Traditional drug repurposing, although successful in treating some diseases, still requires considerable time to identify candidate compounds and even more time to test them in clinical trials. Ebola requires and deserves a much more aggressive approach, while still balancing safety and efficacy concerns.

One way to considerably speed up the drug development process is to use high-end, bioinformatics-oriented computing approaches. When applied to drug repurposing, this approach can allow for a much faster identification of candidate compounds. When applied to clinical trials, this approach may quickly provide valuable animal and human information without the need for actual subjects.

With bioinformatics, drug repurposing can be used quickly without resorting to desperate measures that compromise safety. These bioinformatics approaches are already under development for diseases that are prevalent in wealthy countries, like cancer; Ebola provides an opportunity for this potentially game-changing approach to be applied to a disease primarily affecting those in resource-limited countries.

In a recent interview with NPR, Larry Diamond provides insights and analysis on some of the most pressing political developments confronting the world today. 

Nearly 250,000 refugees stopped to rest at the foot of an active volcano in the Democratic Republic of the Congo, recalled Thomas Fingar, referring to a situation in 1994 when he served as the deputy assistant secretary for analysis at the State Department. Officials asked him how to respond. Would the volcano erupt? If so, which way would the lava, ash and gas plumes travel? Must the refugees, exhausted from leaving Rwanda, be relocated to a safer venue? Aid workers had to decide whether to move the refugees and risk death by fatigue, or leave them there and risk death from the volcano. Specialized knowledge was required to make a decision. Fingar directed Bureau staff to find a volcanologist with expertise on that particular volcano­–the Nyiragongo–and its surrounding area. It was likely to erupt, the expert informed them, and the path of volcanic debris would be away from where the refugees were assembled. Consequently, the refugees did not have to move.

That example was one of many illustrations that Fingar, the Oksenberg-Rohlen distinguished fellow at the Freeman Spogli Institute, offered in a keynote speech delivered at the College of William & Mary, drawing upon his 15 years of experience in senior U.S. national security roles.

His presentation entitled, “National Security in the Global Era,” was part of a three-day conference at the Reves Center for International Studies that gathered a cadre of experts to examine the future of global education.

Specialized area studies and foreign language education have reached a critical point in the age of globalization. The current trend is one of steady cuts in funding. If it is not reversed, the nation will quickly lose critical capabilities. Fingar argued that the teaching and study of foreign languages and areas are more important than ever before. 

Fingar (at Left) speaks with colleagues at the conference, which convened a wide range of leaders with global expertise.

“Meeting challenges, managing threats and taking advantage of opportunities on a global scale require different and deeper kinds of knowledge than was required during the Cold War,” he said.

Any effective strategy or policy – whether addressing economic, health or terrorism-related concerns ­– requires in-depth understanding of the countries involved, especially as new transnational threats and global developments emerge.

“If we do not understand, and cannot communicate with, the still highly diverse world, the downsides and dangers of globalization will erode our prosperity, endanger our safety and degrade our security.”

The full text of his speech is available below.

(Updated Nov. 7, 2014)

The Centers for Disease Control and Prevention reported on Nov. 4 that the death toll from the Ebola outbreak in West Africa has risen to above 4,960 and that an estimated 8,168 people, mostly in Liberia, Sierra Leone and Guinea, have contracted the virus since March. It is the largest and most severe outbreak of the Ebola virus since it was first detected four decades ago. All but nine of the deaths were in those three countries; eight were in Nigeria and one patient died in the United States.

The CDC in October proclaimed that in the worst-case scenario, Sierra Leone and Liberia could have 1.4 million cases by Jan. 20, 2015, if the disease keeps spreading without immediate and immense intervention to contain the virus.

Two American aid workers infected with Ebola while working in West Africa were transported to a containment unit at Emory University in Atlanta for treatment, raising public fears about international spread of the highly virulent virus that has no known cure. The two were released from the hospital after being the first humans to receive an experimental Ebola drug called ZMapp. Another man who recently helped an Ebola victim in Liberia traveled to Texas and died in a Dallas hospital. Two of the nurses who treated him caught the virus as well, but have been released from the hospital. Some states have struggled with the moral 

We ask CISAC biosecurity experts David Relman and Megan Palmer to answer several questions about Ebola and the public health concerns and policy implications. Relman is the co-director of the Center for International Security and Cooperation who has served on several federal committees investigating biosecurity matters. He is the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine and of Microbiology and Immunology at Stanford University School of Medicine, and Past-President of the Infectious Diseases Society of America.

