Purity, impurity, infectious diseases

The cover story of the December issue of the International Journal of Environmental Research and Public Health is devoted to a girl, Jennifer Worrall, and Jasmin, her beloved rat.  “In 2012 in the United Kingdom, a number of people caught Seoul hantavirus from their pet rats –  explains the editor - Pet rat owners were warned about the potential risk their pets posed; however, they did not want to change the way they interacted with them. To understand why, we interviewed pet rat owners to explore how they made sense of the disease and the risk it posed.”

The paper - authored by a multidisciplinary team, including veterinary and public health doctors, and psychologists, at Liverpool University – reports a study based on seven in-depth interviews with pet rat owners and breeders in England. The goal was “to elicit an understanding of disease and risk in human populations in contact with pet and wild rats.”   Researchers identified four themes “relevant to the design of public health messages.” They called the first theme “A Tale of Two Rats,” according to this theme pet and wild rats are no longer perceived as the same species by rat owners. Of course, rat owners do not context biological classifications, and they are rationally aware that pet and wild rats are the same animal, yet, emotionally and practically speaking, they consider pet rats as though they were an autonomous species.  The second theme is the “hierarchy of purity”. Researcher discovered that pet rat owners create their own hierarchy of purity among rats, being wild rats at one extreme (impurity) and their own pet at the other extreme (purity), in between all other rats, ranging from rescued rats (e.g., saved from labs) to pet shop rats. The most a rat is perceived “pure,” the less the animal is object of hygienic and preventative measure, irrespective of any public health authority recommendation. The third theme is “bounded purity.” Purity and impurity appear to be strictly bounded to home borders. Events affecting pet rats, originated in, and happening inside of, the home do not threaten their purity, while purity is threatened by any event occurring outside of the home, and affecting pets. Impurity is associated to out-of-place situations.  The fourth theme is “The Divergent Worlds of Pet Rat Owners and Health Officials.” It concerns the two different models of diseases shared respectively by pet rat owners and health officials. While the latter see the world through the lens of the standard medico-scientific model of infectious disease, the former perceive their own world as a separate space, where standard rules do not apply.  Each pet rat owner believes his own case to be an exception, that cannot be captured by the standard medical model. 

Why – researchers ask themselves and the reader – were these four themes so successful in preventing an effective response to the actual threat to human health posed by Seoul virus? Because – they answer – the biomedical model of disease was problematic for this virus, which can infect rats and human without causing any symptom of infection and disease, e.g. according to Public Health England “one third of pet rat owners tested were seropositive to the virus; however, not these individuals actually experienced the disease by becoming ill.”   Authors conclude “Seoul virus (…) is ambiguous, composite, in-between (…) it is an anomaly. Rather than responding negatively to this anomaly, by ignoring the risk it poses, owners have responded more positively by creating a new reality in which Seoul virus has a place: a ‘hierarchy of purity’”. There are several reasons of interest in this paper. Two of them are worth mentioning, they both regard “purity.”  

The first reason of interest concerns the lesson for public health communication. The couple purity /impurity is in the limelight of contemporary scholarly studies on public perception  of infectious diseases and the origin of  vaccination hesitancy.  Scholarly speaking, considerations on purity and impurity should play a pivotal role in health communication. Unfortunately, professional communicators often lack the necessary scholarship, historical depth, and perspective. So, they fail to grasp crucial cultural nuances. The very notion of contagion – that today we take for granted belonging to the medico-scientific register –  originates from the couple purity /impurity and it is as ancient as human civilization itself. Assuming that less than two centuries of germ theory have modified the collective mindset, is naïve and misleading. Conceptions about purity and impurity return repeatedly, only a bit masked by pseudoscientific languages, and they still rule public perception of communicable diseases.   

The second reason of interest concerns a common misunderstanding. Most scholars, who have recently discussed the issue purity/impurity in relation to infectious diseases and vaccination, have labelled it as a “moral” issue. This is a methodological mistake, which prevents understanding many nuances of the couple purity/impurity, which originates from deep, collective, fantasies, much wider than ethics.  Actually the opposition between purity and impurity provides a valuable interpretative framework for a range of social phenomena, including  attitudes towards GMO foods, xenophobia, and policy preferences.  The Liverpool team deserves the full credit for avoiding such a mistake as well as the easy solution to turn “everything into ethics.”  

When research is aware of complexity and properly done, one could learn a lot even from a young lady and her pet rat, which is, maybe, the most important lesson taught by this paper.

