Technological and scientific advances in recent years have vastly improved healthcare, either through simple practices like handwashing or cutting-edge advances such as artificial intelligence. Despite this, new infectious diseases still arise from time to time. Diseases cross over between species or mutate to evade modern medicine, causing public health crises ranging from small outbreaks to worldwide pandemics. The world has averaged three pandemics per century since the year 1700, with the time between them ranging from three years to 56 years.
Ending a public health crisis is a global effort as scientists and healthcare professionals work to develop drugs and vaccines, treat patients, and conduct research to better understand the disease. The Global Health Security Agenda is a global initiative launched in 2014 by 69 countries to strengthen the global response to infectious diseases posing a threat to public health. This includes putting measures in place to monitor new outbreaks, immunize citizens against avoidable outbreaks, and partnering public health professionals with law enforcement officials to create strategies to limit the spread of disease. Other efforts that can be taken on a global scale include stopping international travel early on during a new disease outbreak, developing effective tracking methods, and ensuring that hospitals are supplied with sufficient personal protective equipment and medical equipment in case of an outbreak.
This article examines some of Canada’s strongest contributions to global infectious disease crises in recent history: HIV/AIDS, Ebola, and COVID-19. These diseases are still quite prevalent today, unlike other recent disease outbreaks. The swine flu, which caused a pandemic in 2009, is now considered a normal seasonal flu and is covered by the annual flu vaccine, resulting in widespread immunity against it.
Severe Acute Respiratory Syndrome (SARS), which broke out in 2003, is currently not reported anywhere in the world and caused relatively few deaths compared to other outbreaks. While the Spanish Flu pandemic of 1918-1920 had a major impact on lives around the world, there is no scientific research from the period that contributed to the end of the outbreak as scientists were unsure what caused the flu. With the main defence against the disease being quarantine and the use of masks, the disease eventually petered out as infected individuals either died or developed an immunity.
Since HIV/AIDS, Ebola, and COVID-19 continue to threaten lives today with Canadian researchers playing a key role in furthering our understanding of these diseases, this article will focus on discoveries made during these outbreaks.
Acquired Immune Deficiency Syndrome (AIDS) is the disease caused by the Human Immunodeficiency Virus (HIV). The virus originated in chimpanzees as the Simian Immunodeficiency Virus, and mutated to a form that could infect humans when chimpanzees carrying the virus were hunted and consumed by humans. It spreads from person to person through sexual activity or contact with bodily fluids such as blood. This long-running epidemic has infected a staggering 75 million people as of 2019 since it began and killed an estimated 32.7 million as of 2020.
A public health message from the 1980s. Calls to the public to educate themselves on HIV/AIDS often used fear tactics. (Image Source: Smithsonian Magazine)
In the early 1980s, there were severe medical and social repercussions to contracting HIV. With no treatment available, the disease would progress to AIDS, at which point the immune system was so weakened that opportunistic infections caused death within an average of three years. HIV was also a highly stigmatized disease since it first appeared mainly in gay men. Some religious leaders condemned HIV-positive individuals, believing they led unhealthy lifestyles and were thus deserving of the disease.
Today, antiretroviral therapy, which prevents the virus from replicating in the body, can suppress HIV levels to the point that HIV-positive individuals can live long, healthy lives and avoid passing the virus to their sexual partners. Attitudes toward HIV-positive individuals have improved as well. One 2019 study found that 87.8% of undergraduate students interviewed had positive attitudes toward individuals with HIV. Additionally, there are many resources available today to help decrease stigma around HIV/AIDS, such as anti-stigma language guides and HIV educational campaigns.
Dr. Mark Wainberg, former director of the McGill University AIDS Centre, was a notable Canadian HIV/AIDS researcher and activist. In 1989, Dr. Wainberg and his research team discovered that the antiretroviral drug lamivudine, or 3Tc, slowed HIV replication in the body. This drug, still in use for HIV patients today, became one of the first available HIV treatments. Later, Dr. Wainberg helped promote the importance of combination therapy – treating HIV with an assortment of antiviral drugs – upon observing that HIV treatment often failed because the virus could mutate quickly.
Dr. Wainberg made political contributions to the fight against HIV as well. By 2000, the HIV/AIDS crisis in South Africa had reached immense proportions, largely due to then-President Thabo Mbeki’s dismissive attitude toward the issue. The panel of experts assembled by Mbeki to fight AIDS included AIDS dissidents, who believed that AIDS was no more than old diseases given a new name and denied the relationship between HIV and AIDS. Mbeki also made the decision not to supply HIV-positive pregnant women with financially accessible HIV medication that would reduce the risk of passing the disease to their children.
Dr. Mark Wainberg. (Image Source: McGill Publications)
Serving as president of the International AIDS Society between 1998 and 2000, Dr. Wainberg fought to hold the International AIDS Conference 2000 in Durban, South Africa. This act was instrumental in holding Mbeki accountable for the HIV/AIDS crisis in South Africa and making treatment more accessible in the developing world. For example, the conference included South Africa’s first-ever AIDS activist march demanding improved access to treatment, and actions were taken to improve access to HIV medication for HIV-positive pregnant women.
A second important Canadian researcher in the field of HIV is Dr. Francis Plummer, who found evidence suggesting that a vaccine against HIV is possible after observing HIV immunity in some individuals. While conducting a gonorrhea study on female sex workers in Kenya, Dr. Plummer discovered that HIV was common among his participants, which was surprising as HIV was believed to mainly affect gay men at the time. He observed that some of the women did not contract HIV despite multiple exposures. Furthermore, he saw a correlation suggesting that the more time spent as a sex worker, the less likely the woman was to contract HIV. These instances of HIV immunity suggest that an effective vaccine would be possible to develop, and Canadian researchers are currently using Dr. Plummer’s findings for this very purpose.