Palmer is the William J. Perry Fellow in International Security at CISAC and a Researcher at the UC Berkeley Center for Quantitative Biosciences (QB3), and served as Deputy Director of Policy & Practices for the Multi-University NSF Synthetic Biology Engineering Research Center (SynBERC).

The two of them have answered the questions together.

What is Ebola and how dangerous is it compared to other diseases?

Ebola is an acute viral infectious disease, often associated with severe hemorrhagic fever. While initial symptoms are flu-like, they can rapidly progress, and include vomiting, reduced ability to regulate immune responses and other physiological processes, sometimes leading to internal and external bleeding. The disease has an incubation period that can last up to 21 days, but patients typically become ill four to nine days after infection, and die about seven to ten days later. Fatality rates for the current Ebola outbreak are nearing 60% (according to the CDC), while past outbreaks in the Republic of Congo have seen rates as high as 90%. This outbreak to date has resulted in nearly 1,000 deaths, more than any previous Ebola outbreak.

Ebola virus is believed to reside in animals such as fruit bats where it does not cause disease, but is then transmitted to and among humans and other primates, in whom disease typically does occur. The route by which the virus crosses between species remains largely unknown. People become infectious once they become symptomatic. Ebola is transmitted via blood or bodily fluid, but can persist outside the body for a couple days. Infection can occur through unprotected contact with the sick, but also when contaminated equipment such as needles cut through healthcare workers’ protective gear, and also through contact with infected individuals postmortem.

David Relman Photo Credit: Rod Searcey

Ebola’s horrific symptoms provoke public fear, and it becomes easy to lose perspective on the relative spread and toll of this outbreak. Ebola is relatively difficult to transmit. This means the latest Ebola outbreak is still small in comparison to the hundreds of thousands of people killed each year via more easily transmitted airborne influenza strains and other diseases such as malaria and tuberculosis. It’s important that we not lose sight of more chronic, but less headline-grabbing diseases that will be pervasive, insidious long-standing challenges for Africa and elsewhere.

Is there a vaccine or cure?

There is no vaccine for Ebola and no tried-and-true cure. Health workers can only give supportive care to patients and try to stop the spread to new victims.

Several experimental therapies for Ebola are under development. One receiving attention is ZMapp, a mix of antibodies produced by mice exposed to the virus that have been adapted to improve their human compatibility. Limited tests in primates show early promise, but the drug had not been tried on humans -- until now. Two Americans transported back to the U.S. from West Africa received the experimental therapy. While the two seem to be improving, it isn’t clear that ZMapp was responsible; another issue is that ZMapp and other potential therapies have not been cleared by the FDA for wider use in humans.

The process for approval, and who gets priority access to such drugs, are complex policy issues. The WHO will be convening leaders and medical ethicists next week to discuss how to develop and distribute experimental therapies. This is not a simple task; many factors need to be taken into consideration and balanced with limited information to guide decisions.

Successful or not, and despite any approval, it’s still uncertain whether enough of such drugs could even be produced quickly enough to respond to this particular outbreak, and if not - whether they’d be effective in a future outbreak.

You can listen to Relman in this KQED Public Radio talk show.

Relman joins other experts in a Stanford panel on Ebola

Why has this Ebola outbreak involved so many more people, and spread to a wider geographic area,  than previous outbreaks?

This is an evolving investigation and many potential contributing factors are being examined by scientists racing to collect information that can help them get ahead of the outbreak.

One factor is population density. This latest outbreak spread early into denser population areas within Liberia and Sierra Leone, rather than remain confined to isolated villages, as in earlier outbreaks in Central Africa. With a greater number of people being exposed within a smaller geographic area, the likelihood of transmission increases. Of particular concern is the prospect that the virus might take hold in Lagos, Nigeria, where a handful of cases have been recently identified. If this were to spread in Lagos, Africa’s most populous city, the death toll would likely increase dramatically.   

Another factor is the ability of affected regions to mount an effective public health response. This outbreak is occurring in three of the poorest African countries: Sierra Leone, Liberia, and Guinea. Civil wars have likely contributed to degradation of an already relatively poor public health infrastructure. This is also the first Ebola outbreak in the region, and the inexperience of local authorities can delay responses and fuel fearful community responses, undermining the ability to deal with the outbreak early when it’s more easily contained.

Cultural practices around the care of the sick and the dead can also fuel progression of an outbreak. In some parts of Western Africa, washing deceased relatives is commonplace. Customs like these increase the likelihood of the infection spreading through proximity between infected individuals and their family members

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What can be done to curtail the outbreak?

