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TEDxLakeComo 2010 - Ilaria Capua: come ci stiamo preparando alla pandemia?

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Good afternoon. This afternoon I'll talk about pandemics, these terrible menaces that really are around the corner, and I'll also try to persuade you of the fact that it is now possibile to have a different approach to pandemics. Pandemics are not only to be suffered we as citizens can do something to enhance our own health services and these of the rest of the world as the world, as I will show you, is living through the globalization era and we are quite interconnected, and the viruses are taking advantage of this. This map shows what you might consider to be fairy tales. Fairy tales! One more tale on the bird flu, the mad cow disease, and then the hantaviruses, these diseases affecting navajos in America. They really aren't fairy tales. They are not tales as there are thousands of people working around the globe attempting to... turn them into tales! That is, they are working toward not letting them harm your and create extremely serious situations that might affect everyone's health, as well as the economy. Many of these illness (according to the journal Nature) come from animals. Why? Because animals have the same receptors humans have. So, even if we tell ourselves, we believe that we are superior from a receptors point of view from a pathogen point of view we are not that much different from animals, and during the last 20 years a succession of these pathogens have come to knock on our doors: some have caused devastating consequences, such as HIV, which comes from monkeys; luckly we have managed to stop some of them in time. We think that, after all, we have antibiotics, drugs, we have we shouldn't worry much about diseases. Thats not true! That's absolutely not true! The occourrences of emerging infectious diseases are increasing and have increased during the last years and what ought to be understood is that the pathogens use the very same globalized systems that bring goods and people around and that the pathogens are far smarter than we can imagine, as they always are looking for a new niche, a new space to occupy, in which to live their life, which in turn causes illness or kills the host. For instance, what are they exploting? If we look at the global population increase trend we can notice that, in some regions of the world, expecially in Asia and in Africa the population is increasing exponentially. What do these population want, what are they expecting for in the future? First of all they are expecting to eat meat, as the speaker before me said. These populations, as the western world did before them after the war, have invested in modern zootechnics, they too will want to eat more and more meat and animal proteins. If we look at the expected consumption of meat in developing countries we notice that it is far greater than the one expected in developed countries. Clearly one has to eat meat. And in order to eat animal sourced products one has to breed animals, and the animals are bred they way they are bred. They use their breeding techniques, such as this - these are gooses that are being risen in Thailand, they are risen in rice field as gooses eat rice parasites, so the goose is fed and the rice is saved; but clearly these animals live in contact with wild ones, and are bred in hygienic conditions that are quite far from the hyigienic conditions of the western farms. These too are bird farms in Asia. Bird farms are quite important in Africa as well, as birds are both a source of meat and a source of eggs, and so it is possible to obtain a protein source without killing the animal. Here you can see different species mingling and that's completely wrong from a biosecurity point of view as they can host and perpetuate infections. This picture was taken in Vietam: I call this the pandemic factory, the flu pandemic factory, as the flu virus is "born" in birds and then, through adaptation in pigs it infects humans. This kind of farm, which has been designed to contain costs is also the perfect instrument to let a flu virus reach an host that is very dangerous for us. Clearly these meats, these products, these animals must be transported and they are, so let's see how they are being moved from a global point of view. These are the transcontinental meat routes. You like eating steaks from Argentina as much as I do. Clearly that steak must come from Argentina, which implies that the animal must be slaughtered in Argentina, loaded on a ship and brought to Europe. But just any kind of product travels along the most controlled products, originating from farms of a rather high level, For instance, these chicken claws (notice their conditions) are a delicacy in Asia. Unimaginable things go on in Africa; for instace, one of those things is the hunting of primates, as their meat is part of the food chain and is also used in ritual and ethnical customs. But clearly the people (as you can see for this hunter) come in contact with blood, they come in contact with the blood of the primates, which really can carry anything. I wonder if anyone here knows what this is. That's the map of the ships going around the world right now. You understand that it is absolutely impossible to stop this, and just anything as I said previously, is carried by these ships, like live endangered animals, that shouldn't be traded, as well as some completely unexpected clandestines. How many among you own one of these? I do! These should be bamboo plants, used to decorate the domestic environment - yet first of all this is not bamboo. Secondly they come from China, where they are cultivated, harvested and loaded on ships; these ships carry containers holding hundreds of thousands of plants, and maybe you have noticed the bottom of these plant is contained in a test tube. This test tube is used to keep the roots wet, so it contains water. But in China one can find insect larvas in the water. When these containers are opened swarms of insect that may carry diseases are released, as well as insect that are not local. And clearly, among these insect are some blood sucking ones, that can bite humans thus infecting them with pathonges that once were defined as tropical. So, what should be done, where should we look? We ought to try stopping the transmission of diseases from animals to humans. Why? Because once one pathogen has reached the first population layer, that is the poorest one, it needs only enter a school and climb the social ladder a little to board a plane and reach every place. Now I'll give you some examples about the things these viruses are able to do by using the instruments of globalization. For those who are not a veterinarian is there a veterinarian among us? This is an horse, an apparently healthy one but in fact ...budubum! He isn't exactly healthy, this horse is the first clinical case of West Nile found in Italy, the West Nile is the so called fever of the Nile valley, it's a disease carried by blood eating insect that causes, in horses and humans, a kind of encephalitis that can be, at times, severe. This disease