00:00We're joined now by Dr. Amesh Adalja. He's senior scholar at the Johns Hopkins Center for Health Security and an
00:05adjunct assistant professor at the Johns Hopkins Bloomberg School of Public Health.
00:10Doc, thank you for joining us. I mean, you've said, quote, you have to think of the World Cup as
00:15a mass gathering event.
00:16It's going to be diseases of crowds or what we call crowd diseases that spread.
00:21OK, we've got Ebola, we've got screwworm and now possibly an uptick in measles. What are you most worried about?
00:28Of those three, it's measles that is actually a crowd disease.
00:32So it's going to be viruses like measles, COVID, RSV, influenza, norovirus and then sexually transmitted infections, including Mpox.
00:42That's likely what we'll see an uptick of. Not Ebola, not screwworm.
00:48This is going to be where people are interacting. So things have to be able to spread efficiently.
00:52And when it comes to Ebola, yes, it's deadly and scary, but it doesn't spread very efficiently from person to
00:58person.
00:58Dr. Adalja, as we watch the news break from Africa about the spread of Ebola, this new strain in particular,
01:04there is this effort underway to develop a vaccine quickly to combat it.
01:08It makes me wonder about measles and why there isn't a treatment like that for measles yet.
01:13What explains that and sort of where is the science on finding something that could be curative for measles?
01:19So measles is something that is an acute infectious disease that it has an incubation period.
01:24You get sick and it and then most people will recover, although, you know, one in five may end up
01:30with it may end up hospitalized.
01:31People may end up with pneumonia and there are severe complications and deaths that occur.
01:35We just don't have something, an antiviral that works very quickly in that early stage.
01:39There is work being done, but it hadn't really been something that we had to think about because we have
01:45a safe and effective vaccine that has been around for almost like 70 years.
01:49And that's really decreased the burden of measles in most places.
01:54And it's been the vaccine that's been seen as the solution.
01:57But now as the anti-vaccine movement has made major inroads and people are turning away from the vaccine, now
02:03there is renewed interest in thinking about antiviral therapies to prevent the severe complications of measles.
02:09But the thing is, you're going to have to get that to people very quickly.
02:13And we don't have a rapid diagnostic test for measles.
02:16So it's going to be a logistical challenge even if we get an antiviral for measles.
02:20The vaccine remains the best way to control measles, though.
02:23I do want to dig into these measles numbers a little bit because as I was reading up on this,
02:27I didn't realize that the U.S. is about to lose its status under the World Health Organization as a
02:33measles-free destination.
02:35It's been declared measles-free twice already, and it has to essentially prove its case.
02:39The U.S. asked for more time.
02:40It was supposed to be about now.
02:41They're going to do it in November.
02:43But according to the study in the Lancet, the number of cases and the genetics of them far exceed the
02:50usual threshold for being able to declare yourself.
02:53A measles-free destination.
02:54Do you think this is kind of a fait accompli and the U.S. is going to lose this status
02:58in the fall?
03:00Yes, it would have been removed earlier if they wouldn't have moved this until after the election.
03:05But yes, I think that measles elimination status is gone in the United States.
03:09And if you look at any of the benchmarks of a measles-eliminated country, the U.S. is not meeting
03:14any of them.
03:15And irrespective of that, we can't control measles.
03:18We have over 2,000 cases in the United States.
03:20We've had deaths last year from measles.
03:22This is not something that the U.S. has the wherewithal to control anymore because people have turned away from
03:29the actual solution, the vaccine.
03:31So yes, I think this is an embarrassment that we will lose elimination status.
03:35And I think that it really is going to take a lot of hard work to regain that measles elimination
03:39status.
03:40What do we know from an epidemiological perspective of how the U.S. government, I guess the Canadian government, the
03:46Mexican government, is thinking about spread of measles, other illnesses at the World Cup?
03:52Is it something that you think there's been enough attention paid to?
03:56Do they have contract tracing teams at these events?
03:59How much is that something that's part and parcel with a major event like this one?