Isolation and quarantine are key to fighting the spread of Ebola. Isolation involves removing infected individuals from the general population to prevent the spread of disease. Quarantine, however, involves removing uninfected or potentially infected individuals from the general population to limit the spread of disease.

Thus far, the strategy to fight Ebola is dependent on isolating infected patients. Unsurprisingly, isolation efforts have proven hard to enforce. Some families, faced with the prospect of being confined to their homes, have denied the existence of Ebola in their localities, or refuted doctors who claim that one of their family members is sick. This is not unique to Africa; Americans had violent reactions to quarantine during the spread of smallpox. Some regions are now taking more extreme measures: Sierra Leone has deployed its army to enforce isolation at clinics and infected families’ homes, but this also risks civil unrest.

These tensions underscore the necessity of improved education and enforcement mechanisms within public health strategies. Response measures involve fundamental tradeoffs between liberty and safety. Because negotiations occur through complex local, national and international processes, one of the biggest risks is that decisions don’t keep pace with disease spread.

It’s important that we not lose sight of more chronic, but less headline-grabbing diseases that will be pervasive, insidious long-standing challenges for Africa and elsewhere."

How likely is it that the disease will spread into and within the United States?

Currently, airports in Liberia, Sierra Leone, and Guinea are screening all outbound passengers for Ebola symptoms such as fever. This includes asking passengers to complete healthcare questionnaires. However, it is difficult to reliably know who has been infected until they are symptomatic. Individuals could theoretically board a plane before they show symptoms, but develop them upon landing in the United States or elsewhere. This makes containing Ebola difficult, but not impossible.

If the virus were to enter the United States, it would be easier to contain and harder to spread. This virus does not transmit that easily to other humans, especially in settings with good infection control and isolation.

As viruses spread, the chances of genetic variation increase. Yet despite all the concerns from the current outbreak, Ebola is relatively bad at spreading in comparison to respiratory viral diseases such as influenza or measles. The likelihood of a pandemic Ebola virus in the near future seems slim as long as it cannot be transmitted via air.  While it’s possible that the Ebola virus could evolve, there is little evidence to suggest major genetic adaptations at this time.

What are some broader lessons about the dynamics and ecology of emerging infectious diseases that can help prevent or respond to outbreaks now and in the future?

These latest outbreaks remind us that potential pathogens are circulating, replicating and evolving in the environment all the time, and human action can have an immense impact on the emergence and spread of infectious disease.

We are starting to see common factors that may be contributing to the frequency and severity of outbreaks. Increasing human intrusion into zoonotic disease reservoir habitats and natural ecosystems, increasing imbalance and instability at the human-animal-vector interface, and more human population displacement all are likely to increase the chance of outbreaks like Ebola.

Megan Palmer Photo Credit: Rod Searcey

The epicenter of this latest outbreak was Guéckédou, a village near the Guinean Forest Region. The forest there has been routinely exploited, logged, and neglected over the years, leading to an abysmal ecological status quo. This, in combination with the influx of refugees from conflicts in Guinea, Liberia, Sierra Leone, and Cote d’Ivoire, has compounded the ecological issues in the area, potentially facilitating the spread of Ebola. There seems to be a strong relationship between ecological health and the spread of disease, and this latest outbreak is no exception.

While forensic analyses are ongoing, unregulated food and animal trade in general is also a key factor in the spread of infectious diseases across large geographic regions. Some studies suggest that trade of primates, including great apes, and other animals such as bats, may be responsible for transit of this Ebola strain from Central to Western Africa.

What are some of the other political and security implications of the outbreak and response?

Disease outbreaks can catalyze longer-term political and security issues in addition to more acute tensions.

There are complex international politics involved in emergency response and preparedness. Disease outbreaks often occur in poor regions, and demand help from more wealthy regions. The nature of the response reflects many factors - technical, social, political, legal and economic. Leaders often lack the expertise to take all these factors into account. It is an ongoing challenge to adapt our governance processes to be more reliable and move from damage control to planning. Organizations like the World Health Organization can provide guidance, but more resources and expertise are needed to get ahead of future disasters.

When help is provided, there is often mistrust of non-local workers, who can even be seen as sources of the disease. At a political level, distrust has been fueled by disguising political missions as health interventions, as was the case with the effort that led to the locating of Osama Bin Laden.

There are other security implications of this latest epidemic. This outbreak has led to a dramatic increase in the availability of Ebola virus in unsecured locations across West Africa, as well as to a growing number of labs across the world studying the disease. The immediate need to study the disease and develop beneficial interventions needs to be coupled to considerations of safety and security. From a safety standpoint, a rise in the handling of Ebola samples risks accidental transmission. From a security standpoint, those who wish to cause harm with this virus could acquire it from bodies, graves and other natural sources in the affected region. Both of these risks demand attention and efforts at mitigation.

