Webinar: Weekly COVID-19 Pandemic Briefing

Emma Ross

Good morning, and thank you for joining us for this week’s Chatham House COVID-19 briefing with our Distinguished Fellow, David Heymann. Today we have with us Professor Richard Kock, who is a Vet and an Academic at the Royal Veterinary College. His background consists of a rather unique blend of work in conservation, livestock and zoonotic disease. His research focuses on emerging disease systems arising from pathogen flow between wildlife, livestock and humans, and the ecological drivers. He is currently working with the World Bank and other UN agencies to understand the zoonotic origin of this pandemic.

A bit of housekeeping first. This briefing is on the record, and you can tweet using the #CHEvents. Questions can be submitted using the ‘Q&A’ function on Zoom. Upvoted questions are more likely to be selected. So, today we’re going to focus on what we know about where the virus came from, how difficult it’s going to be to prove it, and what it means if we never find out, and what the link is between our relationship with animals and the risk of new infectious diseases entering the human population.

Richard, can I start with you? COVID-19 is a human disease, but the conventional wisdom is that it resulted from a so-called spillover event in which the virus jumped the species barrier from an animal. Let’s start with what the current thinking is on where this virus came from and what’s the evidence for that?

Professor Richard Kock

Good morning, Emma. Thank you very much for starting at – you know, with a very clear statement. So, yes, it is a human disease, I think, you know, that’s clear to all of us, but we do believe it came from an external source. We call these, you know, zoonosis when they are a transmission from a vertebrate animal, that’s a backboned animal, to a human, and so this term is – it’s, sort of, abused a bit, but it’s commonly tagged with the COVID-19.

Actually, to date, we have no proof. So, in science, you know, we really need proof. We need the evidence to confirm that this is a zoonosis. I don’t want to create a, sort of, feeling that somehow it isn’t in the sense that all the evidence we do have points towards an origin from animals. Actually, most diseases of humans comes from nature. I mean, where else would they come from? I think that’s the sort of thing that people forget.

You know, we’re not an isolated – we’re an animal, and we get infections from other animals, and remember, the majority of infections that we have are not a problem. Millions of bacteria, viruses and so on, and there are probably only 1,500 pathogens actually, which is remarkable, when you think about it. So we shouldn’t be frightened of zoonosis, but the emergence of new pathogens is not a good thing, in the sense the human species now is in huge population and we’re a very good host, you know, so with this number of human animals, we’re a good host. So, we have to take this seriously, and the evidence that we do have relates to studies of possible sources of the virus.

So, a virus is isolated and we have all the tools to look at the genetics of the virus, and we can then try and match it to viruses that we have obtained from animals, you know, in nature, and domestic animals, and that has given us the idea that the virus comes originally from bats, because bats are a very numerous species. There are very numerous species, about 1,100 bat species, and many bat species carry coronaviruses, but many other animals ca – you know, have coronaviruses as well, from pangolins to dogs, cats, chickens, you name it, basically. It’s a very common family of viruses. So, the closest relatives to the virus that was isolated in the laboratories in Wuhan in China are what we call SARS-like viruses, which have been isolated from bats. So, we feel that the likelihood is that the virus, in some way, was transmitted from bats, possibly directly, but also possibly through intermediate hosts, other animals, eventually to lead to human infection.

Emma Ross

Thank you. Thank you, Richard, for that. David, could you expand on that? You have a very interesting framing for the emergence of infections diseases using a block of Swiss cheese, which is always very easy to understand. I was hoping you could chime in here with some kind of expansion on what Richard’s just said.

Professor David Heymann CBE

Thanks, Emma, yeah, and good morning. The model that I like to use is a model that was developed by someone named James Reason, and first published in the British Medical Journal back in the 1990s, and this is a model that talks about trying to put an arrow through four pieces of Swiss cheese. In order to do that in the most efficient way, you have to line up four holes of Swiss cheese, and then the arrow goes through those four holes, and those four holes, in emerging infections, actually represent risk factors that eventually lead to an emergence.

For example, and there was an emergence of a disease called Rift Valley fever in Southern Sudan back in 1998. That occurred after there was an event, an El Niño event, which warmed the Indian Ocean and caused severe storms and flooding in Southern Sudan and Northern Kenya, pushing animals and humans closer together. So, the first risk factor was the El Niño event, the second was animals and humans closer together. Well, this disease happens to be transmitted from animals to humans via mosquito, and, of course, when there’s increased water, increased breeding of mosquitoes, so that was the third hole, third risk factor. And the final was that these animals that are normally vaccinated against Rift Valley fever were not vaccinated, and so all of these four risk factors lined up in such a way that an emergence occurred and there was a Rift Valley fever outbreak in humans, when normally it’s only in animals.

So, that’s the Swiss cheese model of how things line up, and this is what happened, as Richard said, in the past, whenever there’s been an emerging infection, even diseases such as TB, which we’re very accustomed to, and HIV, have likely had their origins in an emergence, which then became endemic in human populations. And that’s the issue today, we’ve got a new coronavirus, we don’t know yet whether this will become endemic, like the previous four coronaviruses that are circulating in humans now that are endemic and cause the common cold, or will it be like SARS or other viruses that, after a time, disappear. We don’t think it will disappear, but we really don’t have any evidence yet as to what will occur, and Richard may want to add something to that.

