2018 update follow, after which I'll return with a bit more:
    List of Blueprint priority diseases
    The second annual review occurred 6-7 February, 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for*:
    • Crimean-Congo haemorrhagic fever (CCHF)
    • Ebola virus disease and Marburg virus disease
    • Lassa fever
    • Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
    • Nipah and henipaviral diseases
    • Rift Valley fever (RVF)
    • Zika
    • Disease X
    Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown “Disease X” as far as possible.
    A number of additional diseases were discussed and considered for inclusion in the priority list, including: Arenaviral hemorrhagic fevers other than Lassa Fever; Chikungunya; highly pathogenic coronaviral diseases other than MERS and SARS; emergent non-polio enteroviruses (including EV71, D68); and Severe Fever with Thrombocytopenia Syndrome (SFTS).
    These diseases pose major public health risks and further research and development is needed, including surveillance and diagnostics. They should be watched carefully and considered again at the next annual review. Efforts in the interim to understand and mitigate them are encouraged.
    Although not included on the list of diseases to be considered at the meeting, monkeypox and leptospirosis were discussed and experts stressed the risks they pose to public health. There was agreement on the need for: rapid evaluation of available potential countermeasures; the establishment of more comprehensive surveillance and diagnostics; and accelerated research and development and public health action.
    Several diseases were determined to be outside of the current scope of the Blueprint: dengue, yellow fever, HIV/AIDs, tuberculosis, malaria, influenza causing severe human disease, smallpox, cholera, leishmaniasis, West Nile Virus and plague.
    These diseases continue to pose major public health problems and further research and development is needed through existing major disease control initiatives, extensive R&D pipelines, existing funding streams, or established regulatory pathways for improved interventions. In particular, experts recognized the need for improved diagnostics and vaccines for pneumonic plague and additional support for more effective therapeutics against leishmaniasis.
    The experts also noted that:
    • For many of the diseases discussed, as well as many other diseases with the potential to cause a public health emergency, there is a need for better diagnostics.
    • Existing drugs and vaccines need further improvement for several of the diseases considered but not included in the priority list.
    • Any type of pathogen could be prioritised under the Blueprint, not only viruses.
    • Necessary research includes basic/fundamental and characterization research as well as epidemiological, entomological or multidisciplinary studies, or further elucidation of transmission routes, as well as social science research.
    • There is a need to assess the value, where possible, of developing countermeasures for multiple diseases or for families of pathogens.
    (Continue . . . )

    It it feels as if we are being outnumbered and overwhelmed by a rising tide of new pathogenic threats, you aren't wrong. Over the past 40 years we've entered into a new `golden age' of emerging and reemerging infectious diseases, spurred on  - at least in part - by increased speed and ease of global travel. 

    Something which was predicted and described by the late (May 22, 1936 - May 15, 2014) anthropologist and researcher George Armelagos of Emory University in his work The Changing Disease-Scape in the Third Epidemiological Transition, where he posited that since the late 1970's we have entered the age of newly emerging infectious diseases, re-emerging diseases and a rise in antimicrobial resistant pathogens
    For a more detailed review of that paper, you may wish to revisit my 2016 blog The Third Epidemiological Transition.
    While novel influenza - because of its mutability, transmissibility, and impressive track record  - remains the pandemic threat that keeps most scientists up at night, it is far from the only threat.
    The next pandemic could also come from a bat coronavirus, a mutation in the Monkeypox virus, an exotic hemorrhagic fever, or from something completely out of left field. 
    All reasons why pandemic preparedness needs to become a year-round national priority, not just something we think about during severe flu seasons or during the centenary of a particularly bad global epidemic.

    For more on the challenges posed by the next pandemic, you may wish to revisit:

    The Challenge Of Promoting Pandemic Preparedness

    Pandemic Unpreparedness Revisited
    Smithsonian Livestream: “The Next Pandemic: Are We Prepared?"
    World Bank: World Ill-Prepared For A Pandemic

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