Avian Flu Diary: Smithsonian `Next Pandemic' Webinar Now Available Online

Avian Flu Diary: Smithsonian `Next Pandemic' Webinar Now Available Online

The Dengvaxia affair

In 2016 the Philippines started a vaccination campaign against Dengue, a mosquito-borne tropical disease, infecting worldwide hundreds of millions people,  whose seriousness is however usually limited, “Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death”. The Philippines’ immunization programme was based on Dengvaxia, a vaccine produced by Sanofi Pasteur, which was known to provide an effective prevention in subjects who had prior infection. Since early 2016, however, Scott Halstead, the leading scientist in dengue research, had denounced that Dengvaxia could cause a phenomenon that he first described in 1977  calling it ADE, or antibody-dependent enhancement.  ADE, which implies that antibodies increase viral infectivity and consequently severity of an infection, is not rare in lab cell cultures, but it has been rarely demonstrated in vivo, although it has been suspected in some cases. In March 2016, Halstead and Russel published a short paper whose conclusion read “hospitalized cases among vaccinated seropositives (…) were greatly reduced by vaccination. But, seronegative individuals of all ages after being vaccinated were (…) at increased risk of developing hospitalized disease during a subsequent wild type DENV infection”.  Sanofi Pasteur contested this  conclusion, arguing that  it was not enough supported by data.  Halstead went on warning Sanofi and  the WHO to be cautious before launching any mass vaccination campaign. " We have a vaccine that enhances dengue"  he declared  in a 2016 interview “It's clear as the nose on my face: Vaccine recipients less than 5 years old had five to seven times more rates of hospitalizations for severe dengue virus than placebo controls”. In response, the World Health Organization convened a Strategic Advisory Group of Experts (SAGE) who reviewed the evidence. SAGE’s conclusions, published on July 2016, recommended that “countries should consider introduction of the dengue vaccine CYD-TDV only in geographic settings (national or subnational) where epidemiological data indicate a high burden of disease (…) seroprevalence, should be approximately 70% or greater in the age group targeted for vaccination in order to maximize public health impact and cost-effectiveness. Vaccination of populations with seroprevalence between 50% and 70% is acceptable (…) the vaccine is not recommended when seroprevalence is below 50%”.  These conclusions were puzzling  because they were based on the concept that an immunization campaign – addressing  a serious disease, however, rarely deadly – could be legitimate even if  public health authorities suspect that a percentage of vaccinated subjects not only will not benefit from vaccination, but they will be exposed to increased risks.  WHO position paper gave in fact the green light for the Philippines vaccination campaign. Now - on November 29, 2017 - Sanofi Pasteur released a new statement, admitting that-  after analysing data from a six-year study -  Halstead was not probably so wrong because  “the analysis found that in the longer term, more cases of severe disease could occur following vaccination”.  This is particularly worrisome in the case of children vaccination, given that a child is less likely to have had a previous dengue infection. A few days after Sanofi’s release, the Philippines department of health took the decision – soon corroborated by of the World Health Organization  - to suspend the Dengue vaccination programme. Probably a bit too late, however, given that some 830,000 children in the Philippines, and around 300,000 in Brazil, where an analogous programme was running, were already vaccinated. We don’t know how many of them were seronegative, and consequently it is  impossible to predict the impact that Dengvaxia could have on them.

From a risk communication perspective this story incites to make two points and a final reflection.

The first point concerns the “storyline”. Once again, the public is faced with a plot made of a honest scientist, whose alerts are overlooked by public authorities and institutions, and a villain played by pharma industry. Can it be possible that we are still repeating this plot for the umpteenth time? Why people don’t learn the lesson? How could one hope that public authorities, health institutions, the WHO, pharma industry, are trusted if they are so stupid to start an immunization campaign -  addressing a non-mortal disease (at least in most cases), and involving children - when there are concrete risks to be obliged to discontinue it very soon? Both Sanofi Pasteur and the WHO were indeed aware since July 2016 that Halstead was likely to be right, otherwise WHO Position Paper of July 2016 would not make any sense. Could they realistically imagine that political authorities could put up with an immunisation campaign threatening to increase risks in a category – be it large or small – to which each citizen could fear to belong, if she does not take a blood test?

The second point concerns “money”. It has been told again and again that pharma companies do not make money with vaccines,  this is one of the tritest arguments used to challenge conspiracy theory on vaccination. It is probably time to say that this argument is misleading. The global economy is hardly the traditional market economy, and money is not made – if not marginally – by selling items. In a financialized economy, one should  look at the financial market to understand what is going on. In the last five two years, Sanofi share increased its value from a lower bound at 67 Euro in 2016, to around 83 Euro in May 2017. After the Dengvaxia affair, Sanofi share is losing about 0,8 %.  Repeating the tale that industry does not gain money with vaccines is offensive to people’s intelligence, and once again it is a stupid move in communication terms.