Professor Richard Kock

Yeah, I think it’s very important that people understand this idea of risk. So, I’m – you know, I like to say with zoonosis, you know, when I teach students, I say you’re more likely to die from a coconut hitting you on the head than being infected directly by an animal. I mean, if you take the UK, for example, the numbers of zoonosis in the UK are incredibly small. If you look, the number of campylobacteriosis events, which is a – well, one of the commonest zoonosis, this is an organism that comes from the food system, and I think that’s the other thing about zoonosis, you get direct zoonosis from animals, in other words, say, rabies from a rabid dog, you know, in a part of the world where that persists, a human gets bitten, they get infected, that’s what we call a direct zoonosis.

Then you have indirect zoonosis, which are through the food system where perhaps an animal product exposes people to the organism that’s pathogenic, and campylobacteriosis, you know, in the UK in 2017, the last Public Health England report, nine outbreaks. If we look at E. coli O157, people often talk about that one, three outbreaks. So, it’s pretty – it’s rare. Zoonosis, direct zoonosis, is extremely rare. There are – WHO will report in the Global Burden of Disease, you know, very big statistics for zoonosis, but if you add everything together, you know, globally, you can get, you know, to many millions of infections, but actually, on an individual basis, it’s extremely rare.

But the important thing is the emergence, as David has said, you know, in order to get everything lined up is a challenge, and historically, diseases have emerged. I mean, they’re part of our history, part of, you know, all animals’ history, and there is a, sort of, balance in a way, and when species overpopulate, let’s take a prairie dog in the grassland, eventually, they get disease. They get plague, and they will – their population will expand and then it will crash, and so similar, disease. So this is part of the natural, sort of, evolutionary processes and the, sort of, competition, if you like, between animals, and between microorganisms and animals, and, you know, we just have to accept, if we are biological, if we are alive, that we will be challenged by this sort of thing.

What is worrying, in the last 30 or 40 years, is evidence suggesting that the rate of emergence of novel pathogens is increasing, and I think we all know of these events. David mentioned Rift Valley fever, about the same time Ebola virus was emerging. HIV emerged some time in the 1950s, so we’ve had a series of these events, which are having not only an important social impact, but actually a massive economic impact. And so I think, as our population has grown, these vulnerabilities have existed, and in a way, now we’re beginning to understand, you know, that there is a, sort of, problem for us to address, you know, a bit like the, you know, the prairie dog story, there are a lot of us now, and, in addition to that, there are a lot of domestic animals.

Most people don’t appreciate that actually, 96% of the mammals on earth are domestic. Only 4% are wild. So, again, I come back to this point that, you know, wildlife actually is really not a concern. It, you know, it really keeps to itself, it looks after itself, and very, very occasionally, you will get this flow of genetics from, if you like, nature, from the wild populations, into domestic animal populations or into humans, and it’s those events that are very unusual, but can be catastrophic, and I think we appreciate, with the current outbreak, how serious these things can be. So, there are many questions we have to answer, you know, to understand what the risk is of the Swiss cheese model.

Emma Ross

Thank you, that takes me – you said it’s very rare from wildlife, I just wanted to come on, there’s been, as in the SARS outbreak in 2003, speculation that a wet market, where live wildlife was traded, might be the culprit, or at least it played a significant role in the species jump, and that something must be done to either shut these down or regulate them to reduce the risk of sparking outbreaks. Can you talk about how concerned we should be about wet markets and the trade in wildlife and wildlife parts, and what the prospects are for nailing down their role in this pandemic?

Professor Richard Kock

Yeah, I’m sure David will be able to contribute to this as well. I think, inevitably, people – you know, when an event occurs like this, people want to blame something. I mean, it’s – you know, the blame game is such a common thing. You know, I hear on the news, you know, it’s a natural disaster, and, you know, it’s so easy, you know, with wildlife to blame it, because who – nobody owns it, nobody, you know, can be, sort of, made accountable if a disease comes from nature. But I think it’s very important for us to understand that these things don’t happen by accident actually. There are many drivers for these things, and human beings need to recognise that, not only their population growth has increased the susceptibility and risk of this happening, but the way they manage the environment, the way they exploit the environment, and the interactions that they create through that, and I mentioned the domestic animals, whom everybody has contact, pretty much, with animals in one way or another now. So, the risks definitely have increased and I think that fits with the rise in these emergent infectious diseases.

The seafood market, the reason we believe it may have played a role is because roughly, 100 cases of the early cases were traced back to being at the market at about the right time for the incubation of a viral infection. And so that was the, sort of, you know, proof, if you like, that it’s got to be that market, and, of course, SARS had a similar event, and I’d like David perhaps to just describe the SARS event because I think it – you know, it’s also very pertinent to the discussion. So, David, would you like to – since you were the guy who actually controlled that outbreak, I think we should recognise that you did a very good job, it’s just a pity you weren’t in charge this time.

Professor David Heymann CBE

Well, thank you. I think this is a different disease this time, probably, and it’s going to be much harder to stop. But going back to 2003, at the SARS outbreak, it’s thought that this emerged from an animal market in the Guangdong province of China in November, and it’s a one-time mutation. It didn’t – the virus was only found in humans and it didn’t re-emerge from animals to humans again. One-time emergence from probably one animal to one person, and then it spread slowly until it got into hospital workers and they amplified transmission by not paying attention to infection prevention and control in hospitals, and it became the outbreak that it was in China and globally.

What happened at the end of the outbreak, the Chinese began to do some research in the markets in the Guangdong province, looking at the handlers of live wild animals, and looking at them, they took bloods from the humans and they took bloods from the animals, and they found that humans did, indeed, have coronavirus antibody, which was evidence of previous infection, and it was about 17%, as I remember. It was published in the British Medical Journal. So, they showed that animal handlers in markets had coronaviruses.

