COMMUNICATION, INFORMATION, THREATS, AND COOPERATIVE RESPONSES
Professor Peter C Doherty *
A Perspective in Overview
Over the past 6 years or so, we have been dividing our home base between Melbourne, Australia and Memphis, Tennessee. The result of living on both sides of the Pacific is that I speak at a lot of very different venues in Australia, Asia, the USA and Europe.
Those are communities that range from those that contrast great wealth and substantial poverty, to emerging countries, with massive populations and ones that interface very traditional cultures with an upward mobility towards higher education and technological development, to nations like Australia that have, at least until recently, embraced an egalitarian ideal.
Recent formats have ranged from “in group” science seminars at ski resorts, to speaking at high schools and universities where most students do not have English as a first language, to general discussions of science and society at large public events. In addition to than, as a budding author, I have recently has published a book that aims to talk to a non-scientist audience about the nature of the scientific enterprise, its history, rules, ethics, triumphs and also its limitations. “The Beginner’s Guide to Winning the Nobel Prize”1 has so far appeared only in Australia, though it will be published in the northern hemisphere in 2006.
The "book tour" that accompanied the Australian release of my work was at times encouraging but also at times a little depressing, as I had not, for example, ever really grappled with the deep triviality of that greatest of all non-information systems, morning television. On the other hand, using a bowl of fruit to demonstrate "T-cell" recognition on Andrew Denton's programme was, I thought, both fun and also potentially informative for those who were not offended by this profound disrespect for the rights of fruit and vegetables.
As a consequence of engaging in this way, I find myself conversing with a very broad range of people from all types of belief systems and backgrounds. The desire to communicate and to influence rather than (as can often be the case in a discussion between academics) win a point has certainly improved social skills. If, for instance, I could convince the young woman naturopath who called up on Dr Karl Kruszelnicki’s radio program that it simply is not enough just to feed her child the right food that “stimulates the immune system” but that she should also have the child vaccinated against common paediatric infections, this might just prevent a very real tragedy from occurring.
After more than 30 years as a professional immunologist I have, apart from eating a balanced diet and not being vitamin deficient, absolutely no idea what “the right foods to stimulate the immune system” are, and suspect that what is known is less valuable and carefully researched than the main product of the non-biting end of a horse. Convincing people that vaccination is important is not an issue in the developing countries, where parents can still see - and still do see - their children die from completely preventable diseases.
Public discussion can often take on a political aspect. Some at the extremes have a very clear idea of who the "good guys" and who the "bad guys" are, though the groupings obviously differ for those on the far political right who talk about spreading democracy throughout the world, while at the same time favouring mechanisms that limit the protection of personal freedoms offered by democracy at home, to those on the left who argue that the era of capitalism is already over but we are all trapped in some vast, media-fuelled conspiracy as society dies around us. As human beings, of course, we all live in some sort of mental world that oscillates between fantasy and reality, and is often tweaked to justify our own obsessionsand/or self-serving greed.
We are both rational in that big cerebral cortex that allows us to dominate the natural world, and irrational in our lower, “reptile” brains that consume everything in reach and play out the “flight or fight” mechanisms that we share with many life forms.
During the past four of the past six years - beginning for many of us with September 11, 2001 - most of us have become acutely aware that we are experiencing one of the more “interesting” times in human history, with the emphasis on “interesting” being that in the old Chinese curse, “may you live in interesting times”. This has caused a lot of re-thinking on my part. We could, for example, have decided that it is time to decrease our dependency on the bizarre politics of the middle-east, get off the oil kick and start to act responsibly when it comes to the use of nonrenewable resources, but we did not.
Now we are in an even worse mess than we were before in that part of the world. Many of the assumptions that I had about the way that society and the political process works have turned out to be wrong, particularly when it comes to the United States. In part, this reflects that I was not a close enough student of the history of the Republic. The Woodrow Wilson era during the World War 1 was, for instance, much more aggressive in limiting dissension and citizen’s rights than anything we see today.
My perception of Australian politics, on the other hand, is that 9-11 and Bali have not changed the country that much, partly because, so long as government does not mount an aggressive attack on social services and the availability of health care, we tend to be comfortable with a moderately authoritarian form of government.