The final reflection concerns anti-vaccination movements. In principle, the Dengvaxia affair could have been written by them, it seems the almost perfect case to be used to attack vaccines and vaccination, yet anti-vaccination activists are surprisingly absent, at least till today. Google trends shows that impressions concerning this affair are largely concentrated in the Philippines, and, much less, in a few other Asian countries and in Brazil. Industrialized countries, where anti vaccination movements are mostly active, don’t show to be interested in Dengvaxia. The U.S. as well as E.U. countries show a rate of impressions lower than 1% than the Philippines. Even France appears to be not interested, notwithstanding Sanofi is French and France is the country hosting the world largest group of people hesitant to vaccination. This is confirmed by  social conversation. The Dengvaxia affair is having a very low social penetration, geographically concentrated in the Philippines and a few other countries. Maybe this scenario will change in the next weeks, hopefully not, but for now it is difficult to escape the sensation that anti vaccination activists are hardly interested in people's health. This seems to confirm once again that anti vaccination is a symbolic war, which mostly concerns  fantasies on purity and impurity, collective dreams and, unfortunately, also nightmares, but has little to do with facts.

CULTURE AND MICROBIOLOGICAL CULTURES

Let me welcome the November issue of Microbiology Today, the quarterly magazine of the Microbiology Society, which is devoted to ‘Microbiology in Popular Culture’.

The magazine hosts five pleasant articles and a commentary from the editorial team.  Articles range from the interesting and helpful Genome editing and the cultural imagination, which discusses the importance of the choice of words in science popularization reporting the main findings of a recent project carried out by Genetic Alliance UK and the Progress Educational Trust (Basic Understanding of Genome Editing), to Killer microbes in movies, a piece that – as promised by the title - deals with killer microbe doomsday scenarios in movies. Even lighter articles as this one, offer interesting points, which would deserve to be further elaborated. For instance, Andrew M. Burns and David Bhella ask themselves and to the reader why viruses are preferred to bacteria to play the villain role in “films based on mass deaths from infectious disease”. Their answer is thought provoking, because – they argue – virus are simpler. E.A.Poe, who created one of his most fascinating short stories, The Purloined Letter, around the idea of simplicity, and always praised simplicity, would have not provided a different answer; to human nothing is as beautiful and disturbing as simplicity. Other articles deal with forensic microbiology in popular culture, Managing the myths – the CSI effect in forensic science, with fungal diseases and video games, Not such a fungi – fungal disease and the end of the world as we know it?, with spatial exploration and germs, Terra Firma II: terraforming Earth’s sequel. Overall, the magazine is quite enjoyable and educational, notably for those who are involved in microbiology and communication. “Popular culture – notes Amy Chambers in her final comment - can subtly and powerfully communicate ideas and stories about science in ways that other methods cannot. A science-based movie is more likely to inspire rather than (re)educate someone about science”.

Microbiology Today should be read in parallel with another pleasant piece, published on Nov 30 by Forbes and authored by Kavin Senapathy. The article is devoted to “The 5 Most Laughable Non-GMO Project Verified Products”. Kavin entertainingly describes some of the oddest products advertised as GMO free in the U.S. market. They include a brand of cat litter, a marque of “organic” vodka, various homeopathic medications and even HimalaSalt – “the purest salt on earth created 250 million years ago during a time of pristine environmental integrity”. If it is difficult to imagine how salt could be ever genetically modified, and it is also comical to see that homeopathic products, whose ingredients are undetectable, can be promoted as GMO free, yet the funniest case is definitely the cat litter producer, which proudly declares in its website “our litter is made out of 100% U.S. sourced grass, certified biodegradable, no chemicals, fragrances, perfumes or clay, non GMO project verified”. 

Why is it instructive reading this article in parallel with the issue of Microbiology Today? Because comparing the two, it becomes at once clear how science education and communication are hardly a matter of “passing down” information, and they are instead a complex and nuanced exercise of human communication, in which emotions, imagination, desires and fears, are often more important than evidence and data. Dr House, who politely explains to a mother why she should vaccinate her child, is worth hundreds scientific conferences, not to mention many public health campaigns.

In his introduction to the Microbiology Today issue, Neil Gow, president of the Microbiology Society, jokes with the twofold sense of the word “culture”, human culture and microbiological culture(s). He is righter than he probably imagines. “Culture” comes from Latin “cultura, which originally meant agriculture and then, metaphorically, also education, care, and so. Fascinatingly enough, the Latin word cultura was the future participle of the verb còlere, to farm, to cultivate. Culture is thus our future,  it is -so to speak – the fruit of our land, and “by their fruit you will recognize them”(Matthew 7:16)

(from http://riskcommunication.rtexpert.com/#/)

DELIBERATING WITHOUT KNOWING

Two interesting news are worth mentioning this week.  The first one concerns the press conference held by Vytenis Andriukaitis, EU Commissioner in charge of Health and Food Safety, on the State of Health in the EU. The second one concerns the publication of a report on risk perception of genome editing among German consumers, conducted by the German Federal Institute for Risk Assessment (Bundesinstitut für Risikobewertung).  Although their plain diversity, there is a common lesson to be learned from this two news.

