The Remarkable History of Infectious Disease, with Anthony Fauci

Question: Who are we? 

Anthony Fauci: That’s a difficult question. I’ll start with the one that I’m very familiar with because it’s what I do. And I think that the whole issue of global health and health, if you look at history, how diseases have shaped societies going back from the Bubonic plague of the early centuries, to the pandemic influenza of 1918, to the total decimation of the Inca and Aztec populations by measles and small pox, I think that health issues have played a major role on how society has been shaped.

And then, as the era of understanding disease and being able to do something about disease has occurred, there has been a rather dramatic protection against the unavoidable decimation of disease; but mostly in the developed world.

And the thing that I see even now as an answer to your question is that we need to have a more global appreciation of the problems that other people have. Because it’s very interesting that, some years ago when I was first getting involved in medicine – and even in the arena of infectious diseases, which is my sub-specialty – there were very well placed people in this country [USA]  who were actually saying that you can forget about infectious diseases because they’ve essentially been conquered. We’ve got vaccines. We’ve got anti-microbials. You can conquer infectious diseases.

Which means they weren’t paying attention to, as they were saying that; maybe in our own country, in the United States, or Europe, or Australia, or Canada that was going on; but in the developing world, more than a million people were dying of malaria. A million and a half people were dying of tuberculosis. Hundreds of thousands, if not a million people were dying of neglected tropical diseases [NTDs].

So really, disease has a major impact not only historically in the shaping of our society, but also even today where there are the “haves” and the “have nots” of the world. I would hope that an appreciation of that will have us continue to try and do more and more.

Science is telling us that we can do phenomenal things if we put our minds and our resources to it.  I think science is probably the best example of you put resources into something, and you let the creativity and the brilliance of the minds throughout the world – and certainly not only in this country [USA], throughout the world – and phenomenally good things can happen.

You’ve got to make sure that there’s checks and balances on that, because science can also lead to things that are not so good. There’s ethical issues of manipulation at the genomic level. The whole issues of embryos and creating people to your own fashionable, boutique-liking. All those things you’ve got to be really, really careful of. 

But science, at its most pure, where you’re looking for discovery, and you’re going to use discovery for the betterment of mankind; I think science stands out among some of the most important endeavors that humankind can pursue.

This is just only a somewhat provincial view. There was a period in my own discipline of infectious diseases back in the late 19th century when people were just starting to appreciate the germ theory of disease. Instead of the historical components, we had these plagues. We had these influenzas. We have ______. We have this. We have no idea where it comes from.

There were a group of people – Louie Pasture, Cook; all of the group from the Institute Pasteur [in French: Institut Pasteur de Lille; also known as, Pasteur-Lille], the German group, Matchnikoff and others – who were able to take a field that was completely bare bones and no one had any idea what was going on, to actually make those first initial discoveries that a microbe actually caused tuberculosis. You can actually take that microbe. You can inject it into someone or into an animal, and you can create the disease that you once thought was just some ______ from heaven that caused it.

So the heroes and the people that I look up to were those people who struggled against a complete, vast unknown.

Right now there’s so much known in science that when I and my colleagues do it – although we occasionally make transforming discoveries – we’re standing on the shoulders of giants who didn’t have what we have 100 or so years ago when they made those phenomenal discoveries.

Well I don’t know if it’s a universal truth, but I think that mankind evolves. There’s no doubt that we have evolved. The whole issue of evolving through carious lower species to our own species of the human.

But there’s also the continuing evolution that is associated with mankind. And a lot of that is using what specifically and particularly and peculiarly makes you a human being. And that is your intellect and your will. You have a choice. You can analyze things, and you can act in an intellectual manner.

And that is, to me, at the very foundation of what science is – how you can better your own lot, the lot of the other citizens of the world, while you’re paying attention to and preserving the world you live in, which is the reason why things like the environment are so important.

And we try and analyze are we doing things that are detrimental to the environment. And if so, how do we stop it? And if we have to stop it, how do we replace it with something that’s environmentally friendly?

And I think science is going t lead us there. And it’s the good will that you have to try and preserve your own species, as well as preserve the environment, i.e. our planet, so that we can have thousands of more years of people doing good things and leading good lives.

 

Recorded On: July 6, 2007

Anthony Fauci on the past, present and future battles against disease.

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The Barry Glacier gives its name to Alaska's Barry Arm Fjord, and a new open letter forecasts trouble ahead.