04:02It's definitely been something incorporated very early on where the host cities were looking at their public health preparedness, their
04:08hospital preparedness, thinking about what early warning systems they need to have in place, how they might deal with health
04:14care surge from infectious disease and from other events.
04:17There are places doing very innovative stuff by looking at genomic data, like from wastewater monitoring to see which viruses
04:23are high in the wastewater in a given place.
04:25There are people looking at social media posts to see people getting sick, and they're integrating all of that together.
04:32So each city is doing it a little bit differently.
04:34There's some interesting work being done in Toronto.
04:35There's been interesting work done at Georgetown that's monitoring multiple cities.
04:39So there is a lot of innovation going on, trying to integrate kind of that whole radar that we have
04:44around these.
04:44And, you know, some cities are going to be more prepared than others, but I think when you have mass
04:49gathering events occurring, this is kind of how you do it.
04:52You have to expect that you're going to see upticks of crowd diseases and other health care needs, and you
04:58have to prepare proactively, or you really won't be prepared.
05:02I also want to ask, I mean, it does seem like measles is the bigger concern for World Cup, but
05:10I want to ask you about the status of this screwworm outbreak in cattle.
05:13You've got nine cases currently reported.
05:16The FDA has issued an emergency authorization for screwworm treatment for dogs and cats.
05:22Is that likely to spread through, you know, our family pets, and how do you stop this spread?
05:27Is it really, is it difficult?
05:30It is difficult because the screwworm is basically the larva of a fly, the screwworm fly.
05:35And, yes, it can infect domestic pets.
05:38That's not the main thing we worry about, though.
05:40It's mostly domestic cattle because that has major implications for the economy of the beef trade.
05:46And we've already seen Canada ban imports from Texas cattle.
05:49The way that you control this is really by reducing that fly population, and that involves releasing sterile flies.
05:57These are flies that have been genetically modified, they've been irradiated, they're sterile, they go out there and they mate,
06:03and the larva, or they're not able to have viable offspring, and the population goes down.
06:07That's the tried and true way of controlling screwworm.
06:11But it is very difficult to do, and it's going to take some time.
06:14And the number of cases, nine, is probably bigger than that because some of those animals are hundreds of miles
06:20apart.
06:21So you have to really assume that it's in a wider swath of Texas, and it's going to take some
06:27time to actually get countermeasures in place.
06:30I want to ask you, lastly, just about Ebola, I suppose, the Hantavirus as well.
06:34These are, I guess you could say, test cases for if there were an outbreak of a different virus or
06:38illness that spread more widely or could spread more quickly over a wider swath of territory.
06:43We've spoken with Tom Frieden, the former CDC director.
06:46We've spoken with Jeremy Conondyke about Ebola and his work in Africa during the 2014-2015 outbreak there.
06:52How do you gauge the capacity of the U.S. and international health organizations to respond to outbreaks more generally
06:59based on what we've seen with the Hantavirus and with this latest strain of Ebola?
07:03I don't think it's very good.
07:05What you want is a proactive response where you're getting in at the earliest possible juncture with flooding the zone
07:11with lots of resources
07:12to be able to extinguish these things early.
07:15So with Hantavirus, that was a little bit of a curveball because we had not seen that on a ship
07:19before.
07:20It was a version that spreads person to person.
07:22But what you saw was the CDC being very late to the game.
07:25Then you saw kind of conflicting policies relating to the quarantine in Nebraska and home monitoring and how that was
07:32all going to work.
07:33With Ebola, this virus had a several week to maybe months head start.
07:38Initial diagnostic tests didn't pick up this species of Ebola.
07:42And what you've also seen is really mixed policy from the U.S.
07:46Are they going to make a hospital in Kenya to take care of Americans?
07:50Why aren't Americans using our Ebola treatment units in the United States?
07:54All of that doesn't portend for good pandemic coordination if there were something more contagious.
08:00We don't have a CDC director.
08:03CDC has basically been decimated, a shadow of what it once was.
08:06So all of this does play on our resiliency to infectious disease threats.
08:10And if this was a stress test, the U.S. didn't really pass that stress test very well.
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