3 Takeaways - Bird Flu is a Real Concern. Learn the Facts with Former National Security Council Director for Medical and Biodefense Preparedness (#202)

Episode Date: June 18, 2024

Pandemics are on the rise. Will bird flu be next? The government says it’s monitoring the situation, but should we worry? According to former National Security Council Director for Medical and Biodefense Preparedness and expert on emerging infectious diseases, Luciana Borio, the answer is yes. Not only because bird flu is dangerous, but because the government may be giving us happy talk. The more you know, the better. So join us.

Bird flu has caused unprecedented deaths among wild birds, and it's now widely circulating on a variety of farm animals across the United States. Could it be on a path to acquiring the ability to easily infect people? And have we entered, as many believe, an era of pandemics? Hi, everyone. I'm Lynne Thoman, and this is Three Takeaways. On Three Takeaways, I talk with some of the world's best thinkers, business leaders, writers, politicians, newsmakers, and scientists. Each episode ends with three key takeaways to help us

understand the world and maybe even ourselves a little better. My guest today has a deep understanding of infectious diseases. She is Luciana Borio. Luciana is a Brazilian-American infectious disease doctor who previously served as director of her medical and biode Preparedness at the National Security Council. And she was also Acting Chief Scientist and former Assistant Commissioner at the U.S. Food and Drug Administration, the FDA. Welcome, Luciana, and thanks so much for joining Three Takeaways today. Thank you so much, Lynn. It's such a pleasure to be here with you and talk

about these issues that I care so deeply about. Thank you, Luciana, and thank you so much for your time and all of your work on these issues. The H5N1 strain of bird flu is now widely circulating in chickens, cows, and a variety of other animals across the U.S. and across the world, it seems. How worried are you? I'm very worried about this latest episode, Lynn, because as you mentioned, H5N1 is a virus that has been circulating globally, infecting alien species and birds for quite a bit of time, many years now. But this is the first time that it has got into our milk supply into the dairy cows. And it's causing these large outbreaks in dairy cattle herds. And as they move around the country, more infected farms are detected.

There have been three recent human cases linked to exposure to the infected dairy cows. All happened between April and May of 2024. And these human cases are very concerning, especially because of the first two, they only had mild eye infection, which indicates that it was a more superficial infection because they came into contact with the virus. But the last case showed respiratory symptoms. So the individual showed just like a regular flu. And it's very concerning that this third case exhibited respiratory symptoms because that indicates that the virus is continuing to mutate. And it's almost inevitable that it's going to acquire some mutations that make it more fit, if you will, to infect humans. And once it makes it into the lungs, it also indicates that it's one step closer to becoming transmissible from person to person. Because now it's already infecting the very organ that we use to communicate, to sing, to talk,

to cough. So it makes it like the ability to spread through aerosol more likely. And we're not there yet, but these are things that we need to be very concerned about. And we should be doing a lot to prevent further spread and prevent this virus from becoming a pandemic. Before we talk more about bird flu and how to prevent it from becoming a pandemic, let's talk more about pandemics in general. Many believe that COVID will not be the last pandemic we face in our lifetimes, that there will be many more. And in fact, the chief scientist for the World Health Organization, Sir Jeremy Farrar, has said, and I quote, it's clear we're living in a pandemic age, which is going to have more frequent and more complex pandemics, unquote. What do you think?

Have we entered an era of more frequent and complex pandemics? And if so, why? So Jeremy is absolutely correct. And there's no question about that we are in a century of pandemics. There have been at least seven pandemics in the past century. And some of them we don't even think about so much because they've been mild and we tend to forget about them. That's the case with the influenza pandemic in 2009. Some are slow, like HIV is a pandemic, but it's so slow that we don't feel the acute impact,

despite the tremendous human toll. And I think there are several factors that are leading to the situation. First and foremost, environmental actions, such as deforestation, farming practices, wildlife trade and markets, and all these create opportunities for spillover events. That's when viruses that occur normally in nature, in the wild, come in contact with humans and domestic animals, and that allows it to spill over into a new population. And you couple that with a situation where you have large-scale population movement and migration, urbanization, very large population densities that were non-existent before, and this change in population density and movement also facilitates the inter-human transmission of these viruses. And therefore,

we do need to take action to prevent and detect, respond, and recover from these events. You mentioned animals and spillover for animals as one potential source of pandemics. How about mosquito or tick bites from infected mosquitoes or ticks or superbugs or other causes? Are there other potential sources of pandemics? For sure. So right now we are dealing with a huge epidemic of dengue. And we saw Zika a few years ago, and it persists, you know, globally. So these are vector borne diseases where mosquitoes or ticks are responsible for the infection. And the issue there is that climate change and warmer weathers can lead to larger populations of mosquitoes in areas that did not occur before. So you look,

