It’s been 2 years since the founder of the Center for Health Security, DA Henderson, died. Like I wrote then and last year, it is an incalculable loss to the field of infectious disease that such a giant voice speaks no more. Personally, it’s rare that I go a day without thinking about him and the wisdom he always about all things infectious.
Last year to commemorate DA, and concretize how pressing public health and infectious disease issues are, I listed things that happened since he died that I — and the world — desperately needed his expert opinion about. So in that spirit, here are my new set of questions for DA.
1. What do you think about Russia and the current state of their former bioweapons program? There’s been a recent book about this topic and you personally debriefed some of the highest level defectors from the Soviet Union. Also, Putin has shown no qualms about using Novichok agents (as well as dioxin and polonium) so is their anything different about biological agents?
2. What’s your take on the number of food borne outbreaks? We had cyclospora and a big E.coli outbreak this year. Is it that surveillance is capturing what we never knew about or is the risk increasing or is it both?
3. The cholera outbreak in Yemen is the biggest ever and compounded by war. How would you tackle it? You dealt with conflict when you eradicated smallpox. Would you advise vaccines? Antibiotics?
4. Back-to-back Ebola outbreaks have occurred in the DRC. The first one came and went but the second is a lot more scary because of the conflict zone in which it occurred. The vaccine seems excellent and was used in the ring vaccination manner — which you developed to beat smallpox — but they can’t find the contacts of cases so well in this 2nd outbreak. Should they just blanket immunize ? What priority should vaccination have when you can’t do contact tracing?
5. Measles elimination in the Americas is no more. Venezuela and their totalitarian government have seen outbreaks of malaria, diphtheria, and now measles transmission for over a year. How can we fix this? You were never a fan of eradication and now it seems measles, which was on the list, is slipping away.
6. We had a bad seasonal flu year and it had hospitals inundated. We seem no where near able to cope with a pandemic and H7N9 looms. I know you don’t have an easy answer but when this pandemic occurs not having you to lead will make it much worse.
7. We have a new smallpox antiviral. I know you had issues with this drug and didn’t have a good idea for how it would be used and definitely opposed it’s research program being used as an excuse not to destroy the samples of the virus but it’s here now. How should we use it? Individual cases? The vaccine should still be the cornerstone of response, right?
8. Horsepox was artificially synthesized in the quest for a better vaccine. I know you would have something to say about that. The standard vaccine’s cardiac side effects weren’t something you thought was significant enough to scrap it and this is the reason cited for the horsepox version. There’s also the debate about this event lowering the threshold for those who want to synthesize smallpox. What do you think about all this? We really missed your voice on this.
9. Polio eradication is still faltering. Just Afghanistan and Pakistan have wild cases and it looks like type 2 polio is gone the way of 3 and we’re just contending with type I. The Taliban hasn’t stopped their anti-vaccine push either. People are getting hyper about vaccine-derived cases and we’re still using the Sabin vaccine in many parts of the world. I know you taught me to think of vaccine-derived cases entirely separately and I’ve been saying that to people. This is the way to do it right? Wild polio first then switch to Salk and deal with vaccine-cases separate, right?
10. What do you think about my Pandemic Pathogens report? I know this is my own vanity but I spent a lot of time thinking about this topic and really want it to impact the field. It hopefully would be something that would make you proud of the time you spent teaching me.
As is apparent, DA’s intellect is needed just as much now as it was when he beat smallpox off the planet. I don’t know if humans will ever produce another DA. It seems like a dream that he existed, but we should all remember him and how the insoluble problems of infectious diseases fell away when his mind faced them.