Hunger touches the lives of people throughout the world, from the affluent Bay Area to the most impoverished regions of rural Africa. Food security – the availability of plentiful, nutritious, and affordable food – is a pressing issue for rich and poor countries alike as the world population moves toward 9 billion by mid-century.

In her new book The Evolving Sphere of Food Security (Oxford University Press, August), Professor Rosamond Naylor takes a holistic approach to the question of how to feed the world. Naylor, a professor of environmental earth system science and director of the Center on Food Security and the Environment (FSE), convened 18 colleagues from across Stanford’s diverse disciplines to shed light on the interdependent issues that affect global food security.

Throughout its 14 chapters, and a foreword by former United Nations Secretary-General Kofi Annan, the book takes up two important questions: How does the challenge of achieving food security change as countries develop economically? And how do food and agriculture policies in one country affect nutrition, food access, natural resources and national security in other countries?

Collaboration across disciplines

Naylor, who edited the volume and co-authored several chapters, explained that The Evolving Sphere of Food Security is the first book of its kind to engage faculty and scholars from across Stanford’s campus on issues of global hunger.

Professor Rosamond Naylor

“This book grew out of a recognition by Stanford scholars that food security is tied to security of many other kinds,” said Naylor, who is also William Wrigley Senior Fellow at the Freeman Spogli Institute for International Studies and the Stanford Woods Institute for the Environment. “Food security has clear connections with energy, water, health, the environment and national security, and you can’t tackle just one of those pieces.”

Stanford has a long history of fostering cross-disciplinary work on global issues. It is in this spirit that the idea for the book was born, Naylor said. The book weaves together the expertise of authors from the fields of medicine, political science, engineering, law, economics and climate science.

“Stanford was the ideal place for this project. A book like this exemplifies how collaborative, interdisciplinary research can be greater than the sum of its parts,” Naylor said. “We have painted a much more inclusive picture of food security than if we had approached these questions from only one discipline.”

Rooted in field research

Another unique feature of the book is that each author’s insights are shaped by years of hands-on research and policymaking experience around the world.

Several authors, for example, have been instrumental in shaping U.S. and global food policy for decades. Walter Falcon, professor emeritus of economics and the deputy director of FSE, traces his career as an agricultural economics advisor to the Indonesian government, where he witnessed the country’s dramatic improvements in combating hunger and poverty since the 1960s.

Political science professor Stephen Stedman recounts his experience as a security policy advisor to the United Nations during the 2000s. Recognizing that food insecurity can exacerbate civil conflict, weaken governments and threaten international stability, Stedman worked to integrate food security into traditional security agendas.

Other authors have spent many years working in East Asia, Africa, South America, the Middle East and Europe. As a whole, said Naylor, the team has conducted well over a hundred years’ worth of field research all over the world.

Challenges evolve as countries develop

A recurring theme throughout the book – also reflected in its title – is the evolving nature of the food security challenges countries face as they move through stages of economic growth. At low levels of development, countries struggle to meet people’s basic needs. For example, Naylor’s chapter on health, co-authored with Eran Bendavid (medicine), Jenna Davis and Amy Pickering (civil and environmental engineering), describes a recent study showing that poor nutrition and rampant disease in rural Kenya is closely tied to contaminated, untreated drinking water. Addressing these essential health and sanitation issues is a key first step toward food security for the poorest countries.

As nations rise above the bottom rungs of development, they encounter new challenges. Scott Rozelle, director of the Rural Education Action Program, warns that middle income countries like China now face a “second food security crisis” of widespread micronutrient deficiency. Recent rapid economic and agricultural advancements have largely solved the problem of supplying sufficient calories. But this progress masks what Rozelle describes as “hidden hunger,” or a lack of vitamins and minerals that impedes kids’ school performance and could slow China’s long-term growth. Even in rich countries like the U.S., said Naylor, malnutrition can be a drag on educational and economic performance.

Developed countries face other unique tradeoffs in the use of resources for food production. In his chapter on water institutions, Buzz Thompson, professor of law and co-director of the Woods Institute, explains that conflicts over water increase between smallholder and industrial users as countries develop. Eric Lambin, professor of environmental earth system science, and Ximena Rueda, research associate in earth sciences, offer the paradox that as countries grow wealthier, changing patterns of agricultural land use may actually worsen food security by fueling the spread of obesity and diabetes.

