SARS: Lessons Learned for the Future
Dr. Rita R. Colwell
National Science Foundation
A Workshop Sponsored by the Strategic Assessments Group of the CIA
June 4, 2003
Good morning and welcome to the National Science Foundation. We are pleased to host the SARS: Lessons Learned for the Future workshop sponsored by the Strategic Assessments Group of the CIA.
SARS is a vivid reminder of the dangers posed by infectious agents in our increasingly interconnected world. At the same time, our capacity to anticipate and prevent harm has never been greater than it is today. This gathering is a step in the right direction, bringing together the diverse expertise that we will need to address the many facets of this growing problem.
I speak with you today as both an active researcher who has pursued the linkages between climate and human health, and also as director of the U. S. National Science Foundation, an agency responsible for the health of the nation's research enterprise, including a vibrant biosciences portfolio.
The reality today is that biology's almost miraculous applications-whether in the environment, agriculture or health-rest upon our investments in a wellspring of fundamental research in the past. Our ability to deal with SARS as successfully as we have rests in large part upon those previous investments. For example, for the first time, we have the ability to quickly sequence a pathogen.
Our connections to a vast network of sophisticated researchers puts the most advanced thinking, tools, and techniques within ready reach. These tools-from genomics to information technology-are available because of our wise investment decisions in the past.
Our ability to deal with such diseases more effectively in the future will depend on research we are funding now-research without an apparently obvious application.
A key point about research progress in bioscience today is that many of the most exciting discoveries are taking place in what I call convergence zones--where other fields encounter life science. The simple questions in biology have been answered. Questions of infectious disease demand a systems approach; I call it biocomplexity, a perspective that spans scales and disciplines.
Biocomplexity requires a systematic investigation of links at all levels of this hierarchy. Antibiotic resistance, for example, depends both on the evolutionary flexibility of microorganisms and on human actions and institutional choices: from the unwarranted use of antibiotics to inadequate provision of clean water supplies and sewage treatment facilities.
Knowing how microorganisms evolved into pathogens from less harmful relatives and how they differ from them can provide the key in tracking the origin and spread of emerging diseases and their vectors.
We do know that pathogens are integral elements in the complex ecosystems that sustain them. And, ecosystems do not respond linearly to environmental change, nor do the pathogens that live in them. We already know that global change could be nudging pathogens and vectors to new regions. Agents of tropical disease could drift toward the polar regions, creating "emerging diseases" at new locales.
Understanding these multiple links gives us a more generous portfolio of options with which to anticipate and prevent the emergence and spread of infectious diseases.
This group knows well the new and emerging global trends-from climate variability to overuse of antibiotics, from increased cross continent travel to the mutations of pathogens. These could contribute to a more virulent disease future.
The complexity apparent in our research agenda is simply a reflection of the complexity at work in nature-including we humans and our institutional arrangements. We are likely to need a highly integrated effort-from genome to ecosystem to climate to new surveillance systems-to address the problem.
Ultimately it also means we must develop a more effective ability of communicating with the public about such threats.
SARS has brought home another lesson: we ignore the international dimension of emerging and reemerging diseases at our peril. On the one hand, we have seen unparalleled cooperation and communication among scientists internationally. On the other hand, it has not been enough. Even exquisite research fails when the health care system and emergency health care workers are not trained and alert to the smallest perturbations in the norm.
As discussion proceeds today, it is critical to keep the global sweep of bioscience in clear view. Pathogens do not carry passports. Our work today is global and urgent, and our world is more than ever a microbial world. As travel and the threats of bioterrorism increase, monitoring for pathogens, diseases and climate variables becomes all the more critical.
More scientific questions of all sorts are taking on planetary dimensions, and only international partnerships can address them. Both climate and health are global phenomena, and for the first time, we can bring a global perspective to bear.
We have gone beyond the linear, simplistic notion that we can successfully eradicate a disease from the face of the planet. At the same time, as we plot the complex links that constitute the ecology of a disease, and as we recognize signals from environmental climate models and incorporate them into health measures, new opportunities arise for proactive--rather than reactive--approaches to public health and bioterrorism alike.
There are feedbacks, too; smallpox, once an infectious disease problem, has become a bioterrorism threat partly because of success with public health eradication programs.
If we do not understand the natural fluctuations in our environment, we will not be able to spot signals that are human-induced. A bioterrorism attack could appear, in the beginning, like any other natural outbreak.
What have we learned that we can apply to potential bioattacks? Several of the principles I have just cited-the importance of fundamental research, the need to understand a pathogen within its full ecological, human, and social context, the necessity for a global strategy and frank international communication-apply equally well to both human-caused and natural outbreaks.
There is no question that we have the knowledge and ability to tackle this task. The question is, do we have the will?
We will need a comprehensive strategy to move forward effectively. It must encompass research, communication, surveillance, prediction, prevention, and identification. That seems like a long list but in fact it represents a logical path. Solutions will require both a comprehensive understanding of the big picture, and it is very big, as well as attention to even mundane detail. The SARS experience has taught us about each extreme.
I hope we take the broadest possible view of public health in our discussions about SARS-realizing its links to our environment and the need to fuse insights from the worlds of medicine and ecology. It may be that the case of SARS suggests that we need new mechanisms to work more effectively as federal agencies and with other institutions. Today's discussions will be a step towards the multidimensional answers we seek.