Though I might not have made the argument six years ago, I think that Australians benefit from being political pragmatists and not allowing their voting patterns to be skewed against their own self-interest by the great, contemporary “red herring debates”, like “gay marriage” and the “rights” of early embryos versus the needs and values of the women that carry them. While “ordinary” people are absorbed in these issues, the transfer of public funds to the obscenely wealthy continues at an accelerating pace. Perhaps it is a pity that we did not heed that great Republican, President Dwight D. Eisenhower, when he warned us against the military industrial complex.
What worries me most about both the USA and Australia is, though, my perception that the level of information encountered by those who aren’t accustomed to making much effort to find out is being progressively degraded. The excellent BBC World Service is available most places. In the USA, C-Span, the Public Broadcasting Service (PBS) and National Public Radio (NPR) are both balanced and informative, though PBS and NPR are treading very carefully to avoid the ire of those in the US political system who find the even-handed (or even any) reporting of serious issues to be deeply offensive. The ABC has a little of the same problem in Australia and, while trying to maintain standards, is showing very definite signs of a progressive "dumbing-down" of content. The World News on SBS is consistently informative and useful. The problem is that, though all these “quality” venues are readily accessible, they attract fairly small audiences. What is going on in the minds of our fellow citizens and voters?
Even the Australian “quality” newspapers are carrying more and more content that looks as though it could be sourced directly from “People” magazine. The US, having a much bigger population, has the great asset of the “New York Times” which can, of course, be read on-line.
More and more public attention seems, however, to be focused on the thoughts and life styles of entertainers of various sorts, a practice that hardly leads to any depth of perception about anything worthwhile. Add to that the constant, trivial gossip of the mobile/cell phone culture that absorbs what might otherwise have been “thinking time”, and the outlook for living in a fundamentally sane society is not comforting. Over the past couple of years, it has become increasingly difficult to find a PBS station on the TV offerings available in the large US hotel chains. Tune in to local, commercial TV in mid-west and southern America and you will find stories of the latest murders, car accidents, tragic fires and so forth, but any reporting of matters of broader substance seems to resemble more the half-truths and distortions popularized by Joseph Goebbels than what we might expect from the home of Mark Twain and Saul Bellow.
The silent tribute to those who have fallen in Iraq by airing their names and photographs on the PBS News Hour anchored by Jim Lehrer was specifically rejected by many of the large media outlets, presumably because it provides a very stark reminder of the reality rather than the myth of what is actually happening in that sad and degraded country.
Of course, if you listen to some of the media barons, then you will get the message that, “we are just broadcasting what people want to hear’. It is undoubtedly the case that it is always possible to play to triviality and prejudice, but it’s also true that honest reporting can influence many to a more thoughtful better-informed, and saner view of the world. Do the media elites, with their vast wealth and power, ever ask the question whether they are acting to serve the best interests of participatory democracy and freedom? Both in national politics and in the world of information, we seem to be mired in the twin disasters of deliberate obfuscation and defective leadership.
Many look for the statement that what is happening in Iraq, and what occurred in New Orleans, requires a culture of shared sacrifice and a focus on the needs of all in society. As was the case in World War II when there was no lack of inspired leadership, the western democracies are clearly facing some very real threats. After 9-11 and Bali we can be in no doubt that there are those who will do everything possible to damage societies that operate to balance individual liberty with a sense of collective responsibility for general, human well-being.
At the forefront is a deep hatred (or is it fear?) of the idea of women’s equality and self-determination, the central element of many regressive cultural models that hide behind one or other of the great Abrahamic religions.
Clearly, reasonable restraints like the rigorous security procedures at airports are both necessary and accepted. Despite the concerns by civil liberties groups, there has been nothing that I have seen - so far, at least - that has even approached the state-centred political bullying that was a feature of the McCarthy era. Given the danger that some extremist group may set off a “dirty” nuclear bomb in a major city, Australia has, as an exporter of uranium, a clear responsibility to take back the resultant nuclear waste and sequester it in a way that it cannot be accessed by terrorists.