At its core, said Naylor, The Evolving Sphere of Food Security is about more than economic and policy trends. “The book puts a human face to food security, because hunger is an intensely human experience,” she said. “This book tells an integrated story about people’s lives, and how they are shaped by resource use and the policy process around global food security.”

According to a new study co-authored by Stanford professor David Lobell, the chance of a worldwide slowdown in agricultural yield growth in the next two decades is significantly higher due to global warming.

Lobell and co-author Claudia Tebaldi, a senior researcher at the National Center for Atmospheric Research, set out to estimate the odds of a steep drop in global wheat and corn yield progress under several climate scenarios. The study, “Getting caught with our plants down: the risks of a global crop yield slowdown from climate trends in the next two decades” appeared in Environmental Research Letters.

Lobell said he was motivated to pursue the study based on questions posed by stakeholders and decision makers in governments and the private sector.

“I’m often asked whether climate change will threaten food supply, as if it’s a simple yes or no answer,” Lobell said. “The truth is that over a 10 or 20 year period, it depends largely on how fast the Earth warms, and we can’t predict that very precisely. So the best we can do is try to determine the odds.”

Lobell and Tebaldi calculated the chance of a 10 percent global yield loss from climate change over the next 20 years, which would represent a severe impact on food supply, enough to roughly halve the rate of yield growth.

The short time frame of the study was deliberate, Lobell said. “Many studies have looked at climate and agriculture trends over the coming 50 or 100 years. But the next two decades are when most of the global population growth, and dietary shifts driven by a growing middle class, will occur. The growth rate of food demand will be higher during this time than at any other time in the next century.”

Without human-induced global warming – in other words, in a world with only natural climate variability – the likelihood of a yield drop that large is only 1 in 200. But when the team accounted for global warming, they saw the odds jump to 1 in 10 for corn and 1 in 20 for wheat. “In this study, we did not try to estimate the most likely impacts of climate change on crops,” Lobell said. “Rather, we estimated the likelihood of a really major impact, not because we want to scare people, but because there are many people who want to be prepared for all contingencies.”

“The point of the paper is to move from hand-waving about scenarios of what could go wrong, to specific and transparent estimates of the actual odds,” Lobell said. “The odds are not very high, but they are significant and a lot bigger than they used to be. The people asking these questions are accustomed to planning for scenarios with much less than a 10 percent chance of happening, so it will be interesting to see whether this study has any effect on how they operate.”

Lobell adds that organizations working toward global food security, and related issues such as conflict prevention, are most interested in the next 20 years because their decisions rarely consider the more distant future.  “As scientists, we might prefer to work on time scales in which the answers are clearer, but we also want to be responsive to the actual concerns and questions that decision makers have.”

Lobell is associate professor of Environmental Earth System Science at Stanford and associate director of the Center on Food Security and the Environment. He is also a senior fellow at the Stanford Woods Institute for the Environment and the Freeman Spogli Institute for International Studies.

Contact:

David Lobell: dlobell@stanford.edu

Laura Seaman, Communications and External Relations Manager, Center on Food Security and the Environment: lseaman@stanford.edu

A new book edited by FSE director Roz Naylor and deputy director Walter Falcon brings together 21 of the leading global experts on food security and food policy.

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The new volume, like the original lecture series, convenes policy experts from around the world in the fields of food and agricultural development, for a comprehensive dialogue on pro-poor growth and food security policy.

Together, the contributing authors examine the major themes of hunger and rural poverty, agricultural productivity, resource and climate constraints on agriculture, and food and agriculture policy. With a focus on sub-Saharan Africa, the volume also draws on lessons from other parts of the world, notably Asia. 

With the goal of making the book's research insights accessible to a broad global audience, FSE self-published the Frontiers in Food Policy through CreateSpace, and Amazon.com company. Readers can purchase the volume for under $10 through Amazon, CreateSpace and other online sellers. Individual chapters are also freely available in PDF format, and videos of each of the fifteen symposium series lectures are accessible on the FSE website.

The lecture series and book volume were funded by the Bill and Melinda Gates Foundation. 

The new president of the International Rescue Committee, David Miliband, has taken on the challenge of the largest refugee crisis in recent history. The former UK foreign secretary talks with CISAC affiliate Anja Manuell about the most pressing refugee issues today, including those in Syria, Iraq and South Sudan.

The International Rescue Committee has worked closely in the field for CISAC and FSI's UNHCR Project on Rethinking Refugee Communities, hosting and coordinating a visit to Ethiopia last year by Stanford students researching ways to improve conditions at refugee camps via technology and design.

Manuel interviewed Miliband at the World Affairs Council of Northern California.