Countermeasures Season 3 Episode 2 Podcast Transcript: Orthopoxviruses
Narrator: [00:00:00] Globalization geopolitical conflicts, climate change and advancements in technology are making the biological threat landscape more complex than ever before. This is Countermeasures where we explore health threats impacting communities around the world, brought to you by Emergent, a leading public health company that delivers protective and life-saving solutions to communities around the world. From zoonotic disease to bioweapons, orthopoxviruses and more, we’ll explore what it means to protect public health and how preparedness today can lead to a safer tomorrow.
In 1980, the World Health Assembly officially declared smallpox eradicated, following a decades long global effort involving mass vaccination and containment strategies before vaccines. An estimated 30% of people who contracted had died, and survivors were left with life altering scars. It was one of the deadliest diseases in human history, and its eradication is considered one of society’s greatest achievements. Unfortunately, smallpox is only one disease in a larger family of orthopoxviruses, which also includes diseases such as cowpox and mpox. These diseases which are now monitored, still pose a significant health risk. Health threats are always changing. In this episode, we look at orthopoxviruses exploring their history, how they spread, and the challenges they continue to pose from the legacy of smallpox and declining herd immunity to modern outbreaks. We’ll examine what these viruses mean for global health to understand orthopoxviruses. Today we begin with smallpox, a disease that haunted humanity for millennia before its eradication. Dr. Renee Nara, director of Public Health and History of Vaccines at the College of Physicians of Philadelphia explains what we know about its origins.[00:02:00]
Dr Rene: So there’s two, two clues, two big clues. The first one comes from the mummies in Egypt, they have the mummify bodies. You can see sort of what happened through them throughout their lifetime, some of them have some scars on their face and skin that they give us a clue that maybe they had smallpox during their life. And so they have the scarring on their face, on their arms, on their body. But you know, the scientists more recently have a way of telling the changes in the DNA of an organism, in this case, the virus, and they call it a genetic clock. The genetic clock for smallpox is about 4,000 years.
Narrator: Smallpox was a deadly and life-altering illness in the time before modern medicine.
Dr Rene: Yeah. So you would begin with a flu-like illness. You felt feverish and tired. And over the course of a couple of days, you’d start developing little pustules. And if you remember, many people will remember chickenpox. You, you got these pustules all over your face and your, and your arms and, [00:03:00] and, but smallpox was everywhere. Smallpox was all over your, your trunk, your legs, your arms, inside your mouth. Sometimes in the eyes and it would cause blindness. And then yeah, the, the scarring, chickenpox for the most part, you might have a pockmark here and there, especially if your parents were really good about keeping you from scratching yourself as mine were. But if, if with smallpox, it’s almost impossible because the, the actual virus itself just destroys that area.
Narrator: For centuries, societies had no idea what caused smallpox, though they knew it was contagious. Over time, methods like quarantine and later variolation offered some protection.
Dr Rene: Somewhere in China, there were some physicians who started taking the smallpox scabs from people who had smallpox. And once they were healed or they were on their way to healing, they would take the scabs and dry them out in the sun, and then they would ground up the scabs and give them to people through a, a straw and through the nose. And so they, they noticed that when [00:04:00] somebody, somebody took smallpox that way, that they would get a, a slighter course of the disease and they would develop immunity against smallpox. So this was called variolation. It was, uh, very, you know, controversial throughout its whole history because you were giving people the disease.
Narrator: Eventually, the smallpox vaccine was developed a milestone that changed the course of human health and paved the way for eradication. Dr. Martin Muchangi of Amref Health Africa explains what made smallpox eradication possible and what lessons we must carry forward.
