A 21-vaccination salute to the founders of ProMED

Editorial by Merritt Clifton

What causes more animal suffering than even the meat industry?

Zoonotic disease does, meaning diseases transmitted by animals to humans, and sometimes to animals from humans.

Many, if not most, of the most abusive practices in factory farming evolved in response to zoonotic disease, as did culling street dogs and feral cats in response to diseases including rabies, SARS, and the Black Death of the Middle Ages.

Barbara Hatch Rosenberg

The front line of global defense against zoonotic disease outbreaks since 1994 has been the Program for Monitoring Emerging Diseases, a program of the International Society for Infectious Diseases.

60,000 readers per day

Now reaching more than 60,000 online readers worldwide per day, primarily public health professionals, ProMED-mail on December 18, 2014 presented the 20th Anniversary ProMED-mail Award for Excellence in Outbreak Reporting on the Internet to ProMED cofounders Barbara Hatch Rosenberg, Stephen Morse, and Jack Woodall.

Prefaced ProMED editor Larry Madoff, M.D., “In 1994, these individuals had the foresight to recognize the growing importance of emerging biological threats. At the same time, they understood the potential of the Internet in detecting and communicating these threats. Finally, they realized the usefulness of “informal” sources of information, both inside and outside traditional health systems, and the need for transparency in outbreak reporting. They collaborated to found ProMED-mail and launch it as a network of only 40 members. This seed grew to encompass many thousands of individuals all over the world and to become a widely used and highly respected source of global public health epidemic intelligence.”

Larry Madoff

Among the first ProMED-mail postings was a letter to The New York Times from Rosenberg, then director of the Federation of American Scientists Biological Program.

Next global epidemic

Opened Rosenberg, “The next global epidemic, which may be more devastating than AIDS, is waiting to strike, and we are pitifully unprepared to fend it off. In recent years new diseases have been emerging and old ones reappearing in all parts of the world, spurred by environmental disruption, population movements, urban crowding, and the intrusion of commerce into once-isolated corners of the earth.”

After detailing her case for several paragraphs, Rosenberg concluded by noting a “pressing need for surveillance to spot new disease outbreaks early, while there is still time to stop their spread. AIDS has shown the difficulties of trying to cope with a disease once it has become established,” she wrote.

“Yet, astonishingly enough, even now no country, including the United States, and no international organization, has a system for monitoring the emergence of new or unexpected diseases. Alarmed at the potential for worldwide disaster,” Rosenberg continued, “prominent infectious disease experts from some 40 countries and every continent have come together to draft and seek international support for a global program to monitor emerging diseases. The World Health Organization would like to implement this proposal, but it cannot do much without resources and support from its member governments.”

WHO, 20 years later, still tends to respond to emerging diseases at least a day late and a dollar short, despite the efforts of many dedicated WHO personnel. Structurally, as an arm of the United Nations, WHO is too politicized and involved in too much else to monitor emerging disease effectively.

Stone soup

But the ProMED listserv does. Begun by a handful of epidemiologists, including Rosenberg, Morse, and Woodall, who set up and moderated the postings on a rotating basis as volunteers in their limited free time, ProMED today still works much as it did in 1994, on a “stone soup” basis.

The ProMED budget, even today, is much less than the cost of safely treating even one human Ebola, Hendra, SARS, or rabies case––and is a fraction the size of the budgets of many national and international animal advocacy organizations that do far less to reduce animal suffering.

Jack Woodall

ProMED today has several dozen moderators. Some of the cofounders, having retired from long and distinguished conventional careers in academia or government or hospital medicine, now give ProMED full-time attention, along with other older experts who joined later and pitched in.

Each ProMED moderator is an eminent authority on specific types of zoonoses. Drawing upon their far-ranging expertise, the moderators provide on-the-fly peer review of postings, offering thoughtful commentary about the evidence and what it may point toward.

Most importantly, however, ProMED draws immediately from the cumulative knowledge of all 60,000 participants. Few if any other networks pool, sift, and rapidly distill a comparable volume of ideas and information pertaining to any sort of fast-developing problem.