for example, in the south of the United States and Puerto Rico, Puerto Rico and Florida and Texas, these have become places where these vectors live and can transmit these types of viruses. So we're going to see an expanded footprint of new viruses into new geographic locations where they did not occur before because of these types of temperature excursions. If we're at risk from the H5 strain of bird flu, as well as other potential pandemics, it seems like there are many lessons from COVID. Let's start by talking about trust. Many people stopped believing in government and scientists. What do you think needs to be done differently? It's such an important point. And I think that trust is a major vulnerability that we have in public health emergencies. And of course, our adversaries are

going to exploit the fact that there is such high societal mistrust to public health institutions, to scientific institutions, to our government bodies. But I think that as a first step, and my colleagues may chastise me for this, but I think that scientists have a responsibility and have to assume their share of responsibility for the current situation. Because I think that a lot of times scientists conflate facts with their own values and they push certain courses of action and they forget that individuals also have an important voice in what course of action to take with regard to a specific situation. We saw that during the COVID pandemic, when there was a very strong movement to vaccinate. And I think it was absolutely necessary and a no-brainer to vaccinate

individuals, especially the first two doses of the vaccine were so crucial in saving lives. But then it came a point where it may not have made sense for an individual who's young and healthy to keep getting vaccinated over and over and over again, especially after they had had COVID and recovered from COVID. And yet our government really pushed hard on that message as if it's like wrong to choose against vaccines. And I think that left a huge space open for the anti-vaccine movement to seize on that and say, wait a minute, the data is just not so strong to keep recommending these boosters to everybody. We need more data.

And they exploited that weakness. Scientists now have to take a step back and really just reflect on the limits of their influence. Again, they may own the facts, but people also own decisions around courses of action and what makes most sense to them. Monitoring is one of the key elements of fighting infectious diseases. How effectively are we monitoring for bird flu as well as other new

and potentially highly transmissible viruses and bacteria? What should we be doing? I'd like to say that the U.S. has the best, most amazing scientific capabilities, but we don't have the best systems. We need better systems. So, for example, the CDC, the Centers for Disease Control and Prevention, has very limited authorities. And we're seeing that within the H5N1 outbreak, where they've been struggling to really delineate the extent of this outbreak to conduct the proper surveillance to identify even who may have been exposed but not shown symptoms of this virus. How big is this outbreak? And that's because even though we have the scientific capabilities,

they lack the authorities. And this is something that we've seen over and over again during COVID as well. We had to rely on data from sometimes other countries to be able to make sense of what was happening because we have this very federated system within the US. We don't have a really coherent public health system that is able to conduct the surveillance to the degree that it would be ideal. There's been some innovations such as wastewater surveillance, and that is a very important source of data. But again, it's incomplete. And it doesn't really tell us the full story. So we need to strengthen our systems to be able to

get to where we need to be. Where are we, as far as having a global network to alert, monitor and mitigate pandemics? Well, and it brings such an important point. And I like to say that pandemics require like a team. And the globe has never been more had, I think, up close to 200 nations, 190 some nations that were working together to see if they could reach some agreement around pandemic preparedness and response. And they failed. They failed to achieve agreement. And there have been significant clashes around issues. And I completely understand that this is very difficult, but that's what we need to do. We need to be able to come together because no single country can tackle these types of emergencies by themselves. There's tremendous interdependencies, not only with respect to the detection, but also with respect to the response.

Very scary. We haven't yet talked about the discovery and manufacture of vaccines and therapeutics at scale. How do you see the pharma companies and what should we be doing to preemptively develop drugs and treatments for bird flu and future pandemics? Vaccines, drugs, diagnostic tests are integral to a successful response, especially vaccines, but they require the private sector. In the U.S., they are the ones who deliver these types of products, who can make them at scale, who can make them fast. And we saw that during COVID. And it really was a validation of the American research enterprise and the public-private partnerships that are required to support the type of products we need.

I think it's really interesting that both Pfizer and Moderna did a beautiful job in delivering these amazing vaccines. But when you look back, these did not emerge from ashes. They really emerged from decades of research that had preceded the event. And few people realized that the engineering, the biological engineering that led to these amazing vaccines had origins in HIV research. Again, that occurred decades earlier. In addition, there was new technology to stabilize the spike protein in the vaccine that made them so effective.