They didn’t do so well in finding coronaviruses in the animals they examined, which is normal because it was only a small number of animals. But I think the lacking part of that study was to look in the general population and to see what level of antibody they might have had, and if there was more antibody in the workers in the markets. Unfortunately, as happens when outbreaks end, the money dried up and the studies were not continued, and so we’re paying for that actually, today by not understanding exactly how this transmits in markets, if it does transmit in markets. But I think it was a very important study, and the Chinese did show that market workers did have coronavirus infection. I’m not clear what virus – what coronavirus they might have had.

Emma Ross

So, what are the prospects for us finding out the origin of this one? I mean, what has to happen for us to nail that down and how likely is it that we’ll be able to do that, and what’s going on in that vein?

Professor Richard Kock

Yeah, so I think, as David says, it’s really important, you know, for epidemiological understanding, you know, to really nail it down, I mean, find out, you know, which animal might, you know, have been the intermediate host or whether it was a direct transmission from, say, a bat, whether there are domestic animal links. You see, if you take MERS coronavirus, which occurs in the Middle East, the advantage of the Middle East is that there aren’t many species there, you know, it’s a big desert, so, you know, you have very few animals, and, in this case, the link between camels and the spillover to humans is pretty clear.

We’ve had a few other virus spillovers like Nepovirus, people might remember, which was from bats, through fruit trees, to pigs, to humans, that was well-documented, and the whole pathway was understood, and it was a really simple solution. You separate pig farms from fruit farms and then you don’t get that connection, you don’t get that link. So, I think that’s the aim in this case, with the SARS coronavirus 2, we need to be forensic. Unfortunately, politics always comes into these things, and emotion and a strong reaction to these emergent diseases, because of – you know, quite rightly, people are worried about it. But, unfortunately, you need Sherlock Holmes at the time that these things happen, and that Sherlock Holmes needs to be in there with his magnifying glasses and collecting samples and really getting to the root of it.

Unfortunately, not enough of that was done. A certain amount of bacteriological and virological swabbing was done of surfaces at the market, and they didn’t identify a virus, but that virus also could have come from humans, and not from the animal products. So, this is what I mean about forensic investigation, you have to be re – you have to get all the evidence, you have to really – you know, it’s like a court case. Unfortunately, you know, we’re not approaching it like we should, and, unfortunately, time passes and it becomes increasingly difficult.

We still have not identified the source of SARS from 2003, as David quite rightly pointed out, and that’s a big mistake. But you must remember there are very few people working in the field of wildlife health and wildlife disease, so there just isn’t a huge capacity, particularly in many of these countries, to do this sort of work, you know, to pull in the sort of multidisciplinary teams. You know, we call it a One Health approach, that’s something we need to do so if we can, you know, develop for the SARS COVID 2, and in my discussions with, you know, with agencies and so on, there’s a lot of momentum now to try and increase that multidisciplinary, you know, view on this, and begin to study the disease in much more detail.

But we need the right political environment for this to happen and people need to, sort of, relax about it, get the teams and the Scientists out there, and let’s really find out precisely what goes on in this case to avoid it happening again. It will happen again, I’m sure of that, because the conditions clearly are right for this sort of spillover, and, you know, we may get over this one, you know, at a huge cost, but what happens if we get a new one in two years’ time? I think these are the really important questions.

Emma Ross

But aren’t there animals still in China, if you were allowed in, that could give us clues, or are you saying it’s too late and we’re never going to find out about this one?

Professor Richard Kock

No, I think we do have time to do something, but, you see, the first thing that was done was to ban the markets, and, of course, the conservation community is now really – you know, and a lot of other people, as you said in your introduction, are demanding that this practice should stop, but until we really understand how this happens, that actually is not going to help us. We really need to understand the system. There are millions and millions of animals traded. Think about the domestic animals, what happens if it’s a domestic animal? There are, you know, there are tens of millions of domestic animals. We need to know this, we need to understand clearly what is going on here.

Banning, without knowledge, to me, is nonsense. It’s not actually going to help because, in the end, this is food. Food comes from nature. You know, whether we like it or not, it comes from nature, and just because we have a particular, you know, acceptance for certain food products, we shouldn’t be telling other people what they should or shouldn’t eat. So, I, you know, I feel, you know, that’s something which the western world tends to forget. I just think whatever we do in exploitation of nature should be sustainable, and the problem is it isn’t, okay? So, that’s why we get very emotional and very angry about the use of, say, wildlife, because we feel it’s – has a right to be there, and I agree. So, sustainability is the key here.

So, now, I think, going back to the market, finding, you know, these problems. At the SARS outbreak originally in 2003, they also banned markets, but it came back. So – but it hasn’t really been regulated very well, it hasn’t been controlled that well, and I think we have to – it’s like everything, you know, if you want to manage your chicken industry, you have to have very good biosecurity, you have to have good systems, good food systems, you know, to reduce the risk of an infection, a zoonotic type of infection. You know, so it’s all about, yeah, being sensible, being responsible, you know, whatever the product is, and so, you know, I think that if we could have a, you know, a more open and transparent view of this, rather than this gut reaction, you know, that is, you know, causing a lot of angst, I think, in and across the world at the moment.

Emma Ross

So, what really is the problem? It seemed – something you said a few minutes ago seemed to be saying that maybe this is nature’s way of getting us back in line if we misbehave, for all the destructive things we’re doing to it. Is that what you’re saying, that, in the end, it’s our fault and the way we’re acting, it’s not the animals, it’s not – and what do you mean by domestic animals?

