Remarkable science: How to prepare for the fall season of infectious diseases

Our series of podcast-only episodes called Remarkable science features conversations with scientists about their work, recorded in front of a virtual audience at WBUR’s CitySpace venue in Boston.

What is the state of infectious diseases as we move into a new season?

Dr. Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University, and Dr. Albert Ko, professor of public health and professor of epidemiology and medicine at Yale University, explore how we should all go about living in a time of outbreaks, pandemics and other infectious threats.

On how polio was eradicated, and polio's resurgence in some communities

Dr. Jennifer Nuzzo: "It's incredibly frustrating to me that we have to talk about polio outbreaks occurring, frankly, in my backyard. I actually grew up near Rockland County and deeply disappointed to hear about cases there. I knew about polio growing up, because my mom was actually part of the clinical trials that resulted in the development of the vaccine. And it was something she was always so incredibly proud of.

"And if she were alive today, I think she'd be really disappointed to hear that polio was once again circulating, basically in our backyard. Polio is a disease, there's been a global program underway to try to eradicate it, basically to take it off the planet so that we don't have to worry about it, and worry about the severe disease that it can cause, in a fraction of cases. Thanks to vaccines, and there are two in use, we've made good progress in much of the world. But unfortunately in recent years, due to slowing uptake of the vaccine or an increasing share of population not getting fully vaccinated, we are seeing a resurgence.

"What we've seen with these cases is particularly related to one of the vaccines. So there are two vaccines in use. The one that's in use in the United States is an inactivated polio vaccine. But vaccines that are used in other settings, oral polio vaccine, not used here, used in other settings. In very rare circumstances, the virus that's used in those vaccines can revert to a form that can cause disease.

"And so it is mostly a threat for people who have not been vaccinated against polio, in terms of being concerned about that severe disease. So unfortunately, what we saw in the United States was severe disease, actually paralysis, in someone who had not been vaccinated against polio. And it's really alarming because one of the features of polio is that the vast majority of the people who become infected may not have any symptoms, or they may have symptoms that are not noticeable.

"But in about one in 200 cases, paralysis can occur. And of course, this is the very serious form of the disease. So when you find a case of paralysis, you have to wonder how many infections are out there that you're not seeing. And certainly the discovery of this virus in wastewater, kind of echoes those concerns."

On successes of the pandemic

Dr. Albert Ko: "I'll take the obvious one. And that's, again, going back to the meat and potatoes, which is vaccination. We've saved 500,000 or more lives, American lives with vaccination, and we're saving more every day, because of vaccination. And I think that story has a lot of different risks in that. Now, certainly one of them, was enormous successes, is how quickly, from the sequencing of the first genome back in 2020 ... how vaccines we had, within nine months, licensed vaccines, through the emergency use authorization.

"We're getting out to the most vulnerable populations, the elderly, you know, underrepresented minorities. People hit hard here in the United States. So that saved lives. We tend to see the glass half full and looking at the vaccine hesitancy. But we got a lot of Americans vaccinated very quickly in a country which never had an apparatus for mass vaccinations. I worked 30 years in Brazil. ... Brazil trying to ... vaccinate 10 million to 20 million people on a weekend. We never had that here in the United States. So I think that's a big victory that we had."

Dr. Jennifer Nuzzo: "Of course, vaccines. I mean, if you asked me at the beginning of the pandemic, would I think that we'd have had multiple safe and effective vaccines within a year? I mean, the answer would have been no, because that's just truly extraordinary. Though it's really, I think, a testament to what that basically prior research, and investment and research pays off. But aside from that, because that's, I think, a pretty well publicized one, I think there have been a number of important advancements. One is on testing, the fact that we can now test ourselves in our homes. I think it's an extraordinary breakthrough in medicine.

"Obviously, there are equity issues, there are implementation issues. There are surveillance issues that stem from that. But the fact that we can test ourselves in our own home, not just for COVID, virus that causes COVID, but also flu and RSV. I mean, that's an extraordinary development. I had a baby that had RSV on Christmas Day and was hospitalized. To be able to have those tests at home, to know what my child had and to inform that care, that would have been really, really extraordinary.

"I also think we've made some important progress on telemedicine and being able to deliver care. Now there's pros and cons and you know, whether that's the same quality of care is different. But I do think it potentially expands access. And we obviously have to learn more about that, but I hope that that's something that we can continue to investigate and innovate on. And then finally, you know, when I got into this field and I told people that I was an epidemiologist, almost nobody knew what that meant. ... Now people know. Which I think is extraordinary.

"And it's also extraordinary because it's translated to a real surge in enthusiasm for public health. Enrollments at all of our schools are off the charts. Interest in public health as a field, and applications to public health schools, is off the charts. So I am buoyed by that surge in interest from the next generation, who are going to be on the front lines of this. They have kind of discovered a passion around these issues because they've seen it affect their lives and the lives of their loved one. And they want to make a difference."

On structural issues in the U.S. health care system, and countries that did well during the pandemic

Dr. Albert Ko: "When you're feeling well, you have less incentive to do prevention than if you're sick, you know, seeking treatment. And we see this in many senses, not only in terms of adherence to prevention versus treatment, but also in terms of reimbursement, economic reimbursement. And when you said invisible and underfunded. Yeah, these are structural issues. This problem that we've had in the public health system, the CDC, local public health needs.

"And this is not something that happened overnight. It wasn't one administration. This is 20 or 30 years of underfunding that happened. I'm going to go out on a limb for the last point. I think there's a second aspect to it. If you look at those countries that did well, those are countries that invested in social rights, that had a legal infrastructure for social rights, and many of those countries had universal health care.

"And as long as we're fighting that battle, not protecting our communities and populations and social rights, we're always going to be behind. I'm thinking of this as a structural issue .. [requiring] massive restructuring. This is Taiwan, Singapore, Hong Kong, Korea. They did this after the SARS. They had probably, I wouldn't say the worst, but they didn't have really great public health systems before SARS. ... They turned it around, and we just haven't been able to get that right. And those are structural issues."