When you hear the phrase ‘artificial disease’, you might immediately think of a disaster movie in which an illness is engineered in a laboratory and then escapes – by accident or design – to infect the general public.
Chaos usually ensues.
Such risks do exist. Firstly, while rare, laboratory safety failures happen. A report from 2014 highlighted that over a period of five years, more than 100 accidents or near-misses took place at over 600 UK laboratories handling some of the most dangerous illnesses.
There is also a history of state biological warfare programmes. Most information on this is highly classified, but research has suggested that, between 1915 and 2015, around 23 states likely had a programme.
In addition, there have been rare, small-scale terrorist uses like when powdered anthrax spores were mailed through the US postal system in 2001, killing five people.
However, there is some good news.
There are long-standing safeguards in place to stop this from happening and our advancing capabilities in disease diagnosis, surveillance and response mean that these ‘artificial’ diseases are unlikely to pose a threat on the scale of our biggest health fears today – such as cancer and heart disease.
But that is not to say there is no risk at all, as laboratories will continue to work on disease.
You may ask why on earth we want to ‘engineer’ diseases in the first place. Well, quite simply, the more we know about a particular disease and how it works, the more we can expand our toolbox of how to respond, by developing diagnostics, vaccines or drugs to treat it.
By altering the genetic makeup of disease-causing agents, we’re able to understand what many of those key genes do, and we’ve been able to exploit that to create effective vaccines and therapeutics.
We’ve been using the tools of genetic manipulation for decades to understand and deal with disease.
What is new is the speed and accuracy with which we’re able to do some of this work; research that used to take years can be completed in months or less, thanks to vastly reduced costs and step-changes in technical capability.
This has led to a rise in experiments that are potentially risky, some of which have been in the news and – rightly or wrongly – have attracted much speculation about whether they could pave the way for the creation of ever-more dangerous artificial diseases.
For example, in 2011, a set of experiments was conducted where the H5N1 strain of bird flu was modified to become air-transmissible between ferrets.
This caused controversy on both sides of the debate. Was it possible that this modified virus could escape the laboratory? If it did, what would the consequences be? Could an escaped, engineered virus get to the scale and scope of a global pandemic?
Could this research even be replicated by nefarious actors, hoping to create a bioweapon?
Such experiments raise a lot of important questions about where we are going with disease research.
As it turned out, this particular ‘engineered’ bird flu decreased in lethality when it was made air-transmissible.
Understanding what makes one particular strain of flu transmissible between humans and another one not, is a huge opportunity.
And not one we should pass up because of the small risk that the virus may escape the laboratory.
In fact, there are other forms of ‘artificial’ disease that we should worry about and the threat of these is much larger.
Rather than a deliberate, targeted human intervention in a laboratory, these disease threats are an indirect, unintended result of human activity.
For example, many serious disease threats – such as potentially pandemic influenza strains, and the Ebola virus – are able to shift from the animal populations that they usually circulate in to infect humans.
Various human activities bring us into close contact with animal populations, providing more opportunities for such viruses to ‘jump’ to humans, increasing the likelihood of severe human disease outbreaks.
Ebola virus, for example, normally circulates in bats and there’s good evidence that increases in deforestation, bringing bat and human populations closer together, paved the way to a successful ‘jump’, causing the devastating outbreaks of 2014.
And, the recent Zika virus outbreaks depend on transmission by specific mosquitoes, which have, for now at least, restricted geographical reach.
With climate change, we’re almost certain to see these mosquitoes extending their habitats and thus, bringing Zika to areas that were previously unaffected.
When we think about future disease threats – whether natural or ‘engineered’, we also need to consider non-human diseases – because of the consequences for animal and plant health and the potential knock-on effects of catastrophic disruption to food supplies.
With increasing human activity and climate change, ideas of ‘One Health’ and ‘Planetary Health’ are gaining popularity, emphasising the interdependencies between human, animal, plant and environmental systems.
Essentially, it is impossible to have a healthy human population without healthy planetary support systems.
Human health exists in relationship with our social systems (including political, medical and care services), as well as environmental systems, with both the local and global aspects influencing conflict, the movement of people, and disease.
The future health of the vast majority of humans will depend less on biotechnology extending life expectancies for example, and more on how social and environmental systems maintain integrity in the face of climate change and an increasing human population.
Globally, diseases such as heart disease, cancer and diabetes cause 70% of deaths – around 40 million per year. Some of the lifestyle-related components of these might also be considered to be ‘artificial’ diseases.
Although individual choices play a part, these non-communicable diseases are correlated strongly with economic development and urbanisation.
Over time, modern lifestyles can severely damage health, and the very same things that cause problems for individuals – like heart disease from high meat consumption, and breathing problems from air pollution – also produce global problems, such as deforestation for cattle production, carbon dioxide emissions from transport, and sea level rises.
The scenario of an ‘engineered’ disease escaping from a laboratory is scary, but so are naturally occurring disease threats.
Governments do need to pay attention to emerging biological risks associated with technological advances. But, even more importantly, to protect future health, we all need to pay greater attention to more complex threats that may arise from human activities, and to the overall health of the planet.
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