Dr Martin: Yes. So major victory was attained in the 1980s when the WHO was able to declare they were smallpox free. This was of a couple of efforts, some of them, which was more or less around going to the field, engaging with the communities, and making sure that work is done and done diligently. Then the second thing [00:05:00] was around group of solidarity, ensuring that everyone comes together to solve a common problem, and that was coupled with very targeted community engagement, making sure that the corners are involved, communities are engaged, and of course, deploying very novel public health tools. Ensuring containment and above all, ensuring that there is, uh, vaccination and vaccination, which is not just mass vaccination, but targeted vaccination to the most vulnerable and Ines above all. Uh, coupling that was the issues. To do it in data, using data for decision making. Evidence for logistics and ensuring that data actually informs the investment that went on. So I would want to say that the eradication of smallpox set stage for the current systems [00:06:00] that are addressing the current pandemics.
Narrator: The eradication of smallpox showed the power of global solidarity and targeted vaccination. But today Martin warns that the world faces new vulnerabilities, especially for populations born after the 1980s.
Dr Martin: The very fact that we are no longer vaccinating population against smallpox is a danger. I would want to say that those ones who actually received the smallpox vaccination were covered and we were able to attain some sort of hand immunity up to some level. But you can imagine since the 1980s, there’s a whole vulnerable population that are like 45 years old. And so those are vulnerable populations and room to say that any other other pox virus. Could pose some sort of vulnerabilities to population. So at this point, we are at a risk. Of course, those [00:07:00] who are vaccinated are safe, and it’s okay that it’s an indicated disease, but so far there are major of vulnerabilities, especially for those who are not, uh, vaccinated. So we just need to remain alert that while we are celebrating that there’s no more smallpox, it was eradicated. Then there are major vulnerabilities. Should, should, such kind of a virus, heat, or a virus, which is very close, the genetic linkage with it. Then the wound will be at a mental risk
Narrator: Because of this orthopoxviruses are still a major threat to global health, especially in places with high population density. With waning vaccination rates among younger generations, mpox has emerged as an orthopoxvirus threat. Dr. Martin explains the complexity of mpox transmission, and while one size fits all, response won’t work.
Dr Martin: The epidemiology of folks is a little bit complex. There is [00:08:00] urban mix, rural mix. There’s actually the mix that also takes the social among graphic kind of profiles. And so it is distributed not evenly. So if you look at the populations that are living in urban areas, you realize that. Most of them are actually getting it through intimate contacts. And then when you’re looking at the rural communities, like mostly in Central Africa and rural Africa, the transitional pattern is actually emerging as the main transmission route whereby. You. You have people who are living in small communities and they’re living in congested areas, so you realize that the contact kind of transmission is the one which is predominant. And more specifically, we also see kind of zoonotic bureau of us. And so for that case, I want to say that the epidemiology of mpox transmission is mixed. We need to actually be very [00:09:00] cautious and very targeted in terms of like addressing the problem. Not to generalize how we are dealing with this. We need to consider geographies. We need to consider socio demographics. We need to consider urban rural mix and actually try to understand the sociocultural context of individuals and that’s how we can come up with the proper interventions moving forward.
Narrator: The recent emergence of mpox reminds us that preparedness doesn’t end with eradication. It requires being proactive and vigilant access to the necessary medicines and the ability to act fast. Eric Balsley, director of product management at Emergent BioSolutions describes how the world has thought about readiness in smallpox.
Eric: One of the things to keep in mind about mpox as an orthopoxvirus. The reason today we see mpox outbreaks happening around the globe in, and not say in the [00:10:00] 1980s, 1990s as much is because the way the world responded to smallpox was a goal of eradicating smallpox as a, as a virus. And they were, we were successful in doing that, and success was through a vaccination of large numbers of people to prevent the spread of small pocket. Now one of the, one of the benefits of mass vaccination against smallpox is that smallpox vaccines used to eradicate smallpox are also protective against mpox. So for, for many, many decades, the world has benefited from a large amount of the population having been vaccinated against smallpox and therefore also having immunity against mpox as the population is aging and younger people are, are making up a larger percentage of the population. You have more and more people who are not [00:11:00] protected against mpox because they’ve never been vaccinated against smallpox. And unlike, unlike smallpox, mpox has a natural reservoir in, in various animals. So because of that you can see how outbreaks occur. So there’s always a, an animal source for mpox to, to find its way into, into a human. And then that pro provides an opportunity for mpox to spread within communities.