In his press conference, Mr Andriukaitis  was expected to present the yearly report on the State of Health the EU.  Although a chapter of the report was devoted to vaccines and vaccination, this topic was only one among others and probably not the most momentous. Yet, in the course of the press conference, vaccines, vaccination, and objections to vaccination fuelled most questions. Answering one of them, Mr Andriukaitis   stated  “I would like to draw attention to the fact that all these movements, which use different arguments, do not understand what they are doing. It would be a shame if the families belonging to this movement were to bury their children, as happened this year in the Member States where children have died of measles. I would like to invite those who are against the vaccines to visit families, to visit the tombs of the children of those families, and to think what they are doing. I would like to invite all these anti-aging movements to visit the European cemeteries of the nineteenth century, of the eighteenth century, beginning of the twentieth century: they will find many tombs of small children, because there were no vaccines”. Mr Andriukaitis’ answer was not only laudable for strength and determination, but it was almost perfect in communication terms, although commentators and scientists would have probably preferred more sober and reasoned arguments.  On the one hand, Mr Andriukaitis described vaccination as a fundamental right of the child -which is a vital move in this debate -and on the other hand, he did not rely on rational arguments, rather he evoked a powerful narrativethrough the symbol of “European cemeteries” (the same potent image used by pope John Paul II during his 1979 visit to Auschwitz).

On Nov 24 - the day after Vytenis Andriukaitis’ press conference -  the German Federal Institute for Risk Assessment (BfR) presented the results of a new study on risk perception of genome editing. The study was conducted in Germany on a sample made of 39 focus group interviews. Research was quite limited both in number of participants and in geographical scope, yet its great interest relied in being one if the first studies on public perception of CRISPR/Cas9 methodology. Results were summarised by BfR President Professor Dr Andreas Hensel, who said “Although the respondents were hardly aware of genome editing and knew little about these technologies, the majority of them reject the use of these methods in the food sector". In early 2017, the High Level Group of Scientific Advisors of the Scientific Advice Mechanism of the European Commission, suggested to consider CRISPR technologies as “new breeding techniques (NBT)”, keeping them distinct, also in regulatory terms, from established techniques of genetic modification (ETGM). Now, the BfR study warns against this attempt to “downgrade” CRISPR technologies and to subtract them from regulations ruling GMO products. Wisely enough, the BfR study takes seriously people’s concerns, and suggests policy makers to do the same, avoiding any attempt to circumvent existing regulations on GMO products, using people ignorance as an alibi.  

These two stories show – although from different perspectives – that education and public awareness, while still important, are not as relevant as they were in the past. People are not simply “uninformed” or “uneducated”, rather they do not think it is any more necessary to know to deliberate.  Most people think to be legitimate to have an opinion on problems that they deliberately ignore. Knowledge of facts is no longer supposed to be relevant in public decision making, this is the dramatic paradigm shift of our epoch, like it or not.

Blockchain technology for preventing foodborne diseases

So much has happened in the field of emerging epidemics and infectious diseases over these three months, including a resurgence of concern about the health and societal impact of tuberculosis  and  pneumonic plague in Africa.  Focusing, however, on recent times, the past week was marked by interest in blockchain technology for preventing foodborne diseases. A blockchain is a distributed database that maintains a growing list of records reinforced against tampering and revision. It consists in a chain of data blocks, which can be used to prove ownership of a record at a certain time, by including a one-way hash of any transaction affecting the chain. In 2008, Satoshi Nakamoto – the legendary designer of the Bitcoin algorithm -  described blockchain as “a system for electronic transactions without relying on trust”.  Indeed, blockchain is growing in popularity also thanks to the cultural climate of distrust towards institutions, authorities, and experts.

On Nov 6, the Walmart Food Safety Collaboration Center (WFSCC) awarded the project “OriginTrail” with the Walmart 2017 Food Safety Innovation Award. OriginTrail is a project initiated by a Slovenian-Serbian team in 2014, with the twofold goal of preventing foodborne diseases and food counterfeiting. After three pilots in Europe, in 2016 the project has started a vast trial in China, involving 1,200 farms. According to Walmart’s vice-president, Frank Yiannas, “by tracking how and where the food we sell is produced, blockchain provides new levels of transparency and accountability – responsible systems result in safer food”.  Always in China, Walmart and IBM are also developing “blockchain-powered traceability solutions which will enable customers to scan quick-response codes on food products with their smart phones, and determine the origins of the products”. Furthermore, in August 2017,IBM has announced a blockchain collaboration with Dole, Driscoll’s, Golden State Foods, Kroger, McCormick and Company, McLane Company, Nestlé, Tyson Foods, Unilever, with the aim to increase food security.   Finally, OwlTing, a Taiwanese e-commerce platform, has just launched its own blockchain app for tracing food. OwlTing’s promises to provide customers with relevant information about the authenticity, quality, and safety of food products, including information of vaccines and medications received by animals.  

