The next pandemic

What will the next pandemic look like and where could it come from? First it could follow genetic change in a pre-existing human microbe (influenza, Tb), second from a microbe already infecting birds or mammals (HIV, measles), and third from a similar source but transmitted from individual to individual by an arthropod (mosquito, tick, sand-fly) or a mammal (mouse, bat). I will examine the pandemic possibilities using examples from yellow fever, typhus, plague, rabies, Ebola, anthrax, HIV, Bolivian Haemorrhagic fever and the Queensland Horse virus. Once in humans the microbe has to be transferred efficiently, and this is where many potential pandemic candidates have failed (H5N1, monkeypox). What can be done to prepare for a pandemic? The WHO must be kept strong, coordinating global responses, with recognition and reporting of disease outbreaks by local laboratories, at the same time pushing for improved health infra-structure, development of effective vaccines and anti-microbial drugs. In the background as an essential backup is research; as an American scientist recently said ‘If you think research is expensive, try disease’.