Professor Richard Kock

Yes, no, I think, you know, we are generating this – these problems. In fact, many of our diseases, you know, we can trace back. You know, I work on morbilliviruses. If you look at measles, which is a morbillivirus, it looks like it emerged from cattle. When we domesticated cattle, we brought along with it a virus that then became, you know, adapted to humans and then established a disease in humans, so this history is long, we have seen this in many cases. So, it’s a trade-off, in a sense, you know, we’re very successful as a species, but, you know, we are taking a risk of being exposed to these particular pathogens.

Our agricultural systems, you know, there’s a lot of evidence arising showing how the agricultural system itself of generating, let’s say, domestic animals or crop systems, give opportunities to microorganisms, you know, to expand their populations, and so they infect and invade, you know, those abundant species. So, we should not be surprised by that. So it is us, we make the decisions, we create the interactions, we create the markets, we exploit those opportunities. It’s a trade-off. I’m not saying – you know, we can’t stop, we have to eat, we have to have systems, but we need to rationalise, I think, some of those systems, so that I do agree that things like the wildlife markets need to be rationalised. They need to be examined forensically for the risks that they take.

We have done this for most of the domestic animals over centuries, and we have developed practices and so on that enable us to have safe food that doesn’t kill us every day. So, I think that’s the process. Unfortunately, this – because nature’s become rarer and our interests and desires have continued, you know, we have – you know, in Southeast Asia, we have exploited wildlife, you know, to a much greater extent than perhaps in other parts of the world. So, we need to look at that, and I think that does need a collective approach, and, as I say, a forensic approach to understanding what drives those pathogens into a spillover situation.

Emma Ross

David, I wanted to ask you what the consciousness has been about the role of big agriculture, intensified agriculture, and also you, Richard, but, David, I know we’ve spoken about this before, of there is a move for sustainable agriculture, is part of that to do with infectious disease control or where does agriculture fit in here versus exotic wildlife trade or even wildlife parts? If you want to start with that, please, David, and then Richard.

Professor David Heymann CBE

Yeah, sure. Yeah, well, it’s, you know, it’s clear that pandemics occur in animals just as they do in humans, and right now, or in the recent past, there’s been a pandemic of avian influenza in chickens. It’s been very lethal to chickens and killed those chickens, and that has occurred mainly in Asia, but it spread into Europe, it spread into other parts of the world. This likely is chickens that have been infected initially by ducks in live animal markets where the two animals were kept in cages side-by-side, and the ducks possibly got infected from the reservoir of all influenza viruses, which are wild waterfowl.

And so, you can see how the waterfowl might have infected the ducks, the ducks then infected chickens, and this circulated in chickens and became quite virulent by 2005, and was very, very – a very virulent virus, causing a pandemic in chickens, that occasionally spilled over to humans. But that spill over didn’t cause major outbreaks, it only occurred in small outbreaks, but there was great effort to cull those chickens to get rid of the chickens that were infected in the pandemic. So, you know, live – taking care of animals in close proximity to a human is a good way that we can spread infection from one to the other, and we’re a demanding society for protein, and, as countries become richer and people become more able to spend money on food, they want to go for animal protein, whether it’s eggs or milk, or things such as the actual muscle, using – eating steaks or pork or whatever they eat. And so, there’s a great demand for this and there’s been a response to that in commercialised agriculture.

That agriculture is good because it provides food, it provides livelihoods, but there are some risks that are associated with that, for example, when the slu – when the waste materials from the animals are collected each day, they’re put into a sludge pit many times, and that can cause leakage into the water table and into human water supplies. And this is especially important antimicrobial organisms, which itself is an emerging infection, and it’s a zoonosis many times, bacteria come into humans, and they can spread on. So just by not following good common sense and clean agriculture many times, we’re putting our animals at risk, and those animals then put humans at risk.

So, it’s a logical flow of organisms from wild animals to domestic animals to humans. But I’d like to go back now a little bit to the forensics because I really appreciated what Richard said, and there’s one more tool that we have in our hands, and that is the genetic sequencing, which can tell us over time the periodicity with which this virus mutates as it reproduces in humans. And we know that it reproduces, we know that it mutates, with some regularity, we’re not sure exactly how much, but every two weeks it appears that there’s a greater series of mutations that have occurred previously.

So, by tracing those mutations back, you can begin to understand what that virus looked like in the past, and, as Richard knows, this tracing is leading to animal markets in China. Not necessarily this explosive outbreak in the Guangdong market, in the Wuhan market, it may have occurred earlier somewhere in the market and then humans or something else infected that market in Wuhan. The tracing back genetically is another tool that will be useful, not so useful at present, but as we begin to understand the periodicity of mutations of this virus as it reproduces in humans.

Emma Ross

Richard, do you want to come back on that or if you…

Professor Richard Kock

Yeah, yeah, no, I think just quickly.

Emma Ross

…have a question about…

Professor Richard Kock

Yeah.

Emma Ross

…agriculture as well.

Professor Richard Kock

Yeah, let me just, you know, come back on it, so I’m going to talk now – you know, I’m a Veterinarian, but I’m more so an Ecologist really, and – you know, so my interest in nature and wildlife has sort of influenced my thinking a lot. So, if we look at disease systems, if you look at, say, the avian influenza story, which David has, you know, very eloquently discussed, it’s a natural infection of wild birds, and there’s what I call an ecosystemic stability of the system. In other words, you have many different species of wild birds, they share these viruses, and the viruses compete with each other actually, for space within that host community, and they’re always of low pathogenicity.