Newsroom

ProMED could be compared to a responsibly managed newsroom. Indeed it is a newsroom, albeit with the reporters and editors scattered about the globe. But ProMED also and perhaps more aptly could be compared to the triggering mechanism for the immune system of an organism, recognizing threats as rapidly as they appear and relaying information that enables public health agencies worldwide to respond.

As a ProMED member almost since inception, already citing ProMED postings in news coverage before Rosenberg wrote to The New York Times, I recall that the official response to almost every emerging disease pandemic of the past 20 years has at least at first included doing almost the opposite of the moderators’ advice.

I also recall that some of the moderators themselves, especially in the early years, at times offered “conventional wisdom” that they later recognized themselves as misguided, after they learned much more from other members about the cultural, animal behavioral, and ecological dimensions of the issues they were confronting.

Skepticism about the efficacy of “stamping out,” for example, the medieval approach to trying to quell a disease outbreak by exterminating the host species, evolved slowly.

An understanding of the contributions of humane work to zoonotic disease control, and even more, of the potential of humane work and animal advocacy to advance zoonotic disease control, has evolved more slowly still. This has not been, however, because of any evident resistance to the notion among the ProMED community, but rather because of the conspicuous lack of participation in ProMED by those members of the humane community who work at the forefront of providing public information about many zoonotic disease vectors, and lead the universe in providing anti-rabies vaccination.

One Health

Explained Woodall to me in 2012, while launching another of his projects, the international One Health network to further appreciation of how human and animal health maintenance are a continuum, “Of course we understand the concerns of the humane sector; it is important they understand what we are trying to do, as set out in our mission statement:  http://www.onehealthinitiative.com/mission.php.

“We are just three guys and a gal trying to improve communication between all sectors involved in human and animal (and eventually plant) health for our mutual benefit.”

The obstinate resistance among the humane community to joining and using ProMED to share expertise is to me a mystery as bewildering as why much of the humane community opposes bio-engineering in any form, even when it vastly reduces the numbers of animals used in experiments, opposes vaccination, formally opposed spay/neuter from 1923 to 1973, and currently embraces pit bull advocacy despite the reality that pet pit bulls kill more other animals each year in the U.S. alone than are killed in any major university laboratory.


 AIDS was the last major disease to erupt and wreak havoc pre-ProMED. Something else may yet come along––indeed, may already be spreading––that will have a catastrophic effect comparable to AIDS, confounding the ProMED network much as resistant bacteria thwart antibiotics, but as of the moment, post-ProMED, even the most virulent epidemics have been contained while still afflicting relatively few humans.

Ebola-Marburg

The Ebola-Marburg outbreaks currently underway that have killed nearly eight thousand people in half a dozen African nations might have been vastly worse if ProMED had not been keeping the international disease control community informed about Ebola outbreaks, research, and containment measures since the disease was first medically recognized.

ProMED has also contributed mightily to lowering the animal death toll from disease, even though disease containment efforts continue to kill more domestic animals than any other human activity except slaughter for human consumption.

Despite my long tenure as a ProMED member, I have not had the opportunity to become personally acquainted with cofounders Rosenberg, whom I have never met, or Morse, whom I believe I met once.

But I have long been privileged to often exchange e-mails about zoonotic disease issues and to seek the advice of Jack Woodall and another ProMED founding moderator, Charles Calisher, a professor emeritus at the Colorado State University College of Veterinary Medicine and Biomedical Sciences.

Don Quixote

Wrote Calisher, the 2000 recipient of the ProMED-mail Award for Excellence in Outbreak Reporting on the Internet, when Woodall was previously honored in 2004, “No one is more deserving of recognition. A founder of ProMED-mail, its driving force, and its repository of institutional history, Jack’s continued devotion and hard work inspire all of us. From the day that Jack called me to tell me what the Federation of American Scientists were hoping for, with Jack as the Don Quixote in all this, I was sure it would be a success.

“Remarkable in retrospect, in 1994 not many people had e-mail, but Jack and I pooled all the e-mail addresses we had (including cousins) and we started sending messages. These mostly were items clipped from newspapers, rumors we had heard, stories from TV and radio, etc. As the number of subscribers grew from a paltry few to tens, then hundreds, then thousands, now tens of thousands, the complexity of the system, the need to respond to people who had written to us, and the eight or more hours per day, every day it was taking me were discouragements and I thought of bowing out. But then I would feel guilty at the thought of leaving so much more work for Jack, so I would get back at it again until gloominess overtook me again.

