role for research?

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CEA CHRU CNRS CPU INRA INRIA INSERM INSTITUT PASTEUR IRD

CEA CHRU CNRS CPU INRA INRIA INSERM INSTITUT PASTEUR IRD 1

Epidemics emergency: what role for research?

Pr Jean François Delfraissy Dr Bernadette Murgue

Institut of Microbiology & Infectious Diseases

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% of deaths 18%

15%

31%

36%

Pneumonia Diarrhoea

Other infections Non infectious

Infectious diseases account for 26% of all deaths worldwide

Leading cause of mortality in ressources limited countries

Two-thirds of worldwide deaths in children <5 years old

The Heavy Burden of Infectious Diseases

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Medical and Scientific challenges

• Emerging diseases; zoonosis, human ecology, biodiversity

•

Transmission of infection (mechanisms, nosocomial…)

•

Resistance : Tuberculosis, Bacteria, MDR…

•

Infectious agents and non infectious diseases: cancer, cardiovascular, obesity, allergy, inflammation,…

•

Vaccination: new vaccines, immunity, SHS…

•

The big 3 : HIV, Tuberculosis, Malaria

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Emergence: a global threat

– Newly apparent in the human population e.g. AIDS, Ebola, SRAS, H5N1, H1N1

– Rapidly increasing in incidence or geographic range e.g.

dengue, chikungunya, West Nile

– Multiresistant pathogens e.g Tuberculosis NDM-1, E. Coli (O 104)

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Emergence: importance of zoonosis

Vectors

Hosts

Humans

Multidisciplinary approach

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New pathogens and diseases: 1983-2010

Year Agent Disease

1983 HIV AIDS

1983 Helicobacter pylori Peptic ulcer disease 1985 Enterocytozoon bieneusi Microsporidiosis 1986 Cyclospora cayatenensis Cyclosporidiosis

1988 Human Herpes 6 Roseola infantum

1988 Hepatitis E virus Hepatitis E

1989 Ehrlichia chaffeensis Ehrlichiosis 1989 Hepatitis C virus Hepatitis C

1989 Guanarito virus Venezuelan hemorrhagic fever

1992 Bartonella henselae Cat scratch disease

1993 Sin nombre virus Hantavirus pulmonary syndrome

1 994 Sabia virus Brazilian hemorrhagic fever

1995 Human herpesvirus 8 Kaposi sarcoma

1997 H5N1

1999 Nipah virus Nipah virus disease

2003 SARS Coronavirus SARS

2009

A/H1N1v

Influenza pandemic Avian influenza

2010… NDM-1 Multiresistant bacteria

2…. ??? ???

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Relative risk

of an emerging disease event

A: Pathogens from wild life B: Pathogens from non-wild life

C: Drug resistant pathogens D: Vector-borne pathogens

Jones et al, Nature, 451, p990, 2008

A B

C D

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Epidemics/Pandemics: the main drivers

• Human ecology

–

deforestation

–

urbanization…

• Human activities

–

mobility, transportation

–

technology, economic

changes…

• Pathogen changes

–

mutation and adaptation

–

inter-species transfer

Air Passengers, US carriers 1968 - 2007

0 100000 200000 300000 400000 500000 600000 700000 800000 900000

1960 1970 1980 1990 2000 2010

Year

Passengers (thousands)

5-fold increase in passenger numbers in 40 years

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Microbiology and Infectious Diseases Key points: France 2011

•

Major Institutions : Institut Pasteur, Inserm, CNRS, IRD

•

Others : ANRS, CEA, CIRAD, INRA, INVS, Universities

•

12% of French research forces: 300 teams, 2000 Scientists &

Technical staff

•

18% of French biomedical publications: 5000 publications per year

•

Translationnal and clinical research: 35 clinical units involved, including HIV and hepatits

•

Network of vaccine research centers

•

Large research network in ressources limited countries

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French International Research Network

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IMMI: main objectives

•

Improve organization and coordination

•

Implement research orientations

•

Strengthen specific fields, e.g. parasitology, mycology…

•

Develop and improve research with low and middle income countries

• Improve responsiveness to epidemic crises: e.g H1N1

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Responsiveness to H1N1 pandemic in France

- Cohorts: households, infected - Case-control studies

- Serosurveys

- Vaccine trials and observational studies

- Severe disease: ARDS

- Social and Human Sciences - Diagnostics

- Basic research

Main funders:

Public: Inserm, Ministries Research and Health, ANRS Private: Roche, GSK, Fondation Mérieux

30 research projects

€13m Total funding

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Assessment: The strong points

– IMMI/AVIESAN, reactive, flexible and well recognized as chair and coordinator of scientific acitivities

– Interactions with Ministries (Research & Health) and Public Health Surveillance bodies

– Rapid implementation of multidisciplinary projects, including with ressources limited countries teams

– Effective and quick responses of the regulatory agencies – Data quickly reported to the French health authorities – More than forty international scientific publications

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Assessment: The weak points

– Difficulties to implement and maintain the projects in the absence of proper funding

– Complexity of the financial process: several funders – Few social and human scientific teams involved

– No access to biological collections, nor to dedicated paltforms

– Few European and International collaboration

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Research: a key factor to be prepared

to respond to an epidemic threat

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How to implement research to respond to an epidemic threat?

• Set up an Organisation

:

– Decision-making body: rapid mobilisation and effective response – Linked to public health surveillance

– Dedicated and long-term funding

• Define a Strategy:

– Mock-up cohorts

– « Academic » Contract Research Organization

– Tools for detection and identification of new infectious agents

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How to implement research to respond to an epidemic threat?

• Implement Research Programme:

– Transdisciplinary and International research programmes based on platforms and networks

– Partnership with southern countries – Partnership with the private sector

• Improve Communication:

– Decision-making process: expertise and KABP studies

• In a European and International perspective

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Discussion

• New emerging diseases to come

• Scientific approaches are essential to control them

• Challenges: integrating science and practice

• Dealing with the diseases we have…the best preparation for diseases we await

• What next ?

– New reassorted influenza viruses

– Further antibiotic resistant pathogens – New hospital-acquired infections

– Something entirely new!