Fresh off an appearance on Ted Talks, Tracey McNamara provides prophetic insights on Coronavirus and her tireless efforts for zoonotic disease surveillance on a global scale
This interview was conducted on February 11, 2020.
Tracey McNamara is not one to pull punches. Since her involvement as the recognized discoverer of West Nile Virus in New York City twenty years ago, McNamara has been on a tireless campaign to expand government programs that monitor domesticated and wild animals for disease. Now, she’s taking her campaign to a global level.
PHL: You’ve been busy since we last spoke, Tracey. How was the reception on your Ted Talk (Canaries in the Coal Mine, June 2018)?
TM: It was fantastic. A great opportunity to help spread the word about our preparedness (or lack of it) for a global disease outbreak. Sort of ironic, don’t you think? And here we are sitting here and watching it all come to pass with Coronavirus. It’s instant replay of West Nile.
PHL: Have you been contacted to consult on Coronavirus?
TM: I can confirm I’ve been contacted but I can’t really say more about that. What I can tell you is this is serious business we’re dealing with. We’re dealing with a novel virus that has spread faster than any virus we’ve ever known. It is one that people can be shedding and infecting other people with while remaining asymptomatic for a week or more, and can persist in the environment up to nine days. That’s all very unusual for an envelope virus. It’s highly transmissible and seems to be impacting the lower respiratory tract as opposed to upper, which we saw with SARS.
PHL: What are the biggest challenges going forward, from your perspective?
TM: Well, these are point source events. We know now that there’s conjunctive spread. And while it’s rapidly spreading, we can’t really screen for because people are asymptomatic. The quarantine is for 14 days but we don’t really know if that’s sufficient. We are basing the 14-day quarantine on other respiratory viruses. They’re doing blood testing because that’s all that CDC has gotten approved. What if it’s in the urine? What if it’s in the stool? With SARS, people were shedding virus for 39 days. It’s scary.
PHL: What are your thoughts on the possibility of a Coronavirus vaccine?
TM: Veterinarians have been working with coronaviruses for decades and the vaccines we have, I hate to say it, are not so good. I’m not holding my breath for a miracle cure.
PHL: Tell us about some of the work you’ve been doing internationally to raise awareness about these issues.
TM: I’ve started working with an international group called the Global Health Security Alliance (GloHSA). It’s comprised of people from German and US Military Intelligence and the German foreign office. We all recognize that when something very serious happens like a major disease outbreak, the security sector has to become engaged. But conversations about how that happens, exactly, have not even taken place. No one has ever actually figured that out – especially on an international scale.
PHL: How do you get their attention with all of the other threats they have to worry about.
TM: The good news is that their whole job is protection. That’s their mandate, so they’re starting to listen. Think about it – who do you need in a crisis? The military. We need the military because they’re experts at deploying people and deploying material and that’s what we need. We need them plugged in.
PHL: How did you connect with GloHSA?
TM: I chaired a session on Disease X at the World Health Summit (see sidebar) after the World Health Organization took an unprecedented step in January 2018 of adding Disease X to the list of diseases of greatest concern. Disease X would be a virus unknown to man that would spread widely and we be completely unprepared for it.
I brought in experts from FAO, from WHO, from medical intelligence, from wildlife, and from the World Bank. The world has poured in an immense amount of money into something called the Global Health Security Agenda and a goal of that is to help developing nations create the infrastructure that would allow them to detect and respond to vector borne disease.
What doesn’t get discussed is all of the recent pandemic threats that have been zoonotic in their origin, and specifically wildlife. So in the course of my research for this panel, I read all of the joint external evaluations that are done by outside experts. They go to countries that are trying to comply with a Global Health Security Agenda to see how they’re doing. And when you read the external expert on the veterinary sector, you come away realizing there is virtually no capacity. And that’s not good. All these threats are coming from animals and the fact that there’s no veterinary capacity in developing nations should be making everyone quite alarmed.
Targeting Disease X
WHO has developed a tool for determining which diseases and pathogens to prioritize for research and development in public health emergency contexts. This tool seeks to identify those diseases that pose a public health risk because of their epidemic potential and for which there are no, or insufficient, countermeasures.
The first list of prioritized diseases was released in December 2015. Using a published prioritization methodology (2016), the list was first reviewed in January 2017 and a second time in 2018. An updated methodology and a new list are anticipated before the end of 2019. The Blueprint list of priority diseases is not an exhaustive list, nor does it indicate the most likely causes of the next epidemic:
- Crimean-Congo haemorrhagic fever (CCHF)
- Ebola virus disease and Marburg virus disease
- Lassa fever
- Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
- Nipah and henipaviral diseases
- Rift Valley fever (RVF)
- Disease X (Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown “Disease X” as far as possible)
PHL: Is any progress being made at all?
TM: Ha! That’s a good question. Through my contacts, I participated in a four-day meeting at the Salzburg Global Seminar which is a big deal: a high-level, Invite-only meeting and the goal of which is to impact policy and initiate transformative change. In preparation, I read everything that was out there and the bottom line is, we’re not able to measure progress because we really don’t have any metrics in the environmental sector or in the animal sector. The goal of the meeting was to bring together people from the animal sector, the wildlife sector, the agricultural wildlife sector and the environmental sector. We got them to the table and at the end of four days, we jointly came up with comprehensive metrics. The metrics are already being adopted by FAO.
PHL: That’s interesting because we see the same sort of dynamics taking place at the federal and local levels in the US – stakeholder groups trying to form alliances to make better gains.
TM: If you’re seeing grassroots efforts on vector control in the US, that’s good. That’s usually where real progress takes place – at the local level. But there still needs to be a realization at the highest levels that we need money to fund these programs. It all comes down to money and politics. We’ve seen it before: if it hasn’t been a problem in the past three years, well then, we’ve got everything under control.
PHL: We’re also seeing a convergence of technology innovations that are helping our cause as well. Do those kinds of details make it into those conversations?
TM: Today, we cannot do real-time epidemiologic surveillance in animals because we don’t have the bandwidth. But I think the private sector would be willing to invest. I want us to leverage all the advances that have been made on behalf of fear of bioterrorist events or fear of pandemic threats, and maybe we can simply engage the private sector to build them out.
There is a new diagnostic test that can be done in two hours, right in the field. It’s species-neutral and you just put a swab in and it tells you everything that’s in there: every virus, bacteria, fungus, and unicellular organism. It’s remarkable. But it has to be developed in the private sector. It would help also us in terms of helping veterinarians in a practical and concrete way address antimicrobial resistance. Today, if you go to a vet and your dog or cat is sick we’re going to put him on antibiotics if we think it’s something bacterial. But we don’t know when we dispense whether or not your pet will actually respond to that antibiotic or if the organism is resistant. You have to wait for your culture and sensitivity test to come back from the lab…a week later!
If you could have an in-house diagnostic test that would tell you in two hours whether there are resistance genes to that antibiotic in the organism, well that would transform antibiotics.
PHL: What’s next for that diagnostics technology?
TM: It just has to be validated. I’m trying to obtain funding to validate it against known DNA samples that are stored in freezers at the University of Nottingham in the UK and at the Swedish Veterinary agency. Those two entities were part of a wildlife disease surveillance program that has since become outdated.