In other words, they don’t cause harm and, you know, there’s very, very little evidence for any clinical disease associated with that family of viruses. Similar in bats, bats have many, many viruses, but they don’t have many diseases associated with those viruses. So, nature produces this balance. Humans have rather upset that balance, and I think they’ve pushed things too far. Agriculture, in a sense, is what has supported our population growth, and agriculture actually has destroyed most of the natural environment, because that was inevitable, to feed us, that is what we did.

So, we’ve created what I say is an instability in our environment, so that now the organisms are in a, sort of, perturbed state, and so we have these opportunities for the evolution and genetically changing, they just respond to those circumstances. So, I think it comes back to the sustainability agenda, you know, so the SDGs, United Nations process, it’s not just about emerging infectious diseases, it’s about climate change, for example. So, we have disrupted these systems, so we end up with this kickback. Climate change kickbacks also influence emerging infectious diseases through vector dynamics, for example, but also in the emergence of pathogens, we see some really interesting phenomena.

I have worked on a lot of mass mortality events, and I – there’s one that occurred in Central Asia, affecting a very rare antelope, which used to be around with mammoths and sabre-toothed tigers, it survived the Pleistocene, very resilient animal, in the, sort of, central grasslands of places like Kazakhstan, and this animal died – about 88% of the population died in three weeks in 2015, and I studied this disease and it was caused by a bacteria called Pasteurella, which is ubiquitous. Okay? It’s everywhere. You’ll find it in all, you know, all environments, all animals, it’s a, sort of, part of our, if you like, our commensal relationship with these organisms. It’s also a zoonotic infection. It’s actually one of the more common zoonotic infections in Britain. But it was able to kill nearly 100% of this species, which survived the Pleistocene. We did work on this, we published it, and we showed association with weather.

Now, we’re not saying it’s climate change, but the fact is microorganisms respond to the environment, they respond to the climate, and they respond to populations, and we are getting ourselves in a very dangerous situation, I believe, for emergent infectious disease. So, we do need to make these changes in the way we impact our planet, and I think everybody recognises that now, but we have to get that into our political economy, and the new strategies on agricultural, on how we do things as human beings.

Emma Ross

I’m going to move onto the questions now ‘cause there are quite a few. I’m going to bunch two together. One from Philip Nelson and one from Michael Fortuna, and this is both on the origins of the virus. “Do either Professor Kock or Professor Heymann have any comment on the role of Chinese laboratories in the origin of the pandemic?” And the second question is, “Apparently, the affinity of SARS COVID 2 spike protein is very high for human androgen receptor and to [inaudible – 34:10] receptor, how likely is it that this occurred spontaneously, by means of random, single mutation? There are voices saying that it was engineered. Could you comment on that?” Those two questions together on…

Professor Richard Kock

I’d like to pass the, you know, the Wuhan lab thing to David ‘cause I’m sure he has a better insight than I do.

Professor David Heymann CBE

Thanks, Richard. You know, if you look at infectious diseases, and the smallpox is a good example, smallpox is a disease that was eradicated by a global effort back in the 1970s, and the last human case of smallpox was not a – did not occur in nature. It occurred from a laboratory accident in the United Kingdom, and so two people were infected from a laboratory accident in the United Kingdom. Laboratory accidents occur. We know that also, in the UK and in Russia, there were accidents in laboratories where people were potentially infected with the Ebola virus. They could have then spread this outside the laboratory, if they didn’t know they had been infected, but they isolated themselves and were treated and survived.

In addition, there – the last cases of the SARS coronavirus outbreak were laboratory accidents that occurred in laboratories in Singapore, in China, and possibly in Taiwan. So, the laboratories do play an important role in infectious disease research, and occasionally, if biosecurity is not what it should be, they can escape from the laboratory. This is in no way saying that this virus escaped from a laboratory. As Richard said earlier, it appears that this virus is very close to a virus that is in bats, and it looks like it came directly from bats, either through an animal or directly to humans. We can’t be sure of that. We’ll probably never be sure of that, but, you know, it doesn’t make any sense to try to accuse one group or another, to shame and blame one group or to shame another, we have a disease we have to deal with today and we need to deal with it now.

There will be time to make sure that in all laboratories in the world, not just in China, but in all laboratories, there are the biosecurity requirements fulfilled that permit those viruses to do essential research in security. I know that after the accident in China, back in the SARS period, they strengthened their capacity throughout the country. They developed a Chinese Centre for Disease Control, with satellite laboratories in each state, and they’ve increased their biosecurity. So, you know, all that we have now are many hypotheses going around. One is from a market, one is from a laboratory accident, one is from deliberate use, and we will probably never be able to prove if any of these three were the source of the infection, but we’ve now got to deal with it and that’s what’s most important moving forward. So, I turn back to Richard. Richard might want to make some comments after.

Professor Richard Kock

Yeah, look, I think what’s most important about this whole story is transparency, and I think, as Scientists, you know, we do it as an international community, and, you know, I’ve been working with colleagues on the COVID-19 across the planet. We have no agendas. We want to understand what’s going on, and so I think, you know, China, in the early period of this outbreak, compared to, perhaps, you know, the SARS outbreak, were pretty transparent, and so, the, you know, the virus was put out there, the genetics were put out there, and I know that some of the bat viruses that were held at the Wuhan Institute, virus institute, were also pulled out of the freezer, but after the outbreak had occurred, and then they looked at that virus in relation to, you know, the current – you know, to try and again do the forensic work to say, well, do we have evidence?