is now in Italy and where do you think it has gone to? It has reached a swamp, it has reached the delta of the river Po, and that's obvious, if you were a mosquito were would you go? In the delta of the Po! And this disease, the West Nile, was considered as an exotic disease until not long ago, and in fact little has been spent in attempting to contain it. Look at what has happened in America and look at the years counter. This disease was introduced in New York and subsequently it has spreaded all over America up until the 2008, excluding only the state of Maine, that's the one on the top. So you can understand that if the Americans haven't stopped it, it is not likely that we are going to stop it now. This is - I have spared you one, because this is a picture of moneky smallpox I haven't shown you a face. And you may think "Why should I mind monkey smallpox?" Well, in America they do the oddest things: they took some rats from Gambia imported them as pets, the infections spred to the praire dogs and infected some childrens and was contained, but we could have failed at that. Now two things about flu pandemics. What do we know about the origins of these diseases? We know they come from animals, not much but that's sure. Two things about the pig flu first I would like to tell you that this infection is caused by a virus that could be seen as the harlequin of the globalized era, for its genes come from three species of animals and two hemispheres, it's the first time in history. And now I'll ask you: Do you think it was a pandemic? Next slide. First of all, what does pandemic mean? Pandemic does not mean that it will kill millions of humans, but that it is an epidemic that tends to spread to every place and that will affect the whole population. Let' see what has happened: the virus was identified in Mexico during April in the last year, the pink ones are the countries affected and the red ones are the lethal cases. Let's go onward. They are spaced roughly 2 months one from the other: you see this infection has spred like wildfire all over the world. And I can tell you we were lucky, for had the virus been slightly more aggressive, we would have been in a far different situation. So what I'd like to say is that the moment these viruses become able to pass from the animal reservoir to other animals and then to humans, what will the next disease be? What will be the behavior of the next virus? In addition to the trade routes in the case of the flu we also must account for migratory routes making the transmission path of these viruses far more complex. Let's look at the future, what could we do so as not to mistake again? How can we face these problems? We are able to send a starship to Mars, morover, we are able to decide at what time it will reach it, we are able to make weather forecasts for Mars, to me that really seems to be useless, well, in short, we can talk about that. And there I reach the end of my presentation, for I have found myself involved in a thing far greater than me I have made a mess that I didn't consider to be a mess, I tought I was following common sense, but in fact I found myself engulfed by an enormous vortex that, however, has changed many things. About Nigeria, the scarcity of available proteins, the fact that childrens must eat meat, my lab had diagnosed the first bird flu case in Nigeria and I was asked by the WHO to deposit the sequence, the genetic code of the virus, its "digital fingerprint" into a reserved access database. I refused, for I said "Excuse me, but we all must work togheter, it's a problem involving everybody, so my database, my genoma, I will put it into a public access database!" That's the mess I have made! I have ended up on the pages of half of the world newspapers. However, we have changed many things as the three international organizations that are involved in public health and animal health that are, first, the OIE, the World Organization for Animal Health, has now proposed a resolution, better still has approved it, which provides that those labs which deal with these diseases are to deposit the sequences in a public access database, for all the researchers in the world must be able to study those viruses, not just an handful of rich and famous ones. The WHO, initially, didn't take this event well, also because it hadn't made a good impression, but now says: "We recognize the importance of the transparency of the data and we recognize the importance of sharing information in improving public health". and the FAO as well, which is the United Nations organization for agricolture, for the food sector is sustaining and bringing forward the concept of the need to share information But why is that so important? It's not just about the flu, the matter is that we don't know what may happen tomorrow, so the flu model could be used to create a network of laboratories sharing information and helping us in fighting these infection. And let me tell you: I am slightly displeased by the fact that that was done by the government of Netherland, the Italian one could have done that. Well, it doesn't really matter. Yet following to my having taken a position, the government of Netherland asked WHO to take a position and said: "With regard to the genetic data of the microbes that cause significant problems and endanger public health, what does WHO want to do? Is WHO finally affirming that there ought to be more transparency, does WHO want to create collaboration networks?" So we have made a significant step ahead as the issue has been arisen and it will be faced, it will coped within the time it takes to be coped with yet we have made a significant step. So this is my messagge: the challenge that the globalization era is posing to us is that of using the information we have there's no longer enough time for placing viruses and sequences in a drawer so as to say " I will be the only one studying it, so I'll have my publication, too bad if some people will die. The important thing is I'll have my work published." And with that I am concluding and I would like you to remember these concept, at least until the next speaker starts as eventually we make the difference and we too, as citizen, can bring forward a different vision of public healthcare. Thank you.

Video Details

Duration: 19 minutes and 2 seconds
Country: Italy
Language: Italian
Producer: TEDx
Director: Gerolamo Saibene
Views: 58
Posted by: tradottiinitaliano on Dec 19, 2010

Dirige il Centro di Referenza Nazionale, FAO e OIE per l'influenza aviaria e la malattia di Newcastle presso l'Istituto Zooprofilattico Sperimentale delle Venezie dove coordina progetti di ricerca a livello nazionale ed internazionale e promuove la libera e veloce condivisione on-line dei dati scientifici. La rivista "Science" le ha dedicato un profilo, definendola una ricercatrice di carattere che unisce alla competenza scientifica una grande determinazione. Tra i numerosi riconoscimenti vi è il premio Scientific American 50, assegnato ai 50 migliori ricercatori al mondo (2007) e l'inclusione fra le cinque "Revolutionary Mind" della rivista americana SEED (2008).

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