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Thinking systemically in a shrinking world: disease

emergence, global change and human carrying capacity

Visva Bharati University, Shanti Niketan W.B. India, September 3, 2013

Prof Colin Butler, ARC Future Fellow

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“As early as my first years at University I had begun to feel misgivings about the opinion that mankind is constantly developing in the direction of progress.

My impression was that the fire of its ideals was burning low without anyone noticing it or troubling about it.”

Albert Schweitzer (1875-1965)

(Nobel Peace Laureate, advocate of ahimsa)2

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I selected a beautiful place, far away from the

contamination of town life, for I myself, in my young

days, was brought up in that town in the heart of India,

Calcutta, and all the time I had a sort of homesickness

for some distant lane somewhere, where my heart, my

soul, could have its true emancipation...

I knew that the mind had its hunger for the ministrations

of nature, mother-nature … "

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“It was always the objective in Santiniketan that

learning would be a part of life's natural growth.

The first step towards this objective was to

establish in the child a sense of oneness with

nature. A child has to be aware of his

surroundings - the trees, birds and animals

around him. The mind is deprived if one is

indifferent to the world outside. From the

beginning, he wanted his students to be aware of

their environment..”4

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Dian Fossey (1932-1985) and young mountain gorilla

Eco-connection

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Three examples

1. Infectious Diseases of Poverty (journal article) (2012)

2. Climate Change and Global Health (edited book)

(2014)

3. Human carrying capacity and human health (journal

title) (2004)6

Thinking systemically in a shrinking world: disease emergence, global

change and human carrying capacity

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Acknowledgements

6 “Di TRGIV: “Environment, agriculture and infectious

diseases of poverty”

Prof AJ McMichael (ANU)

Prof Xiao-Nong Zhou (China CDC)

WHO Technical Report

Also Bianca Brijnath, Adrian Sleigh

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Special Programme for Tropical Diseases Research

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EIDs = emerging infectious diseasesGEC = global environmental change

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A. Global environmental change

B. Nipah virus case study

C. Emerging infectious diseases: a call for deeper

thought

D. What causes a really major epidemic?

E. Thinking systemically – things are connected

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resources climate nutrition governance

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weakening global health determinants

global environmental change

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0-2013 c.e.

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Borlaug’s warning Nobel prize speech

President Reagan: population problem “vastly exaggerated”

Le Bras: “The problem has become a bit passé” (US Pop Mtg)

1st “check”

2nd “check”

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Last Glaciation

CO2 has not been this high in >half a million years.CO2 from fossil fuel is dominant cause of current warming.

Last interglacial

350

300

250

200

Carbon Dioxide Concentration (ppmv)

600 500 400 300 200 100 0

Thousands of Years Before Present

[Adapted from Figure 6.3, ©IPCC 2007: WG1-AR4]

Carbon Dioxide Concentration in Atmosphere over past 650,000 years

280 ppm (‘pre-industrial’) Modern Homo sapiens

Agriculture begins, 10K BP

Holocene

400 ppm CO2

(2013)

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Most radiation absorbed byEarth, warming it

Most radiation absorbed byEarth, warming it

Some energy is radiated back into space as infrared

waves

Some energy is radiated back into space as infrared

waves

The strength of the sun varies a littleThe strength of the sun varies a little

Aerosols: net cooling effect

Aerosols: net cooling effect

Feedback - additional GHGs

Some outgoing infrared radiation trapped by atmosphere, warming it

Some outgoing infrared radiation trapped by atmosphere, warming it

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CH4 CO2

Green house gases

N2O

Sulfate particles

Radiative forcing

NO2

CH4

O3

CH4

CO2

Slide adapted from one courtesy Prof Steffen Loft, University of Copenhagen,

Denmark

wetlands, rice, tundra, biomass burning,

deforestation

CO2 CH4, black carbon

CO2

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Sea Level: 1993-2012

Rainfall intensity : 1900-2011Land-ocean temperature: 1880-2011

Earth system observations

Greenland ice melt 2013

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“Anthropocene”: the human dominated age (Paul Crutzen)

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integrative

interactive, feedbacks, thresholds

(emergence, phase changes, shocks )

context – milieu – “terrain”

Systems thinking

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EIDs = emerging infectious diseasesGEC = global environmental change

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s

20Apologies to unnamed photographers

Nipah outbreak Malaysia 1997-9

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Pigs (millions)

Mangoes (104 tonnes)

Pulliam et al, 2011

Agricultural intensification in western peninsular Malaysia

response

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Emerging diseases – a call for deeper thought

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emerging disease perspective in developed

countries

focus on novel and exotic pathogens

less attention to drug resistance in familiar

pathogens, e.g. TB and malaria

& insecticide resistant vectors, molluscs

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335 Emerging Infectious

Disease “events”

Jones et al. Nature, (2008)

No category for vectorial resistance

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Acinetobacter baumannii resistance:

gentamycin, imipenem, multiple drug, polymixin [4 in total]

Bartonella bacilliformis; + resistance to chloramphenicol ; elizabethae , henselae , quintana [5 in total]

Candida krusei, tropicalis, albicans (1981) + resistance: fluconazole, ketoconazole, micronazole; Candida glabrata (fluconazole-res); [7 in total]

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EIDs: not all equal

Jones et al. Global trends in emerging infectious diseases. Nature, 451, 990-994. (2008) supplement

16/335 Emerging Infectious Disease “events”

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3 needles in the 335 “event” EID haystack

HIV-1

artemisin resistant Plasmodium falciparum

multiple drug resistant Mycobacterium tuberculosis

Nipah?

spilling over .. matter of time .. efficiently spread among

people” NYT 2012

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?

