International Consultation on Research to Combat Nipah Virus Disease
6-8 August 2018, New Delhi, India
Professor Bhargava, Mrs Preeti Sudan, Dr Gangakhedkar, experts from around the world, distinguished partners and participants, ladies and gentlemen,
In May of this year an outbreak of Nipah virus occurred in the state of Kerala.
By June the outbreak was declared over.
Though the disease killed seventeen people, the toll could have been much worse: In 2017 WHO identified Nipah virus as one of the top eight emerging diseases likely to cause severe epidemics.
It was indeed gratifying to witness how Indian authorities, both at the state and central levels, handled the situation. My congratulations.
The response was rapid, decisive, meticulous and courageous.
WHO was pleased to be part of the response, including by mobilizing and coordinating the international community and supporting critical research efforts conducted by the Indian Council of Medical Research – or ICMR. ICMR demonstrated immense capacity in leading the scientific community and played a fundamental role in supporting the local government stem the virus’ spread.
Indeed, at the same time as immediate, life-saving action is taken, every outbreak of an emerging pathogen provides opportunities to gain new insights into its characteristics and the danger it poses to human health.
In 2004 in Bangladesh, for instance, humans became infected with Nipah virus after consuming contaminated date palm sap. But following subsequent outbreaks elsewhere, many scientists now consider it likely that it is not just bats but several other species of domestic animals that are involved in the chain of transmission, some of them acting as intermediary hosts between bats and humans.
Notably, during the recent outbreak, human-to-human transmission of Nipah virus was documented, including in a hospital setting. That is especially concerning given there is no vaccine against the disease. It likewise underscores the very real danger Nipah virus presents, both in the WHO South-East Asia Region and beyond.
WHO is acutely aware of these realities. They are precisely the reason we have begun work on a Research and Development Roadmap for Nipah virus.
Why a roadmap?
Because there is a clear need for sound, robust planning to go from where we are to where we need to be.
Because there is a clear need to know more about how Nipah virus is transmitted and spread among humans, and to develop medical countermeasures such as diagnostics, therapeutics and vaccines.
And because there is a clear need to be confident in the tools we have and our ability to save life and stop the disease’s spread.
Given these imperatives, WHO attaches great importance to developing and finalizing the Roadmap at the earliest. The meeting we are now gathered for is of critical importance to achieving this outcome.
Owing to our Region’s own experience, we know Nipah virus’ case fatality rate is high.
It follows that if we want to save life and protect public health the infection needs to be diagnosed quickly and accurately, meaning the development of rapid point-of-care diagnostics is an urgent priority.
We then also require safe and effective treatment, including post-exposure phrophylaxis.
That is easier said than done.
We live in a world of competing demands and limited resources. This requires us to prioritize accordingly and proceed in ways that harness available resources to maximum impact. I am confident the brainstorming sessions we will conduct in coming days will be of immense use to this end.
But before proceeding, allow me to flag some of the challenges we are likely to encounter while pursuing our outcome.
First, while dealing with diseases caused by zoonotic infections such as Nipah virus, we may need two distinct streams of R&D. That is because these infections affect both humans and animals, particularly livestock.
We must therefore devise different sets of parameters while deciding research methodologies such as animal models which, in turn, have different regulatory and ethical requirements.
And second, we must contend with challenges related to biosafety while handling the virus, especially given most outbreaks have occurred in rural areas and resource-poor settings. Target product profiles for diagnostics will have to be developed keeping such ground realities in mind. Basic research is also needed in the kinetics of virus detection in cerebrospinal, blood, saliva and other bodily fluids.
Distinguished partners and participants, ladies and gentlemen,
I would also like to emphasize the centrality of the One Health approach in how we think about Nipah virus and its causes and consequences. Indeed, Nipah virus is as much about ecology as about epidemiology. It is as much about human health as about veterinary health.
The One Health approach provides the paradigm needed to understand and address these realities and act accordingly.
I also take this opportunity to note that Nipah virus is, in many ways, a test case for us all. It is a test of how rapidly we can develop a quality research roadmap to an emerging disease. And it is a test of how quickly and effectively we can implement it. It is also a test of our collective ability to meet the challenges emerging diseases present, both now and into the future.
Given the response to the recent outbreak, I am confident together we can pass that test, overcome the challenges we face, and better protect health at the human-animal-ecosystems interface both here and across the South-East Asia Region.
I wish you three engaging and productive days and all success in working towards the Roadmap’s development and finalization.