Narrator: Stockpiled vaccines and medicines as well as disease surveillance remain essential, but as Martin points out, equity and response is still a global challenge.
Dr Martin: One of the most important thing to point out is that when you look at when EM impacts broke out, there was major campaigns around vaccination. So like if you pick the US itself, there was very quick movement of vaccination around [00:12:00] 1.2 million doses were administered. That is very good. And of course when you’re looking at the other countries, like the ones which are in Africa, there was some gap in terms of like the supply chains. When you’re looking at the quantity in systems and when you’re looking at the reach and the ones who actually required. Those who needed the vaccine most were somehow not covered. But I would say that. Just looking at the transitions between the previous struggles of smallpox and how mpox was actually handled, there’s a major improvement in terms of the way these outbreak has been handled. Group awareness, group of solidarity, putting science into perspective. Bringing people together and, you know, uh, also changing policies in a way that they can accommodate a procured intervention was one of the key things that I would see is positive in terms of the, uh, [00:13:00] impacts.
Narrator: From vaccination campaigns in the US to inequities in Africa, mpox has tested global systems. Eric Balsley reminds us that readiness is not only about supply, but having systems in place to roll out vaccines when they’re needed.
Eric: Readiness to respond, I think goes back to the policies that have been established and the investments that have been made to be able to deal with these, these threats. So I’ll, I’ll go back to the US and if you look back to the early two thousands. At that point in time, the US set a, set a goal of having a smallpox vaccine for every single person in the us And it’s an ambitious goal, and it’s a, it’s a goal that means you’re prepared, right? If you have a vaccine for every single person in the us. Yes, there’s going to be a disruption to day-to-day life, but it is a, it is a situation where you have to roll [00:14:00] out vaccines and be able to respond. And, and there are numerous countries around the globe that do have relatively robust preparedness programs to ensure that if, if something like an orthopoxvirus outbreak. That is becoming more and more of a pandemic and more and more threat to life. Um, they’ll be able to respond. Um, I think, I think what we see today still, if you look at the response in Africa, there is, there is a delay in vaccines being made available. And that’s, you could have debates with people on whether it’s vaccine supply, vaccine pricing, infrastructure. Approval processes, readiness on the ground for, for the vaccines to be administered. Vaccine acceptance within communities. There are a lot of things that, there are a lot of, there are a lot of challenges that you’re going to face when you introduce, when you introduce a new virus into a population, and you have to find ways to educate, deliver, ensure vaccine compliance.[00:15:00]
Narrator: Preparedness is not just about vaccines and warehouses. It’s also about knowing when and where an outbreak is starting. Dr. Martin stresses that surveillance communication and community engagement are as important as stockpiles.
Dr Martin: Yeah, indeed. Stockpiling of vaccines is very necessary, but beyond stockpiling of the vaccines, there are other things which we need to think about critically. The first one is around surveillance and want to emphasize the importance of surveillance, and these integrates the elements of community-based disease surveillance, the elements around genomics. The elements around, uh, community intelligence and, and citizen science that is getting the knowledge of the community, like the way they perceive things. Then the second element is around precision vaccination, because again, to avoid wastefulness and [00:16:00] being targeted from a pap precision vaccination is necessary. Who requires this vaccine? Who is the neediest and when do we begin? When does it end? Then the learned element is around the therapeutics. We need to be very clear about the kind of drugs that we need to use, the most effective drugs, and then proper communication, community engagement that is often ignored, but without that then uptake of the. Therapies, uptake of the vaccination, uptake of the preventive practices normally for forced apart. And we wouldn’t want to have such kind of a thing because when you’re giving a service to a customer, a customer must be able to appreciate that and communication. That communication does that in terms of engaging communities, then, I would want to say that the effort that goes into financing. For this, [00:17:00] for this action needs to be apt. We need to think about how to reinvent some money that can help us to address pandemics without major struggles.