ProMED staff at the International Meeting on Emerging Diseases and Surveillance, 2013.

“Not Jack. He was always positive, always hopeful, always willing to stay up (all night, if necessary), always cheerful and positive. He made a great role model and I am very pleased that I stuck with it for so long.”

Born in Tianjin

Now 79, Woodall recalled to me several years ago that he “was born in Tianjin on the China coast of British parents, and have been back several times. My mother, pregnant with my younger brother, entered the British Hospital on December 1, 1941. Peter was born on December 2, after the hospital had been occupied overnight and renamed the Japanese Imperial Hospital of Tientsin, the city’s former name. Ever see the movie Empire of the Sun? We were all together in that civilian internment camp outside Shanghai for the rest of the war.”

ProMed moderator Marjorie Pollak

Surviving that horrific childhood, Woodall before cofounding ProMED achieved distinction in a variety of leadership roles with WHO in Geneva, Switzerland; the Centers for Disease Control in San Juan, Puerto Rico; and as director of the Arbovirus Laboratory at the New York State Department of Health in Albany, New York. He is now director of the Nucleus for the Investigation of Emerging Infectious Diseases at the Federal University of Rio de Janeiro, Brazil.

Along the way, Woodall has often taken calculated risks as great as any undercover investigator to discover the sources of deadly disease.

Braving machetes

“I’ll never forget standing at the side of a cattle slaughter platform in Ibadan, Nigeria, in the half-light of dawn, with slaughtermen wielding machetes with gay abandon, me holding sterile McCartney flasks under the slashed carotids to collect blood for virus Studies,” Woodall mentioned to me once during a discussion of Crimean-Congo hemorrhagic fever. “It was a miracle to me that nobody lost an arm or a leg in the chaos. We also tried to collect ticks from the carcasses afterwards.”

Eventually Woodall and other ProMED participants established that the Crimean-Congo hemorrhagic fever is an occupational illness of livestock handlers and slaughtermen in much of the world because the ticks who carry the Crimean-Congo hemorraghic fever virus leap from dying livestock to nearby humans––and because the virus itself travels from animal to human with spurting and splashing blood.

ProMED-mail moderator Tam Garland with students at Texas A&M University.

I was honored to have a minor part in that investigation myself, as well as parts in several other ProMED-led investigations, chiefly pertaining to rabies,  for which I received the 15th annual ProMED-mail Award for Excellence in Outbreak Reporting on the Internet in 2010.

Acknowledgements

Other past ProMED-mail winners include leading members of the teams who identified mad cow disease in humans, the H5N1 avian influenza, Nipah virus, and Sudden Acute Respiratory Syndrome.

Shamsudeen Fagbo, DVM, MSc., coordinator of zoonotic diseases for the Ministry of Health in Riyadh, Saudi Arabia, received the 2001 ProMed-Mail Award chiefly for his work on Rift Valley Fever, an tick-borne illness afflicting hooved animals in both North and Sub-Saharan Africa––but Fagbo has also made a huge, if indirect contribution to humane literature with his observations about zoonotic diseases transmitted by eating dogs. In addition, Fagbo was the second known reader of ANIMALS 24-7, commenting on one of our first posted articles less than 20 minutes after we opened the site to public viewing.

Arnon Shimshony

To attempt to list all of the ProMED award winners and moderators who have contributed time and expertise to my reporting over the years, beyond those already mentioned, runs the risk of accidentally omitting some who should certainly be included.

Martin Hugh-Jones

Among them, though, are also Marjorie Pollack, Stuart Handysides, Donald Kaye, Susan Baekeland, Pablo Beldomenico, Peter Cowen, Tam Garland, Martin Hugh-Jones, Matthew Levison, Larry Lutwick, Eskild Peterson, Craig Pringle, Arnon Shimshony, Tom Yuill, and Joseph Dudley, with apologies to anyone I neglected to mention.

These people, little known to most of the humane community, are as much at the forefront of relieving and preventing animal suffering as any animal advocate. In lieu of the shots from a 21-gun salute on a ceremonial occasion, they are quietly honored with vaccinations and other disease prevention measures, each and every day.

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