Blockchain technology could undoubtedly  enhance product traceability,  because “anyone with access to the blockchain could see exactly what hands the product has been through”.  Yet, here is where the problem is. Blockchain technology used by cryptocurrencies such as Bitcoin is an open system, it works through and thanks its participants, being a class of them responsible for securing the entries and providing a mechanism for self-rewarding. Active participation is thus incentivized. This system could hardly work with food supply blockchains, not the least because access to supply chains cannot be free and it would be difficult to enforce a direct global rewarding mechanism. As a consequence, food supply blockchains can work only if they are backed by an owner or a group of owners. They are “permissioned”, which means that they are closed and controlled; they are restricted to authorized actors, which are the sole allowed to participate in growing the chain as well as approving the records.

The most relevant aspect of permissioned blockchainsis that they are trustworthy only as long as their owners are trustworthy. In other words, food supply blockchains, far from creating trustless systems, are relocating trust from health authorities to blockchain owners. The final result will be that consumers - who hardly trust now authorities, health institutions, and experts - are going soon to be asked to trust Walmart, IBM, and Nestlé. There is some lesson in this.

MOVIES, YOGURT, AND VACCINE MISINFORMATION

During the past couple of weeks, the attention of the media was chiefly captured by the endless quarrel on compulsory vaccination.  The WHO Regional Office for Europe released data about death for measles in Europe in 2016, which amounts to 35 fatalities,  an outrageous number, considering the vaccine-preventable nature of measles. New legislations enforcing mandatory vaccinations are  in progress in Italy and in France, raising, however, fierce objections not only among anti vax people but also among people merely unhappy with the intrusion of the state into what they consider their private life. Such a point of view seems to be supported by a report issued in early July by the British Medical Association, strongly discouraging compulsory vaccination because it would disrupt the doctor-patient relationship.  In the while, anti vax activists continued their  never-ending polemics  against Big Pharma. Nothing new under the sun; each actor persisted in playing its role in the wider “vaccination comedy”. Yet, playing again and again the same character on the stage is risky. Repetition blinds, prevents seeing novelties. This is well illustrated by three parallel stories, which received far less attention from the media.

The first story is reported by Harriet Hall, “a retired family physician who writes about pseudoscience and questionable medical practices”. Harriet devotes her 11 July comment to What the Health, a successful documentary,  released on March 16, 2017. The documentary claims to provide the evidence that meat and dairy food are responsible for most “modern” deadly diseases, and that all health agencies and scientists know this truth, but they conceal it because they are on the Big Food and Big Pharma’s payroll. The audience of the documentary had a sudden and unexpected spike last June, after it was added to Netflix, as showed by Google trends. After carefully reviewing the movie, Harriet Hall concludes “The “What the Health” movie is not a balanced documentary, but an alarmist, biased polemic. It cherry-picks scientific studies, exaggerates, makes claims that are untrue, relies on testimonials and interviews with questionable “experts,” and fails to put the evidence into perspective. It presents no evidence to support the claim that a vegan diet can prevent and cure all the major diseases. It is simply not a reliable source of health information”. Notwithstanding Harriet’s efforts, it is easy to predict that many people all around the world will continue watching this movie, finding in it the evidence that eating meat and dairy causes cancer and chronic diseases.