You know, it takes years of scientific discovery and non-competitive science to get to a point of scientific maturity where we can have these amazing products. And the U.S. does that very well. It could do more, of course. More funding for science is always good. And then we rely on these companies. One of the reasons the pandemic agreement negotiations did not work out is because some disagreed with issues of sharing of products and benefit sharing and IP issues. You know, I find it very hard for the U.S. government to agree to give things that ultimately

it doesn't really own. You know, these are privately held intellectual property. And it's difficult for a country like ours to say we're just going to give away with that because, again, we need those protections for pharma to be able to respond when we need. Recently, the government has taken steps to produce new vaccines for H5. And that's really welcome. You know, I think in the treatment space, it's a little bit more challenging. I do not agree with the happy talk that we have antivirals in the stockpile. For one, these are very weak antivirals, and they may not really make much of a difference in the outcome from a serious H5

infection. And they have to be given so quickly that it's very difficult to administer them in a time that is required to make a difference. Flu is not the same as COVID. It's a very different virus. And then we need to rebuild our diagnostic infrastructure that was built and then dismantled right after the COVID. We sometimes lose sight of the need to continue the work that this work, it cannot just be stop and go, stop and go, stop and go. We need to continue the work in the inter-pandemic period so that we can maintain a certain level of preparedness. And today we still have a lack of adequate ability to diagnose H5 should this virus continue to expand. Is the government's messaging then that we have nothing to worry about as far as bird flu sending the wrong message to the public and Congress? Yes, absolutely.

It's a false reassurance in my view. Maybe nothing will happen. Let's hope for the best. Let's just hope for the best, right? But we need to prepare for the worst and the government will need the resources. HHS, Health and Human Services will need the resources to be able to quickly step up production of vaccines, to test antiviral drugs, to expand diagnostic testing, and the happy talk does not help them. You can also lose credibility with the public. Should this take a turn for the worse? The happy talk really leads to lack of credibility. And as I mentioned earlier, I think scientists and politicians have to take a look and self-reflect on their role in contributing to the lack of trust that we see that is so

prevalent in today's society. It is so prevalent. It's such a big issue. Can you summarize what else we should be doing to prepare? One component of response that the responsibility for that is unclear because it's not traditional like NIH or HHS, National Institute of Health or CDC, has to do with indoor air quality. And to me, that's a missed opportunity. We really ought to focus on improving the indoor air quality for large spaces where there's population density, like workspaces, schools. And we've known that there are engineering controls to be had that could actually make a big difference in whether these viruses are transmitted within these enclosed spaces. The University of Colorado is one of the leading global places for these types of studies.

And they implemented their own research, if you will, during early pandemic. And they've had great success in preventing transmission within the university because of these indoor air efforts. And I think that, you know, this is a missed opportunity because it could pay dividends for every respiratory season, you know. And with these types of multi-purpose techniques, we could really feel safer in our workplaces, in our school, in the places of congregation. What are the three takeaways you'd like to leave the audience with today? First, I would say that pandemics are inevitable, but we can take action to minimize their impact,

both at the individual level and at the societal level. And I think there are things there is, there are things that, you know, again, both individuals and society can take to mitigate their impact. You know, sometimes we talk about these pandemics and it feels like the sky is falling and people feel like they're helpless and, you know, they're not helpless. For one, they vote and they can communicate their priorities to politicians. You know, like this is important to me. It's important for my community. It's important for my community. It's important for our country.

It's important for our national security, for economic competitiveness and wave setting response. And at the individual level, you know, it's possible that, you know, one cannot develop their own countermeasures, their own vaccines,

but they should definitely, you know, do what they can in an emergency, prevent needless, especially early on before vaccines are available, minimize number of personal encounters. They can wear masks when there's a high risk of exposure. They can focus on their own indoor air quality. And it's not something that every individual has the ability to, but there are actions that people can do if they're worried about it that can minimize their own risk of getting infected, even in the most severe pandemic.

Two, the U.S. is very privileged with respect to its scientific capabilities, but we need to improve coordination of these capabilities, not only domestically, but also internationally. This is a team sport and needs to be played at the global level. And the world needs U.S. leadership for pandemic preparedness and response. Number three, mistrust is a major risk. And scientists, including like our government institutions, like the Food and Drug Administration, have a share of responsibility for the current situation. And we need to attend to this very carefully so that we minimize the impact of these weaknesses in the future response.

Luciana, thank you. Thank you for taking the time today for Three Takeaways. And thank you for your work on infectious diseases and protecting us all. My pleasure, Lynn. And let's hope for the best. Yes, definitely. If you're interested in health, you might be interested in our three episodes on health. One is former Secretary of Health and Human Services, Alex Azar, who shares on previously unknown reasons for the stunning success of Operation Warp Speed. That's episode 174. Then there's the one and only Dr. Atul Gawande in an eye-opening, wide-ranging talk about global health. That's episode 182. And we have an earlier episode from 2021 with former FDA Commissioner

Scott Gottlieb on uncontrolled spread, why COVID-19 crushed us and how we can defeat the next pandemic. That's episode 59. If you're enjoying the podcast, and I really hope you are, please review us in Apple Podcasts or Spotify or wherever you get your podcasts. It really helps get the word out. And if you're interested, you can also sign up for the Three Takeaways newsletter on our website at threetakeaways.com, where you can also listen to previous episodes. You can also find on our website, our featured speakers, as well as our episodes organized by category. And if you'd like, you can also follow us on LinkedIn, X, Instagram, and Facebook. I'm Lynn Toman.

This is Three Takeaways. Thanks for listening.