Those in my own research field of infection and immunity are acutely aware of the dangers of bio-terrorism, and are involved in the ongoing efforts to develop suitable counter-measures. Though biological weapons way not be particularly useful on the battlefield nobody can, after the still un-resolved anthrax attack that used the US Postal Service as a delivery system, doubt their effectiveness as agents of terror. As it is of considerable current interest, I should like to consider the threat to humanity that is posed by what are, perhaps, our oldest and most intimate enemies, the viruses that grow in our own body cells. We are not necessarily talking about a malevolent human agency, but the danger posed by nature itself.
Here, at least, those from all extremes of the political spectrum can, in the main, get together to protect society. In particular, we will talk briefly about three virus diseases,
• Influenza and SARS; and, • HIV/AIDS,
that are, or have been, very much in the public eye, although influenza and SARS will be discussed together, because of some of their similarities. It is not my intention to subject you to a detailed scientific discussion, but will emphasize instead the nature of these threats, and how positive and negative cultural values and political decisions impact on both society at large, and on the most vulnerable among us. They give cause for both hope and despair. I hope that you will find these stories to be both interesting and informative.
Influenza and SARS
The worst, single infectious disease catastrophe of the twentieth century was the extraordinarily lethal influenza pandemic of 1918–19. Somewhere between 20 and 100 million people died, the wide variation in estimates reflecting the fact that accurate counts are not available for what is now called the developing world. At time of writing, there is considerable trepidation that we could be in for something even worse. Influenza viruses spread very rapidly and, with jet planes rather than ships and more than three times as many people on the planet, this is a disaster waiting to happen.
John Barry’s recent book The Great Influenza2 gives a very readable and engrossing account, not only of the events of 1918–19, but also of the considerable political and social consequences.
The problem is this.
The influenza A viruses that cause most cases of genuine influenza infect a wide range of species, from birds to horses, to seals, to pigs, to humans and so forth. Though they can cross from one species to another, they do tend to be most infectious for their ‘maintaining host’.
For some years now, the Asian countries have been experiencing a massive, and highly lethal, outbreak in birds of an avian influenza virus called H5N1. The ‘H’ stands for haemagglutinin and ‘N’ for neuraminidase, the two surface proteins of the ‘flu viruses that are recognised by the protective neutralising antibodies elicited by the standard vaccination procedures.
These H5N1 viruses have transmitted naturally to people, causing death rates of greater than 50 per cent. However, there has been little spread from person to person.
Why are we so concerned?
The genetic material of the influenza viruses is inherited as eight distinct segments. If, for example, the lung cells of a human or a pig were to be simultaneously infected with an ‘avian’ H5N1 virus and a standard ‘human’ H3N2 virus (the familiar Hong Kong influenza) we could end up with a new ‘re-packaged’ virus that had someelements from the avian, some from the human strain. The possible flash point with H5N1 is in countries like Vietnam and Cambodia where there is little vaccine coverage against the human virus and large numbers of pigs and people living in relatively close proximity to H5N1 infected ducks, the highest-level virus shedders.An H5N1 virus with ‘human’ growth and transmission characteristics could be immensely dangerous, as none of us have pre-existing antibodies to H5 or N1.
This has probably happened many times before: the H3N2 virus that emerged in 1968 originated from a duck virus. Variant H3N2 viruses generated as a consequence of the selective pressure applied by neutralising antibodies (a process called ‘antigenic shift’) have been causing pandemics every two years or so since 1968, commonly killing between 20 and 40,000 Americans in a typical influenza "season". Anyone who doubts Darwinian evolution can see it constantly at work in both influenza viruses and HIV/AIDS. Science has thus given us the means to combat a disastrous influenza outbreak using technologies that were not available in 1918–19 - tthat virus was not even isolated until 1933. Nonetheless, the logistics of first making and then distributing the ‘right’ vaccine could mean, according to a recent World Health Organization estimate, that humanity might well sustain some seventy million-plus deaths worldwide before sufficient of the product could be available for widespread use. We do, however, have the specific anti-influenza drugs “Relenza”, which was developed in Australia, and “Tamiflu”.
These are taken at the beginning of symptoms and, though they do not prevent infection, can lead to a rapid decrease in virus growth and, hopefully, an early recovery.