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335 Emerging Infectious

Disease “events”

Jones et al. Nature, (2008)

No reflection of disease burden, now or

potential

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milieu and microbe

captionClaude Bernard (1813-1878)

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“Pathogenic tradeoff”

Pathogens “want” to reproduce

Effect on host not of concern:

Sometimes 1. hurt, don’t kill

2. don’t hurt

3. kill slowly

4. kill quickly

pathogen reproduction chance enhanced

4. In comparison, reproduction harder

trend to co-existence

29Ewald P (2004). Evolution of virulence. Infectious Disease Clinics of North America 18:1–15.

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New milieus: different tradeoff?

pathogens in crowded host milieus that kill quickly have

- numerous other hosts to colonise

- hosts may have high genetic similarity

- LITTLE or No evolutionary penalty from rapid host mortality

might viruses that cause rapid infections (even severe) be favoured? (do slower acting viruses have less opportunity to reproduce?)

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Low Pathogenic H ighly

Pathogenic

Avian Influenza

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Crowded, immobile hosts: new pathogen

opportunities?

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Milieu and the

Adapted from Oxford et al Lancet Inf Diseases 2002; 2:111-4

2.5% global mortality (with bacterial co-infections)

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Future civilisation: a risky milieu

energy, raw materials: emerging scarcity

economic system: archaic

inequality: civil stress, terrorism, fascism, war

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Adapted from Murray & King, Nature. 2012; 481: 433-5.

Apparent production cap

2005: Plateau Oil

Production (million barrels/day)

Oil price (US$ per barrel)

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$1 billion a day, from Europe, Nth America

Third carbon age? Runaway warming, water risk

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Wise TA. The Cost to Developing Countries of U.S. Corn Ethanol Expansion: Tufts University; 2012.

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(nominal prices)

37Butler, 2013

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Russia/Ukraine heat/drought

US droughts

Butler

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rapid public health response*limited antimicrobial resistance, but increasing nutrition ok

public health breakdownnutrition worseliving conditions worseconflict increasing?

Could civilisation failure “breed” a

megapandemic?

* For diseases perceived as major threats to developed countries

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Potential EID categories later this century (by burden of disease)

all connected – a systems view

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Secondary

Tertiary

Tertiary

Primary

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Heat waves, fewer cold waves, injuries, floods, fires

Infectious diseases, especially vector borne, allergies, air pollutants, infrastructure

secondary

primary

tertiary

Health effects of eco-climate stress

famine, conflict, pop’n displacement, refugees, development failure

4343

Men

tal h

ealth

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Waterscarcity

Regions afflicted by problems due to environmental stresses: • population pressure • water shortage• climate change affecting crops • sea level rise • pre-existing hunger• armed conflict, current/recent

From UK Ministry of Defence

[May RM, 2007 Lowy Institute Lecture]

Climate Change: Multiplier of Conflicts and Regional Tensions

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“The dangerous impacts of climate change can only be

discussed in terms of nonlinear behavior.’’

Hans Joachim Schellnhuber

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Butler Climate Change and Global Health, CABI, UK, in press

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“Social vaccine”

“Demand will create a parachute”

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Toxicity

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Placebo

Vaccine spectrum

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Panic, despair, or indifference

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“Polyanna”

“Social vaccine” spectrum

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Not just “natural” capital –But interaction of natural, human, social, built, financial

And some would say moral

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Dian Fossey (1932-1985) and young mountain gorilla

Eco-connection

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Crisis = opportunity53

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Ingenuity in the Year without a summer (1816)54

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Global Energy Assessment, 2012

Solar (1975-20072007-10)

NUCLEAR

US$/kwH(2005

dollars)

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India: planning 455 new coal plants

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Global Energy Assessment, 2012Global Energy Assessment, 2012

Unmet electricity need

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Global Energy Assessment, 2012

Lack of “modern” energy

Most electricity is not clean

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Lock-in of Technological and Social Cultures &Institutions

The QWERTY Phenomenon

SUBSIDIES: fossil fuel /renewables: 6 to 1 (2011 )

10 times more than costs of Hurricane Sandy

59Hurricane Sandy 2012

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He Had a dream

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ÉdouardLe Roy

Paul Crutzen

noösphere(planetary thinking, sharing)

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