The second story is reported by Jonathan A. Eisen, professor at the Genome Center of UC Davis, California. Jonathan wrote a nice post instigated by the echo raised by a paper published  on June 28 on Psychosomatic Medicine, a leading, peer-reviewed,  journal, which has been the official journal of the American Psychosomatic Society​ since 1939. The paper, a bit pompously entitled “Brain structure and response to emotional stimuli as related to gut microbial profiles in healthy women”, claims to demonstrate that there is a causal association between gut bacteria and emotion, which is a misleading statement, because – argues Jonathan – the paper only shows a statistical correlation between some gut microbiome patterns and some behavioral traits.  Not only “behavioral traits” are not emotions (in case, they are just indirect signs of emotions), but turning a correlation into a causal relationship is a fallacy known since Aristotle's time. Eisen comments,  “it could be that people with different thought patterns eat differently.  Or people with different thought patterns exercise differently.  Or just about anything.” Yet, the findings of this paper have been overemphasized by media, e.g., the Huffington Post had the headline “Your Gut Bacteria Really Do Affect Your Emotions”; Science Alert, “Human Emotions Really Are Affected by Gut Bacteria, New Study Suggests”; the Daily Mail, “Gut feelings are real: Some people have stomach bacteria that makes them more anxious and stressed, study shows”; Forbes, “The Fascinating Connections Between Gut Bacteria, Weight and Mood”. The study was promoted by UCLA, the  University of California, Los Angeles, whose annual economic impact totals the equivalent of one percent of the entire California economy. Purposely, Dr. Eisen investigated about recent UCLA press releases, and he discovered that, on June 29, the University Press Office released a statement, claiming that a UCLA team has  “identified gut microbiota that interact with brain regions associated with mood and behavior”. Jonathan concludes that the source of misinformation was that press release. Well done, but he mercifully omits to add that the first author, Dr. Kirsten Tillisch, received funding from Danone Research, the research branch of the famous world food company; also his main co-author, Dr. Emeran Mayer, was on the advisory boards for yogurt product company Dannon and its parent company Danone. Moreover, 3 other persons of the team were employed by Danone Research; while another researcher was employed by Symrise Group, a German multinational  providing “fragrances, flavors, active ingredients (…) for the (…) food, beverage and pet food and baby food industries”. Since 2014, Symrise AG has made massive investments on the probiotic market acquiring two leading companies, the French Dianafood and the Swedish Probi. Finally, the whole study was partly supported by grants from Danone Research. It is difficult to avoid the unpleasant impression that movies such as “What the Health” are not totally groundless. To be sure, they are misleading people about their health, which is a lot worse than covertly advertising probiotic products, which is not that horrible crime. The UCLA team just marketed  its findings and, incidentally, also yogurt consumption. Yet, there are reasons not to be happy with such a way to inform the public, notably in a moment in which we need to strengthen public trust in science.

The third story has received for now less press coverage, although it is by far the most important.  In early July, a group of Canadian virologists from the University of Alberta announced to have recreated an extinct horsepox virus using synthetic DNA strands. Horsepox viruses are not dangerous for humans, but the research demonstrates that in principle all types of pox viruses could be generated in the same way, including the lethal smallpox. The novelty is not in the technical procedure, because since 2002, we know that it is possible to assemble pox viruses  from scratch, rather it is in the demonstration that this could be done by a “small scientific team with little specialized knowledge half a year and cost about $100,000”, purchasing DNA available on the market,  and without asking for (or by-passing) any authorization or security clearance. This dreadful news passed nearly unnoticed, without anyone - either scientists, regulatory authorities, public health agencies, scientific journals, general press, or social media – realizing the enormity of the event. With the laudable exception of HuffPost UK,  and a couple of online scientific magazines, this news was completely ignored. Yet, this is still half story, the second half is that this news was not at all new. Actually, Canadian virologists had already presented their findings in November 2016, at the WHO Advisory Committee on Variola Virus Research meeting in Geneva, and a report from that meeting has been available on WHO's website since May 2017. When researchers tried to draw  WHO's attention on their experiment, “the first response was, ‘Well let's have another committee to review it,’ and then there was another committee, and then there was another committee that reviewed that committee” tells David Evans, the Canadian team leader, who eventually comments "It became a little bit ludicrous”. Almost in the same period, (on March 2, 2017), Tonix, a pharma company which collaborated with the University of Alberta in this study, announced the “successful synthesis of a potential smallpox-preventing vaccine. This vaccine candidate, TNX-801, is a live form of horsepox virus (HPXV)”. Reading their press release, it was evident that the horsepox virus was recreated from scratch in a quite trivial way. Yet, the story still got unnoticed.  Evans also sent the draft paper describing the study to the Canadian Public Health Agency, as well as to the Food Inspection Agency, only getting the staggering, candid, answer that “these things potentially fall under export legislation”.  The whole chronicle was finally reported by the July 6 issue of Science, which was  the sole media, and prominent scientific journal, which gave to this story the relevance that it deserves. Thus a happy end? Almost. Actually, as Caroline Ash, an editor at Science, honestly admits, the paper of the Canadian team was initially submitted also to Science, which rejected it, because it did not offer “a sufficient gain of novel biological knowledge to offset the significant administrative burden the manuscript represents in terms of dual-use research of concern”, an answer which is a terrific example of bureaucratic miscommunication.


These three parallel stories - the fortune of a pseudoscientific documentary; an oversold study, covertly promoting yogurt consumption; an unnoticed research, showing how it could be easy today to recreate a deadly virus -  illustrate quite well the subtleties of today science communication. It's just a shame that most media, including social media, didn't realise it, getting instead trapped into the bubble of the anti vax quarrel. 