So, I think, you know, when we look at the Scientists and so on – let’s not talk about the Politicians, they have a different agenda, but if we look at the science and the Scientists, I think they’ve been co-operating, you know, we have gene banks which are shared by everybody. So, let’s keep that transparency, let’s keep the agencies working together, and let’s be multidisciplinary, let’s not be too narrow in the way we approach this. It’s not just the Geneticists or the Modellers or the Clinicians, it’s everybody needs to work together, and I would, you know, strongly support that. Talking about spike proteins, yeah, of course, this change had to take place, and, you know, the evidence is, you know, is pretty strong that we’ve now got a virus that is well-adapted to humans, it’s spreading very, very well.

The exact point this happened, it could have been 50 years ago actually, you know, and it’s just as we go back to the old Swiss cheese, to get all things lined up, you know, it takes 50 years. If we look at the history of many diseases, you know, you have these so-called stuttering epidemics, things, you know, if you look at Ebola virus, it started in small places, the odd village here and there, and then suddenly, after 30/40 years, it ends up in a city, you get a big outbreak.

So, I think, you know, we just need to recognise that, you know, these things happen, and it takes time. There’s an increased frequency of it happening, and you know, we need to look at the root causes, and try and – you know, preparedness, response, of course, is vital, but I think we’ve not done enough to really understand some of the fundamental drivers. And I would like to see society as a whole, you know, bringing forward into the political agenda greater investment in looking at risk in relation to what we do as humans in our environment, and this has many benefits. If we can stabilise our ecosystems, if we can reduce the impacts causing climate change, we have a rosier future, we have a healthier future, and nature’s part of that. So, we need to give space to nature, to – you know, that doesn’t – we don’t have a silver bullet in that, it’s just recreating that stability that occurred before. And it does obviously mean our population needs to stabilise, etc., our domestic animal population probably needs to go down. I’ve often said to people we need to reduce meat eating by 75%. It could be done next week, actually, without, you know, affecting people’s diets and nutritional intake that much. So, there are many things we can do. So, I think we need to get on with that, but it’s going to need a very strong, you know, and well-organised and co-operative political agenda globally.

Emma Ross

David, I wanted to pick up on that and ask you that a lot of the investments and the political drive is to put more money and effort into pandemic preparedness and all that that entails, whether it’s stockpiling kit in advance, making deals on vaccines before this happens, you know, strengthening detection and response capacities. It’s been hard enough to get the commitment and the money put into that to prepare us, now we’re talking about we’ve got to put focus and energy into reshaping the way we do agriculture. How do these two knit together and that seems to be further upstream, if we address the more ecological drivers, does that mean we don’t really – we won’t have any need for pandemic preparedness? Is it cheaper to address the drivers? How much of our energy should be spent? Are these in conflict with each other? And please don’t say we should just do everything ‘cause let’s look at some politically practical and feasible way of divvying up the attention. So, David, you must have seen this come up before. Where do we go with this?

Professor David Heymann CBE

Well, you know, Emma, it’s been very hard on the climate change agenda to get health issues. Health issues are one of the most important parts of climate change and we’ve seen glimpses of what can happen with outbreaks with various – such as the outbreak in Sudan that I talked about earlier, after the El Niño event, we know that these things are very – that it’s very important that we do something about the climate change issues. But the health community has been very slow in getting the political leaders to understand the importance of health in that agenda, and that’s a gradual process that people are beginning to learn.

But you asked about preparedness, and certainly, every country needs to be prepared with a basic understanding of infectious disease and public health epidemiology, and we need to be putting our money into that, in helping countries develop that capacity, to understand how diseases emerge in their own countries, what they can do in their own countries to mitigate these or to even prevent emergence, and that could be such a simple thing as making sure that some animals are vaccinated, for example, with Rift Valley fever vaccine, or other simple interventions. But countries need to be empowered to do this, and to do that, they need to have investment from their governments and from the outside, especially if they’re low or middle income countries, on developing the capacity to understand what’s going on epidemiological, at the human-animal interface, in that One Health area of work.

And so, it’s very important that we stop investing so much in global preparedness and getting all these different mechanisms that we can respond to outbreaks and do more at helping countries understand what they might be able to do to prevent at the source. And a good example of this is a very wise Epidemiologist in Bangladesh, who figured out that this virus that Richard mentioned earlier, Nepovirus, was coming from fruit bats into palm sap that was being collected at the top of palm trees and stored overnight in those containers in the top of palm trees, and then the next morning sold in local markets. That was being infected by bats. There’s evidence that bats were infecting that palm sap with the Nepovirus, and the Nepovirus then caused outbreaks in humans.

So, to prevent that at the source, it’s a simple way of doing it. It’s using good national understanding, which occurred because there are good Epidemiologists in Bangladesh, and then covering the containers so that bats couldn’t contaminate them. A very simple solution. And so, this is the way that we can begin to see a change occurring at the microlevel by making sure that countries themselves can do the research and analysis that they need to do to deal with their own infections and their own emergence at the animal-human interface, and then globally, we have to be more wise in getting health and other issues onto the climate change agenda, which is certainly the biggest threat that we have right now to human sustainability, and also, to emerging infections as they continue to occur. Richard may not agree, but, well, I’d like to hear what Richard’s view is on that.