Thanks to global warming, the glacier has been retreating, so far removing two-thirds of its support for a steep mile-long slope, or scarp, containing perhaps 500 million cubic meters of material. (Think the Hoover Dam times several hundred.) The slope has been moving slowly since 1957, but scientists say it's become an avalanche waiting to happen, maybe within the next year, and likely within 20. When it does come crashing down into the fjord, it could set in motion a frightening tsunami overwhelming the fjord's normally peaceful waters .

"It could happen anytime, but the risk just goes way up as this glacier recedes," says hydrologist Anna Liljedahl of Woods Hole, one of the signatories to the letter.

The Barry Arm Fjord

Camping on the fjord's Black Sand Beach

Image source: Matt Zimmerman

The Barry Arm Fjord is a stretch of water between the Harriman Fjord and the Port Wills Fjord, located at the northwest corner of the well-known Prince William Sound. It's a beautiful area, home to a few hundred people supporting the local fishing industry, and it's also a popular destination for tourists — its Black Sand Beach is one of Alaska's most scenic — and cruise ships.

Not Alaska’s first watery rodeo, but likely the biggest

Image source: whrc.org

There have been at least two similar events in the state's recent history, though not on such a massive scale. On July 9, 1958, an earthquake nearby caused 40 million cubic yards of rock to suddenly slide 2,000 feet down into Lituya Bay, producing a tsunami whose peak waves reportedly reached 1,720 feet in height. By the time the wall of water reached the mouth of the bay, it was still 75 feet high. At Taan Fjord in 2015, a landslide caused a tsunami that crested at 600 feet. Both of these events thankfully occurred in sparsely populated areas, so few fatalities occurred.

The Barry Arm event will be larger than either of these by far.

"This is an enormous slope — the mass that could fail weighs over a billion tonnes," said geologist Dave Petley, speaking to Earther. "The internal structure of that rock mass, which will determine whether it collapses, is very complex. At the moment we don't know enough about it to be able to forecast its future behavior."

Outside of Alaska, on the west coast of Greenland, a landslide-produced tsunami towered 300 feet high, obliterating a fishing village in its path.

What the letter predicts for Barry Arm Fjord

Moving slowly at first...

Image source: whrc.org

"The effects would be especially severe near where the landslide enters the water at the head of Barry Arm. Additionally, areas of shallow water, or low-lying land near the shore, would be in danger even further from the source. A minor failure may not produce significant impacts beyond the inner parts of the fiord, while a complete failure could be destructive throughout Barry Arm, Harriman Fiord, and parts of Port Wells. Our initial results show complex impacts further from the landslide than Barry Arm, with over 30 foot waves in some distant bays, including Whittier."

The discovery of the impeding landslide began with an observation by the sister of geologist Hig Higman of Ground Truth, an organization in Seldovia, Alaska. Artist Valisa Higman was vacationing in the area and sent her brother some photos of worrying fractures she noticed in the slope, taken while she was on a boat cruising the fjord.

Higman confirmed his sister's hunch via available satellite imagery and, digging deeper, found that between 2009 and 2015 the slope had moved 600 feet downhill, leaving a prominent scar.

Ohio State's Chunli Dai unearthed a connection between the movement and the receding of the Barry Glacier. Comparison of the Barry Arm slope with other similar areas, combined with computer modeling of the possible resulting tsunamis, led to the publication of the group's letter.

While the full group of signatories from 14 organizations and institutions has only been working on the situation for a month, the implications were immediately clear. The signers include experts from Ohio State University, the University of Southern California, and the Anchorage and Fairbanks campuses of the University of Alaska.

Once informed of the open letter's contents, the Alaska's Department of Natural Resources immediately released a warning that "an increasingly likely landslide could generate a wave with devastating effects on fishermen and recreationalists."

How do you prepare for something like this?

Image source: whrc.org

The obvious question is what can be done to prepare for the landslide and tsunami? For one thing, there's more to understand about the upcoming event, and the researchers lay out their plan in the letter:

"To inform and refine hazard mitigation efforts, we would like to pursue several lines of investigation: Detect changes in the slope that might forewarn of a landslide, better understand what could trigger a landslide, and refine tsunami model projections. By mapping the landslide and nearby terrain, both above and below sea level, we can more accurately determine the basic physical dimensions of the landslide. This can be paired with GPS and seismic measurements made over time to see how the slope responds to changes in the glacier and to events like rainstorms and earthquakes. Field and satellite data can support near-real time hazard monitoring, while computer models of landslide and tsunami scenarios can help identify specific places that are most at risk."

In the letter, the authors reached out to those living in and visiting the area, asking, "What specific questions are most important to you?" and "What could be done to reduce the danger to people who want to visit or work in Barry Arm?" They also invited locals to let them know about any changes, including even small rock-falls and landslides.

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