FROM DANGER TO RISK

In a research letter published by Nature in the last week of June, Kevin J. Olival and his team at the EcoHealth Alliance, a New York based global environmental health nonprofit organization, have announced the results of their latest study on “Host and viral traits predict zoonotic spillover from mammals”. Researchers investigated whether it is possible to predict human pandemics of viral origin by focusing on “by phylogenetic relatedness to humans, host taxonomy and human population within a species range”. Their findings suggest that “both the total number of viruses that infect a given species and the proportion likely to be zoonotic are predictable”, consequently “providing a novel framework to assess if a newly discovered mammalian virus could infect people”. The study size was remarkable. Researchers investigated 54 mammalian species (in this preliminary study they focused only on mammalians), say 14% all mammalian species, and identified 586 different viruses. Among these viruses, 263 (44,8%) were shared by animals and humans, including 188 zoonotic viruses, which were transmitted from animals to humans in the past; 73 viruses, previously considered “specific” to humans, were instead found in animals, so providing the evidence of “inverted” zoonosis, say, transmissions from humans to animals.  Overall this study demonstrated the ongoing infective cycle between humans and animals, which strongly supports the notion of “one health”.

Surprisingly enough, the results of this study have been immediately reported and amplified by world leading media, including The Economist, Time, Wired, Science Magazine, International Business Times, Wall Street Journal, Spiegel, BBC News, CNN News. It is rare to see such an interest for a news which could seem, at a first glance, of interest only for biologists and epidemiologists.  Why so many media were “thrilled” by this study? The Economist provides a possible answer, “maps”. The research team was as smart as to distillate their results into very catching graphics, “heat maps showing places where the actual and predicted number of zoonotic viruses least resemble one another, and which therefore have the highest risk of springing a nasty surprise on the world”.  Brief, “having maps like these – continues The Economist - is important because they can help researchers choose the most fruitful places to conduct studies into zoonotic transmission and (…) increase the chance that the next SARS or AIDS might be spotted, almost before it has emerged”. This is then the first lesson to be learned, in the information society – like in the illiterate medieval Europe – images are much more effective than words if one aims to reach a wider audience. In the medieval Europe, where most people could not read, the Church, which included most educated people of that epoch, sponsored artists to educate the mass by images. We should then thank illiteracy for the windows of the Chartres Cathedral and Giotto’s paintings. Although one can hardly recognize today Giottos, effective tools for communicating scientific discoveries are welcome.

Yet, there is probably a deeper reason why this news has had such an impact on media, something novel happened recently, deeply changing the nature of epidemics and pandemics. Once, epidemics and pandemics were considered non-insurable risks. The Insuranceopedia  defines non-insurable risk “a risk an insurance company deems too hazardous or financially impractical to take”, which is a right definition but still insufficient. A more precise definition is provided by the Financial Time Lexicon, “A risk for which an insurance company will not provide cover because it cannot calculate the chance of it happening”. More precisely, a non-insurable risk is a risk whose odds of coming to be cannot be calculated, and therefore the insurance company cannot work out a premium that must be paid. Typical non-insurable risks are political, reputational, and regulatory risks, whose odds are unpredictable because they depend too much on human contingency and randomness; also “acts of God”, the legal formula used in the English–speaking countries to indicate natural disasters, are non-insurable. For insurance purposes, acts of God are events that cannot be foreseen, avoided, or anyway prevented.  Today, however, some acts of God are considered insurable (e.g., flood, earthquake, volcanic eruptions, and so) either because they turned out being the consequence of human intervention (e.g. environmental disasters) and consequently preventable, or because their chance of occurrence can be inferred from statistics of similar past events. Epidemics and pandemics have been always considered totally unpredictable and unpreventable, consequently uninsurable. Given that the definition of risk entails that 1) the odds of a negative event can be calculated; and 2) the negative event may be avoided through preemptive action, epidemics and pandemics should  be considered – rigorously speaking -  dangers, threats, but not risks. This holds true till to 2014.

In 2014, the Munich Reinsurance Company (Münchener Rück), a world’s leading reinsurance company, started a strategic partnership with Metabiota, a San Francisco-based global company that “has pioneered the use of near-real-time data collection and comprehensive risk analytics for epidemics”. In 2015, in the midst of MERS epidemics, Munich Re, on the basis of data provided by Metabiota, accepted to reinsure the Korean government, which wanted to offer a full insurance coverage to all international travelers and tourists. This decision contributed to prevent massive travel cancelations and consequent economic loss. In May 2016, the World Bank in collaboration with the World Health Organization initiated the Pandemic Emergency Financing Facility (PEF), a global insurance scheme for epidemics and pandemics risks, offered to 77 low income countries. The PEF covers most zoonotic viruses involved in potential pandemics, including new Orthomyxoviruses (new influenza pandemic virus A), Coronaviruses (SARS, MERS), Filoviruses (Ebola, Marburg) and other zoonotic diseases (Crimean Congo, Rift Valley and Lassa fever). PEF financing is triggered when the infection reaches a certain level of contagion, calculated on the basis of WHO data on the number of deaths, the speed of the disease spread and whether the disease crosses international borders. Munich Re, Swiss Re and GC Securities  accepted to reinsure the World Bank for this program, so making it feasible.  Finally, in 2017, Munich Re made pandemics  and foodborne infectious diseases  strategic priorities.

