The viruses are winning: There’s still time to fight back
In the last 103 years, viruses with pandemic potential have arisen at least 10 times. Five of these occurred in just the last 14 years. SARS-CoV-2, Monkeypox virus (MPxV) and now the re-emergence of poliovirus, appeared in less than three years. This suggests not only an increasing rate of emergence of novel zoonotic viruses (viruses that jump from animals to humans) but also the startling reemergence of known viruses.
The viruses are winning unless something changes.
Just two and half years after the World Health Organization (WHO) declared SARS-CoV-2 a public health emergency of international concern (PHEIC), MPxV has risen as the newest virus with the designation. Until recently, Monkeypox was an endemic virus of rodents in western and central Africa. It occasionally infected humans, predominantly children that played among wild animals in endemic areas. However, the present outbreak is different; infections are widespread globally and the virus seems to have acquired a better ability to spread from human to human.
COVID should have taught us lessons about attacking emerging viruses early, hard and fast.
Dr. Li Wenliang, a Wuhan physician, raised early alarms of a SARS-like illness based on a cluster of cases that occurred before SARS-CoV-2 was identified. His early warnings were silenced, although the full pandemic potential that he had warned about came to be. The resulting COVID-19 pandemic was destructively politicized and mishandled in numerous countries. Despite a heroic effort by the international scientific community to develop effective vaccines and treatments, continued high-level transmission of SARS-CoV-2 pushes the generation of new variants of concern.
In another case of missed opportunity, five years ago, Dr. Dimie Ogoina, a physician in Nigeria, noted an unusual increase in monkeypox infection in men ages 20-40. His early warnings were also dismissed and silenced. Now the belated, sluggish implementation of monkeypox mitigation, and the slow rollout of vaccines, jeopardize controlling the virus. This provides MPxV with time to spread, increasing the risk of infecting indigenous animals where it can become endemic; then a new human virus will be established and impossible to contain.
The situation gets worse. The only other virus that has public health emergency of international concern designation is poliovirus. Typically considered a historical childhood disease, poliomyelitis (polio) is an ongoing threat. Polio is controlled by widespread vaccination and global vaccination campaigns by the Global Polio Eradication Initiative. Thus, it is alarming that in July the first case of paralytic polio since 2013 was reported in the U.S. Studies suggest that the unvaccinated patient was infected in the U.S. by a virus that originated outside of the country, meaning that it was brought here in an infected individual. Most poliovirus infections are mild or asymptomatic, not paralytic, suggesting that there are many more infected people in the U.S. than we are aware of. The virus is silently spreading communally, particularly among the unvaccinated, likely in several countries.
The accelerating emergence of zoonotic viruses and reemergence of known viruses are harbingers of a future where epidemics and pandemics occur with increasing frequency. There are many causes, but low vaccination, climate change and encroachment on animal habitats rank high. A large reservoir of worrisome viruses with the potential to jump to humans exists in many different animals, particularly bats, rodents and birds. The woefully inadequate response to COVID and, so far, to monkeypox, makes this future foreboding.
This has laid open for view a profound dysfunction of our society and institutions to deal with a global public health crisis, and a shocking lack of care for each other, especially the most vulnerable. We must apply lessons of the current pandemic and its challenges to implement increased surveillance and rapid response plans in the face of increasing viral threats.
We have a fighting chance if we quickly become aware of emerging viruses at the point of their emergence, then respond to squelch the virus before it becomes epidemic or pandemic. The overarching infrastructure at the level of governments, the United Nations and the WHO is critical for this effort. However, we should learn from the effectiveness of the global collaborative response by scientists that arose during the SARS-CoV-2 pandemic; it must be maintained, broadened and formalized. This can be done through the establishment of a virus response infrastructure which would include global virology organizations and societies, academic and industrial researchers and nonprofit global health agencies. This group can direct early detection initiatives, guide collaborative research efforts, disseminate data-driven information and aid in local mitigation efforts and equitable vaccine distribution.
Importantly, we must deeply engage scientific communities in nations where potential zoonotic viruses exist. Early alerts, like those of Drs. Li and Ogoina, cannot be ignored — they are our window to early response. These measures require significant national and international investment. However, the costs for early detection and prevention pale compared to the immense economic, social and personal costs of pandemics.
James Alwine is a virologist and a fellow of the American Academy for Microbiology and of the American Association for the Advancement of Science. He is a professor emeritus at the University of Pennsylvania and a visiting professor at the University of Arizona. Felicia Goodrum is a fellow of the American Academy of Microbiology and a professor of immunobiology and the BIO5 institute at the University of Arizona College of Medicine. The authors are members of the Global Partnerships and Advocacy Committee of the American Society for Virology.