The ways our changing physical and social environment have shaped the emergence of infectious diseases around the world was the focus of a talk by Yale epidemiologist Dr. Albert Icksang Ko on Sept. 5 at Yale Center Beijing.
Ko, who is chair of the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health and professor of medicine (infectious diseases) at the Yale School of Medicine, also told an audience of Yale alumni and friends about how researchers at Yale are applying innovation and novel analytical approaches to develop solutions for these new global health threats.
Ko began his talk by looking back at the history and development of the field of public health. He pointed to the increase in life expectancy and the decrease in childhood mortality as clear signs of the global progress made over the last few decades in combating infectious diseases. Much of this progress can be credited to simple solutions like vaccines and oral rehydration therapy, he said.
However, with the latest global re-emergence of measles, as well as well-known cases of recent outbreaks of SARS, MERS, and Zika, Ko explained, rapid urbanization, globalization, and climate change have created a perfect storm for infectious diseases to spread.
“For the first time in human history, we have more people living in cities than in the countryside. Rapid urbanization has many consequences for health,” explained Ko. “Urbanization is shaping and changing the types of diseases we’re witnessing.”
Urbanization means higher population density, which leads to quicker and easier transmission of diseases, said the Yale professor, but there are other consequences as well. “People have access to treatment, but don’t complete the treatment, leading to drug resistance in diseases.”
Citing multi-drug resistant tuberculosis in China as a primary example, Ko noted that the standard drugs that used to work in combatting tuberculosis are no longer effective. Drug resistance is creating more complications for the delivery of healthcare globally, he explained.
Urbanization, globalization, and climate change have also created the perfect environment for mosquitoes to thrive. “Mosquitoes are now able to survive and transmit disease in places they wouldn’t have been able to before,” said Ko.
Ko, who spent 15 years in the Brazilian Ministry of Health working with local community groups to fight infectious diseases, was part of a team that was at the epicenter of the Zika outbreak.
“Zika was driven by rapid urbanization and the lack of basic services like refuse collection in slums,” explained Ko. “The vector for Zika virus is mosquitoes, which like to breed in small collections of water.” With the lack of access to basic services like refuse collection and an increase in plastic usage because of the urban lifestyle, mosquitoes carrying Zika were able to breed easily and spread quickly, he said. “The intersection of poverty, environment, and demographics led to a perfect storm.”
After talking about the work his team in Brazil and at Yale did to help combat Zika, Ko went on to say that “we need a new paradigm of understanding and responding to emerging infectious diseases.” When he was being trained as a doctor, Ko said, he was only taught about the interaction between microbes and humans, but now we “need to talk about the genetic and biological factors, ecological factors, physical environmental factors, and social, political, and economic factors” that impact infectious disease transmission.
Along with looking more closely at the various factors that haven’t historically been sufficiently considered in disease transmission, Ko highlighted various projects at Yale that use a multi-disciplinary approach to create innovative global health solutions through tools such as field epidemiology, laboratory research, big data and modeling, and genomics.
Among the many examples he cited at Yale was the Public Health Modeling Initiative, which uses mathematics, epidemiology, economics, and financing to create innovative solutions to global health issues.
Ko concluded by stressing the importance of training and capacity building to help other countries contribute to the fight against global health threats. “Yale has had a long history of working in places like Brazil or Africa or Asia to build the capacity to respond to such epidemics,” whether by giving care, developing new technology, conducting large trials, or doing basic research to understand more about these diseases, he said.
Ko’s talk was part of the Yale Starlight Science Series, which brings outstanding science faculty from Yale University to China to present their latest research, and engage with audiences on related topics of interest. The series previously featured Marvin Chun, dean of Yale College and the Richard M. Colgate Professor of Psychology; Hui Cao, the John C. Malone Professor of Applied Physics and of Physics; and Xi Chen, assistant professor of global health policy and economics at the Yale School of Public Health.
Yale Center Beijing, Yale’s first university-wide center outside of the United States, is a convening space and intellectual hub that advances Yale’s mission to improve our world and develop leaders worldwide who serve all sectors of society. Founded in 2014, the center acts as an activity space for Yale’s collaborations in China, enables the university to expand existing activities and form new partnerships, supports research and study from each of the university’s schools and divisions, and serves as a gathering place for alumni from throughout Asia.