This is then the second lesson to be learned from the EcoHealth Alliance’s study. Advanced genomics, big data, and predictive analytics are not only changing our scientific and operational approaches to epidemics and pandemics, but they are also deeply changing the very notion of infectious outbreaks, which are now entering, in their own right, the world of predictable and preventable “risks”.  The impact of this event is much wider than one could guess, also implying important communication consequences.  

NATURAL OR SAFE?

In early June, Kavin Senapathy - author and public speaker on health, medicine, food, and parenting - has published a nice article devoted to a – minor, but, in its own way, epochal – event. Johnson's Baby, the brand of baby cosmetics and skin care products owned by the American multinational company Johnson & Johnson, has created  and distributed a commercial video, promoting its products by declaring “Natural may be the trend, but safe will always be our bar. Some natural ingredients that work for adults are too harsh for babies skin. We’ll never sacrifice safety to be all natural.” 

"Given the natural-is-best craze permeating the market for food, cleaning products, cosmetics, personal care and even cat litter,-asks herself Kavin -  why go against the all-natural grain?” The question is more than legitimate, considering Johnson & Johnson well-established marketing strategy.  Since 1897 - when the brand was created to commercialize a talc based baby powder, the Johnson's Baby Powder - Johnson & Johnson has had its own marketing strategy based on communicating an image of healthy and soft products.  As early as 1913, the company invented the catchphrase "Best for the Baby – Best for You", contributing to instill into the public the idea that baby products are safer, smarter and smoother than corresponding products for adults. In 1953, Johnson & Johnson launched the “No More Tears baby shampoo”, which was a true revolution not only in soaps (being based on a new class of cleansing agents, never used in the past), but it was also a real breakthrough in promotional campaigns. Since then, Johnson & Johnson – notably its subsidiary Johnson's Baby – has betted on consumer awareness and natural products that do not have any chemicals inside. Johnson & Johnson is member of the American Green Power Partnership; its promotional campaigns usually aim to inspire healthy living styles (e.g., “Having a Baby Changes Things” and “The Campaign for Nursing’s Future”); and natural products and environmental friendly packaging have become two pillars of corporate policies. This is why the slogan “At Johnson’s, being natural is never more important than being safe” is not only a “refreshing change from the all-natural marketing norm” – as Kavin comments – but it bodes well that it could herald a real revolution.

The idea that everything natural is better, safer, healthier and more environmentally friendly, is a popular misconception, which does not need even to be disproved. It is apparent that natural substances might be – and often are – as harmful, unhealthy and dangerous for the environment, as synthetic substances. Yet, “due to the widespread assumption that artificial ingredients are somehow more harsh or harmful than natural ones, companies have been reformulating products to eliminate synthetics while others build niche brands based on the fallacy”. In the last decades, such a fallacy has largely informed anti GMO and anti-Vax movements, and has contributed to feed the current, global, wave of “anti-scientism” and mistrust towards scientists, health institutions, and drug companies.  The suspicion of synthetic substances is producing paradoxical consequences, for instance these people mistrust vaccines - which are one of the most “natural” medical interventions -  and ignore the danger entailed by infectious diseases, one of the chief “natural killers” in human communities.  Yet, it is not easy to oppose the zeitgeist, as it is illustrated by another, apparently minor, event happened.

Since the mid-1970s, a chemical weed killer, marketed by Monsanto as RoundUp, has become the world most widely used pesticide, being an effective and apparently safer alternative to traditional weed killers. In 2015, the WHO Agency for Research on Cancer (IARC) declared RoundUp a probable carcinogen (category 2A), causing inter alia the postponing of relicensing in the EU and a harsh public campaign against Monsanto led by Greenpeace. On June 14, 2017, Reuters investigation revealed that Aaron Blair, the scientist who led the IARC’s review panel, “had access to data from a large study that strongly suggested that Roundup did not cause cancer after all—but he withheld that data from the RoundUp review panel”. When this odd story emerged, both Blair and the IARC justified themselves by claiming that data (whose existence they admitted being fully aware) was published only after the IARC report and the agency has a policy against using unpublished data. No matter here whether such a self-defense is tenable (in this writer's opinion,  it is not), and whether they were instead driven by untold conflicts of interest, I mentioned this story only to illustrate the power of the stereotype dictating that Monsanto, as well as other chemical giants, are by default producing dangerous and unhealthy items, even that they are “criminal” companies. Admittedly, may be just this once,  Monsanto was not at all the villain of the story, rather the victim.