Professor Richard Kock

Yeah, look, I think we need to have strength in our health systems, you know, obviously, we’re not going to get away from infectious disease, and, you know, whether this particular disease is going to have a resurgence through a second wave, it’s – you know, Modellers can predict and plan, but, you know, I think we just need to understand that these things are going to happen. So, we have to be prepared for them, but we also need to recognise that if our systems are generating these problems, we need to look at the systems. I mean, that’s the logic of it. And so, I, you know, I think the agricultural system is a particularly important one, particularly the animal-based, you know, food sources. So I do think we need to examine that very critically and, you know, we can solve many problems actually, including climate change, because it enables us to free up a lot of land for restoration of forests and so on, and that brings that stability back into the system.

And these are big calls, but I think in order to deal with these, you know, fundamental changes that are taking place on the planet, that, you know, in the end, we’re not going to have an economic system probably, if we carry on like this. So, let’s think about a system that is going to be more stable and sustainable, and bring in those regulatory frameworks, but also maintain strong health systems. I – people talk about COVID-19 being a mild disease. It sort of frustrates me because it still kills people, and if it affects, you know, seven billion people, it kills a lot of people.

So, you know, it could be my 91-year-old grandmother, so I’m sort of fed up with that attitude because it’s really wrong. I think it’s fundamentally wrong. You know, we value life, whether it be animal life, plant life, human life. Let’s do our best to reduce the risks, you know, and if you want a really pathogenic disease, there are potentially diseases that will cause 90% mortality on the planet of people. I don’t want that, so I think we must take measures that prevent, you know, such a catastrophe, a sort of prairie dog collapse, because unfortunately, you know, we think we have all the tools to stop it, but look at COVID-19, did we stop that? Did the top, you know, countries, in terms of preparedness and response, did they stop it? Actually, they are demonstrating the worst situation, probably because of that complacency you get from thinking you have, you know, you have a great – you know, that you’re great, that you have a great health system, that you have all the tools and all the magic, but actually, in reality, we are biological and we are at risk. Thanks.

Emma Ross

David, that sounds like something for you to come back on.

Professor David Heymann CBE

Yeah, I would agree. I look at it, as you can see, from a human side, and Richard looks at it from the animal side, and that’s why it’s so important, in the world moving forward, that we work more closely together. And a good example of that is what does occur in the UK, with a unique group that’s been setup between human health and animal health called the HAIRS Surveillance Group. This is a group that, once a month, meets, looks at infections, which are occurring around the world, and decides whether or not these infections, whether they’re in animals or in humans, are a risk to the United Kingdom. If they’re a risk – considered a risk to the United Kingdom, there are then guidelines and preparedness that’s developed.

So, you know, what Richard says and what I say come from two sides of really the same coin, and that same coin is human survival, and to do that, we need to really make sure that we’re including both of those sectors, and the ecological sector as well, in the activities that we do going forward, so that we can be sure that we’re working together and not looking at it from one side or the other, without taking into consideration both sides. And I always like to say that there is a difference. In human health, the bottom line is saving a life. In commercial agriculture, which Richard has said is the majority of animal agriculture or animals in the world, the bottom line is saving lives of animals, but it’s also in making a profit, and that’s where we have to be able to work together to be sure that we can show which is more important at the present.

And a good example is rabies, which is caused by dogs, it’s an emergence from dogs or from rabid animals into humans, and there’s always been a discussion as to who should be vaccinated. Should the animal sector pay for animals to be vaccinated or should the human sector be paying for humans to be vaccinated? And that’s a discussion, which continues to go on in many countries, and agriculture not willing to put in the resources necessary.

Fortunately, in Europe and in many parts of the world, there has been a One Health movement, where animals have been vaccinated with live bait, so that there’s no more rabies in Europe, Western Europe, for example, because those animals have been vaccinated, and this was a joint effort in a One Health approach to make sure the humans were protected by vaccinating animals. The same might be true with MERS coronavirus, which is occurring in the Middle East in camels, carried by camels, maybe there is a vaccine one day that will prevent camels from becoming infected, and therefore, prevent humans, but you can only do that if you’re working human and animal health together, in a One Health environment.

Emma Ross

Just to come onto dogs actually, now that you mention it, there’s a question here that is well upvoted from Guy Taylor, and he’s saying “That’s an amazing number, 96% of animals on the planet are domestic. In the UK, we have over eight million dogs, without any licensing system in force, should we be thinking about bringing one back?” A political hot potato with the electorate, I suspect. So…

Professor Richard Kock

Yeah, perhaps I can jump in on that about animals.

Emma Ross

How scared should we be from dogs?

Professor Richard Kock

Yeah, this is an animal story. Yeah, so, it’s – 96% is the biomass, so, you know, just in case there are a few factcheckers out there. So, you know, it’s a conversion factor, you know, but it’s the same principle, it’s the mass of animals, basically. Yeah, so there are a lot of domestic dogs, you know, there are nearly a billion dogs on the planet, and when David talks about rabies, of course, you know, it’s not a wildlife disease that goes to humans, it’s a dog disease that goes, you know, to humans. I think there have been four bat origin rabies cases in Europe in the last 50 years, so, you know, it’s a dog problem.

I like – I love dogs, and, you know, I’m – I think they’re wonderful animals and they’re a domesticated animal that, you know, brings – has brought human beings an enormous amount. But we do need to recognise that there are a billion dogs, and they have to be fed, and, you know, similarly, you know, with domestic cats and then the food animals, so, you know, this is a huge issue actually, at a global scale. So, I think having dogs for the fun of it, perhaps we have to rationalise, we have to think about do we have, you know, a large dog in a flat in the middle of a city? So, I think we can rationalise why we have these animals.