Governments have been stockpiling these drugs, though there may only be sufficient to treat key personnel, like health care professionals. Tamiflu is, however, available on prescription and can just be kept in the medicine cabinet.
The international influenza network that monitors emerging virus strains, then decides on which should be used to make the vaccine for the coming year, also operated very effectively in the recent SARS outbreak.
At first it was thought that SARS might be a form of influenza, but it was soon found to be a hitherto unknown coronavirus virus (one cause of the common cold) that crossed into the human population from Himalayan civet cats. Once the virus was identified and suitable diagnostic tests were developed, appropriate control measures were put in place and the outbreak was brought to a rapid end.
In the meantime, though, the countries that were affected suffered some US$20 billion+ dollars of economic loss and a number of deaths.
People were terrified of SARS, and there was no problem getting broad acquiescence to the necessary limitations of travel and quarantine restrictions. Apart from being a triumph from the aspect of how quickly the scientific issues were resolved, SARS showed us how effectively social groups and nations states can cooperate when there is a very real and present danger.
HIV/AIDS
The continuing horror of HIV/AIDS is taking enormous numbers of lives, approximately 3 million annually in fact, including more than 600,000 women and a comparable number of children. The AIDS challenge for medical scientists is to develop affordable, effective preventive measures. All types of approaches are being tried, from the topical application of lemon juice and more sophisticated formulations that can be used by women to prevent transmission, to the development of very complex vaccines.
One problem is that, unlike the influenza virus that is completely eliminated within one to two weeks of exposure, HIV both persists and mutates to avoid immune control.
Another problem is that there is no mouse model of AIDS that we can use quickly and cheaply to try new immunisation strategies, while the HIV-like viruses that infect nonhuman primates seem not to provide a perfect mimic of the human disease.
Even so, this is the best we have and it is unlikely that a candidate vaccine showing little protective effect in preliminary monkey studies will be of much value for people. The result is that the only true test of a novel AIDS vaccine is to do human trials in endemic areas where the disease is currently spreading.
Such studies are politically and strategically complex, very expensive and, in any case, we do not currently have any obviously outstanding candidates to test. We also see the effect of global inequity in the shape of the current AIDS pandemic. The use of expensive triple drug therapy in the advanced world means that contracting this infection is no longer an immediate death sentence— though there is no cause for complacency, as it is still a shocking disease, and the daily ingestion of anti-viral chemicals can have major side effects that shorten life.
The lack of financial resources to pay for the drugs and to provide the necessary infrastructure means, however, that the mortality rates in the developing countries are horrendous. Whole societies are losing many of their teachers, farmers and public officials. Planning for the future is impossible in situations where the survival of both parents and children is uncertain. The distribution of cheaper, generic drugs is now more widespread, but they are still unavailable to many, and the AIDS pandemic remains an enormous challenge for humanitarians.
Until recently, the experience in Thailand, Senegal and Uganda was showing that it is possible to promote behavioural change and to reduce the AIDS toll by strong public education programs combined with the ready availability of cheap prophylactics.
Unfortunately, the implementation of current US policies that remove resources from women’s health programs, together with religious value systems that are opposed to one of the few effective preventive measures in AIDS, routine condom use, look to be effectively destroying the preventive effort in Uganda. Some religious conservatives prefer to emphasize the “A” of the ABC mantra: “abstinence, be faithful, use a condom”. The other interpretation of ABC is: “acknowledge human sexuality, be realistic, use a condom”
What type of “moral values” system is it that favors policies that condemn innocent women and children to a horrible death? Is sexual morality the only morality?
* Professor Peter C Doherty, Laureate Professor, The University of Melbourne, Department of Microbiology and Immunology and Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee. Co-winner of Nobel Prize in Medicine, 1996, for work in immunology.
1 “The Beginner’s Guide to Winning the Nobel Prize”. Peter C. Doherty, The Miegunyah Press, Melbourne University Publishing, 2005.
2 The Great Influenza: The Epic Story of the Deadliest Plague in History. John Barry, The Viking Press, New York, 2004.
Copyright 2005. Greek Legal and Medical Conference