While the Ebola virus was first discovered in 1976, the most severe outbreak to date began in Guinea in late 2013. This outbreak saw nearly 29,000 cases over 10 countries, with over 11,000 deaths. Ebola spreads through direct contact with bodily fluids, most notably blood and vomit. Due to poor infrastructure in place to contain the virus, such as weak public health systems and monitoring of the outbreak, it spread throughout West Africa. A handful of cases made their way into Europe and the United States but did not lead to outbreaks. On the other hand, West Africa was devastated by the disease. Liberia lost 8% of its doctors, nurses, and midwives to Ebola. Additionally, routine child vaccinations in West Africa decreased by 30% as funding for immunization was redirected toward Ebola efforts. Tragically, an estimated 30,000 children in West Africa were orphaned due to Ebola.
Canadian researchers at the National Microbiology Laboratory in Winnipeg began working on a vaccine for the Ebola virus in 1999, led by Dr. Heinz Feldmann. Since the disease did not pose a threat to Canadians, it was difficult for the researchers to obtain the funding they required to continue developing the vaccine and take it to human trials – it took four years to secure only half of the money they requested for the project. Even before obtaining funding to continue with the vaccine, the researchers had already taken great strides by immunizing mice against the virus with an early version of the vaccine.
A vial of the Ebola vaccine created at the Canadian National Microbiology Laboratory. (Image Source: CTV News)
Despite the funding barrier and the fact that Ebola did not pose an immediate threat to Canadians, the researchers felt it was important to study Ebola because it showed signs of becoming a real threat to public health. During its first outbreak in 1976, it killed 88% of its victims and continued to cause occasional outbreaks in Africa with very high death rates. Also, since Ebola is deadly and highly communicable, the researchers recognized its potential to quickly spread globally and turn into a pandemic or even be used for bioterrorism.
By 2005, the team had created a vaccine, VSV-EBOV, that was 100% effective in macaques. VSV-EBOV is comprised of a benign virus, specifically, vesicular stomatitis virus, coated with Ebola’s protein and sugar exterior, which is the part of the virus that poses a threat to the immune system. Patients can thus build immunity to Ebola’s most dangerous component without being exposed to the virus itself. After the 2013 outbreak, the vaccine proved useful again during another Ebola outbreak in the Democratic Republic of Congo in 2018.
COVID-19, the disease caused by the virus Severe Acute Respiratory Syndrome Coronavirus 2, was officially declared a pandemic by the World Health Organization on March 11th, 2020 and continues to be a threat today. In the relatively short time that this pandemic has been raging, Canadian researchers have already taken strides toward fighting the virus.
The most significant Canadian advancement so far is the isolation of the virus by researchers at Sunnybrook Hospital in Toronto. Isolating the virus is the first step toward studying it for therapeutic purposes and developing a vaccine. According to the researchers, Dr. Samira Mubareka, Dr. Rob Kozak (Sunnybrook Hospital and the University of Toronto), Dr. Arinjay Banerjee and Dr. Karen Mossman (McMaster University), this breakthrough is the gateway toward testing potential vaccines and antiviral drugs against COVID-19 and studying its pathogenesis, the disease’s development. Studying COVID-19’s pathogenesis can help scientists develop better testing methods and treatments and understand how the virus infects and may evolve.
Scientists involved in the isolation of COVID-19. From left to right: Dr. Robert Kozak, Dr. Samira Mubareka, and Dr. Arinjay Banerjee. (Image Source: Sunnybrook Research Institute)
The researchers obtained the virus from clinical specimens, which are samples of matter taken from the human body such as mucosal swabs or blood, from two COVID-19 patients. They then isolated the virus from these samples and were able to culture it, which is to grow it in a controlled setting within petri dishes.
In addition to this discovery, Sunnybrook Hospital is actively working to further our general understanding of COVID-19. Some current studies include brain imaging to determine the impact of COVID-19 on brain health, and investigating whether plasma donations from COVID-19 survivors could be an effective treatment for new patients. COVID-19 studies are also being conducted at other Canadian institutions such as the University Health Network.
Sunnybrook Hospital in Toronto. (Image Source: Sunnybrook Hospital)
Another exciting Canadian discovery comes from London, Ontario, where researchers believe they have isolated six immune system molecules that reach very high levels in critically ill COVID-19 patients. Elevated levels of these molecules can cause hyperinflammation, which can be fatal. The lead researcher, Dr. Douglas Fraser, states that the next step will be developing drugs that block these molecules from reaching critical levels so the immune system can fight the virus more efficiently.
The fact that Canadians have made important contributions to three major disease outbreaks in recent history is something to be proud of. The research on COVID-19 is especially promising as it paves the way for the development of a vaccine or more effective treatment measures. However, Canada’s standing as a global scientific giant is dwindling. When 15 years ago Canada ranked seventh in the world for federal research funding in relation to GDP, it is no longer in the top 30. Ranked fourth in the world for scientific research in 2012, behind only the United States, Britain, and Germany, Canada’s failure to increase funding for scientific research in the 2017 federal budget is indicative that the government is not attempting to maintain that status. As a result, many researchers will need to take on fewer graduate students and trainees, conduct their research outside of Canada, or consider shutting their labs down.
That being said, the breakthroughs discussed in the article show that Canada is capable of producing quality and cutting-edge research that can save millions of lives, should the government decide to re-prioritize funding research. The COVID-19 pandemic may not disappear for a while, but in the meantime, Canadians can be reassured by the knowledge that scientists around the country are working hard to fight the pandemic. When the inevitable pandemic-related panic sets in, it helps to remember the obstacles we have overcome and our past victories against infectious diseases.