I personally feel that a lot of the companionship from animals is because we’ve lost companionship with nature. We just don’t have nature around us and we, sort of, need animals. They’re, sort of, part of our DNA actually, in more ways than one. So I, you know, I think that just regulation, but we have to be very careful how we do it, but I’d much rather see society, you know, rationalising and creating conditions in cities in, you know, agricultural environments, which are much more conducive to health and happiness of people.

So, it’s, sort of, returning to some sort of – I’m not going to call it Eden, but, you know, a better structure, if you like, of respect for our environment, and what it gives us, you know, in terms of, you know, oxygen, you know, deals with CO2, provides us with beauty and colour and variety and also microorganisms, let’s face it. So, I feel we need to get back to that, you know, rather than just land is for food, you know, cities are for living, you know, so that is my philosophy, and, you know, I think in this context, we have a good reason actually, for promoting that nature, health and agriculture.

Emma Ross

The dogs thing, is there any reason to fear that dogs are major disease carriers and we should be clamping down on that because we live in such proximity to dogs?

Professor Richard Kock

Well, you know, I’ve – actually, you know, from that perspective, cats are probably a bigger risk because their carriage of things like toxoplasmosis, but no, I think, as I said at the beginning, zoonosis is rare. Zoonosis, direct zoonosis and, you know, from an animal, is really, you know, very, very unusual. You ask the average Physician, human Physician, have you dealt with a zoonosis in your career, let alone this week? It is extremely rare, so we don’t – you know, we get – these animals are – you know, many people will argue that actually owning a dog is better for your health because it actually creates a bit more of this ecosystemic stability, that exposure helps your immune system. So, this idea that isolating ourselves from animals is a good thing, I don’t – you know, I don’t think it’s true.

I think we need to be integrated into our environment, we need to be exposed from a very early age to those microorganisms, so that we get a degree of stability in our system, health in our systems. Why are so many people dying in these western advanced societies with a virus like coronavirus is because I think we buck the system. We create unhealthy people, who are then very vulnerable and susceptible to disease. I’m not saying that we want to stop that because I value what medical science has done in prolonging life and so on, but we need to recognise that that risk is there. So, no, let’s encourage, you know, having contact with animals, but you don’t necessarily have to own them, you know, they can be part of your environment and it doesn’t cost you anything, and it doesn’t cost the planet as much. So, I think we need to rationalise, that’s all.

Emma Ross

David, do you have any last thoughts on that? We’ve got to wrap up soon, maybe one more question after this. Do you have anything quickly to…?

Professor David Heymann CBE

No, I clearly agree with what Richard has said, and I think let’s go to the last question…

Emma Ross

Okay.

Professor David Heymann CBE

…since we have limited time.

Emma Ross

Yeah, and the last question is from Kathleen Rowe, and this is – actually is a good one to wrap up with. “Is there a rational ask of Politicians to allocate a certain percentage of budget towards disease control of pandemic preparedness?” And I’d expand that to, you know, looking at the agricultural, the drivers as well, rather than generally saying we need to be prepared? Is there some minimum investment we should expect from governments to increase our likelihood of being prepared, and protected, I would expand that to? So, a short sound bounty answer from each of you on that. David, do you want to start?

Professor David Heymann CBE

Okay, yeah. What I would say is that each country has the opportunity now to have peer reviewed preparedness assessments done. The UK has gone through one, the United States has gone through one, when people from other public health institutions in other countries come in and work with the National Public Health Institution to determine where the weak points are and what needs to be done. After that, there are budgets made and plans made, and those budgets and plans must be filled by government, whether it’s by assessing their – whether it’s allocating a certain percentage of the budget or some other means, there needs to be investment in public health in countries.

That not only makes sure that there’s preparedness, but, as Richard was saying earlier, it makes sure that those comorbidities that develop in people because of unhealthy lifestyles can be prevented, and that includes such things as smoking, obesity, hypertension, cardiac disease, all the things that cause chronic disease and that put people at greater risk of serious COVID disease, can be dealt with through proper investment in public health, and not just in making an imbalance between investment in curative medicine at the expense of public health. Richard.

Professor Richard Kock

Okay, yeah, I’ll try and be very quick. Yeah, so, I just think it’s a whole of society issue. Let’s get a discussion going. Let’s get, you know, all strata of society, who have a stake in health. You know, it – many, many people have a stake in health, and the Politicians need to be in there as well, and then we get a common understanding of what the problems are, and then we will seek common solutions, and I think, you know, we need strong disciplinary components to health and I, you know, I value that. But I think unfortunately, we’ve rather boxed health into a, sort of, silo, and we don’t – you know, we just pass responsibility to somebody else for the health of the planet, for the health of people, for the health of animals. And, you know, I’m a professional, I appreciate that position, but let’s bring in the whole of society. I think we have to do a, you know, a root and branch examination of what’s happened with COVID-19. Its impact has been far too great to ignore it. We sort of need that, but it needs to be open, transparent, and involve the whole of society.

Emma Ross

Okay, thank you. Thank you both. I think we ought to wrap up now. For any of you that missed the beginning of this, the full recording will be on our website and on YouTube in a couple of hours. But thank you both for joining us, and for a fascinating conversation, which is really taking a step back from what we’ve been doing the last couple of weeks, so it was really interesting to get a bit of perspective, and an important topic. So, thank you very much all for joining us.