14 July 2017 Vol 357, Issue 6347
Special Issue – Emerging Infectious Diseases
Introduction to special issue
By Caroline Ash
Science14 Jul 2017 : 144-145 Full Access
Outbreaks of infectious diseases regularly shock human societies. Outbreaks may be unpredictable, but future events are inevitable. During an outbreak, the exigencies of current circumstances tend to be overwhelming, and all we can do is respond. Collectively, the international community fails to coordinate and plan interventions preemptively between crises. Why can’t we predict outbreaks or mount faster and more effective responses?
What should we be doing in anticipation of a future infectious disease outbreak? This special section points to tools that could be incorporated into anticipatory programs, whatever the pathogen involved.
International surveillance is essential for early discovery of potentially dangerous infectious diseases, but this also requires local community involvement and redressing inequalities in health systems. If a pathogen eludes surveillance, mathematicians can be among the first to help by modeling the patterns of transmission among the chaos. Mathematical models can indicate the trajectory of an outbreak and show how to optimally target data collection. As outbreaks develop, vaccines and drugs may become available. However, it is not ethical to deploy such interventions in an affected population without any test of effectiveness. Therefore, we must design rigorous and controlled trials so that interventions are ready for use. Anticipation must also stretch into the post-outbreak phase. As incidence drops and fear declines, emergency responses are redeployed elsewhere. If a pathogen is not eliminated, it can become endemic—as has happened for HIV. The disease becomes normalized, governments lose interest, and elimination become impossible. Then, individuals—often those least able to afford it—are expected to pay the price of treatment and control.
Driving improvements in emerging disease surveillance through locally relevant capacity strengthening
By Jo E. B. Halliday, Katie Hampson, Nick Hanley, Tiziana Lembo, Joanne P. Sharp, Daniel T. Haydon, Sarah Cleaveland
Science14 Jul 2017 : 146-148 Restricted Access
Opportunities and challenges in modeling emerging infectious diseases
By C. Jessica E. Metcalf, Justin Lessler
Science14 Jul 2017 : 149-152 Restricted Access
Improving vaccine trials in infectious disease emergencies
By Marc Lipsitch, Nir Eyal
Science14 Jul 2017 : 153-156 Restricted Access
Unprecedented global effort is under way to facilitate the testing of countermeasures in infectious disease emergencies. Better understanding of the various options for trial design is needed in advance of outbreaks, as is preliminary global agreement on the most suitable designs for the various scenarios. What would enhance the speed, validity, and ethics of clinical studies of such countermeasures? Focusing on studies of vaccine efficacy and effectiveness in emergencies, we highlight three needs: for formal randomized trials—even in most emergencies; for individually randomized trials—even in many emergencies; and for six areas of innovation in trial methodology. These needs should inform current updates of protocols and roadmaps.
When an emerging disease becomes endemic
By Graham F. Medley, Anna Vassall
Science14 Jul 2017 : 156-158 Restricted Access
Labmade smallpox is possible, study shows
By Kai Kupferschmidt
Science14 Jul 2017 : 115-116 Restricted Access
Reconstitution of horsepox virus from mail-order DNA reignites synthetic biology debate