Narrator: Surveillance, therapeutics, vaccines, communication, financing. All of these pillars have to stand together and when outbreaks cross borders, no country can respond alone. Eric Balsley says, global collaboration across governments industry and NGOs is key.
Eric: You would hope. You would hope that you’d be able to get vaccines to people faster. That’s why we see things such as the public health emergency of international concern that was issued for the 2024 outbreak of mpox in Africa. I don’t think the vaccination level is where you’d want to see African countries being right now. I do believe that’s, that’s. High income countries do recognize this, this gap and the need for coordination to be able to be prepared not [00:18:00] only for how they work together in, in general in preparedness, but also in response to outbreaks as again, the example that we can, we can reference here is, is what’s going on in Africa with mpox right now. So I do believe that there is, is a recognized need for better coordination across countries and across. NGOs to make sure that it’s not just the high income countries that benefit from, from preparedness, but rather the globe then benefiting from preparedness. I don’t know if there’s a, a clear answer on how to do that yet, but I think what’s important is that there’s, there’s continuous discussion and alignments with, uh. Industry with governments, with, with nonprofits on how to, on how to approach this. And one of the, one of the examples that I would use from the outbreak that I do think is, is something we should pay attention to is, is [00:19:00] Gavi’s recent announcements around the fact that they’re going to have a global stockpile for mpox vaccines. Right? That’s, I don’t know if that has happened in the past where you have an entity like, like Gavi stepping up and saying, we are going to be the ones who ensure. A stockpile capability for the globe to respond to these outbreaks. And I think that’s going to be an important piece because you, you establish more centralized procurement, more predictability around demand.
Narrator: Global collaboration is essential, but it’s not just about moving vaccines and resources. It’s also about moving knowledge, building trust, and sharing data. Dr. Martin says progress is being made, especially in Africa, where local evidence and. Citizen science are driving new approaches.
Dr Martin: Yeah, I would want to say that, uh, that having initiatives that generate evidence is something very positive. And this is for the purpose of contextualizing solutions. So like the study which was conducted in Africa is, is one of the kind of the standards that is an example of how we can use evidence, testing the drugs with the people, making sure that it works actually as defined, making sure that it’s acceptable and above all. Building the capacities of the scientists who are undertaking the standards to do even better in future, and this is part of what I would want to say, couldn’t encourage data sharing, sharing of innovations and evidence. From the group or south from the group or north, building a strong group of solidarity towards answer, addressing these challenges for other orthopoxviruses. So I want to say that’s a positive thing, like that study which happened here [00:21:00] in Africa and I, I do hope that many more are going to happen in the future
Narrator: Despite the challenges of preparedness. There are reasons for optimism. Dr. Martin explains why he believes the future can be different if the world builds on the lessons of smallpox and impacts.
Dr Martin: But that makes me optimistic that we have a starting point of as where we, we are not starting from zero. Then the, that element is that we’ve picked lessons, uh, all the way from. COVID 19, the one which hit nearly everyone in the world. There was a lot of lessons which were picked and above all I see, group of solidarity and a movement, which is emerging that appreciates that.An epidemic, which is somewhere in Africa, in Asia, in Europe, America. Actually can heat the launch within hours. And within this, everyone can be in problems there.[00:22:00]
Narrator: The end of smallpox didn’t meet the end of ox viruses. The rise of mpox shows us how fragile preparedness can be and how inequities in access to medicines and proactive surveillance can lead to lower trust in health systems and shape outcomes. As we’ve heard from Dr. Rene Najera, Eric Balsley and Dr. Martin Muchangi. The lessons of history, the realities of today and the hopes for the future are all connected. Solidarity, equity, innovation, and one health approach are all factors determining whether we are ready for the next challenge, the world defeated smallpox. The question now is what will we do with the lessons that left behind?
Thanks for listening to countermeasures. If the content of this. Episode resonated with you. We recommend subscribing so you’d never miss an episode. You can find more about Countermeasures at emergentbiosolutions.com. The views and opinions expressed by guests on this podcast are their own and do not necessarily reflect those of Emergent BioSolutions or its affiliates.