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April 20th, 2013:

An ounce of prevention

Pre-empting pandemics

An ounce of prevention

As new viruses emerge in China and the Middle East, the world is poorly prepared for a global pandemic

Apr 20th 2013 | Bangkok and New York |From the print edition

IN FEBRUARY an 87-year-old man was admitted to hospital in Shanghai. What started as a cough progressed to a fever. One week later, unable to breathe and with his brain inflamed, he died. Shortly afterwards, a 27-year-old pork butcher was admitted to the same hospital with similar symptoms. He died too, within a week. A 35-year-old housewife who went to hospital in Anhui on March 19th lasted only slightly longer. On March 31st officials confirmed these were the first three cases of a strain of influenza, H7N9, that had never before been seen in humans.

The government responded quickly—a far cry from its reaction, ten years ago, to a similar cluster of cases in Guangdong. That infection turned out to be SARS (severe acute respiratory syndrome). At first, officials tried to hide that disease. The deceit served to ensure its spread and it went on to kill nearly 800 people. Much has changed in the past decade. This time officials quickly posted H7N9’s genetic sequence, then published a detailed report in the New England Journal of Medicine.

Even so, H7N9 has infected at least 82 people and killed 17 of them. The virus’s path of transmission is not well understood. The recent detection of H7N9 in a boy with no apparent symptoms suggests people can carry the virus unwittingly. Meanwhile a new coronavirus (the family of viruses that SARS belongs to) is circulating in the Middle East. It has killed 11 people since it was noticed in September. Though Saudi Arabia has welcomed some foreign investigators, other scientists claim the country should be more transparent.

Be prepared

These cases illustrate both how far the world has come, and how far it still has to travel, on the journey towards building a system that can identify new infectious diseases and snuff them out before they become threatening. As the case of AIDS shows, a novel pathogen that spreads around the world unnoticed by the medical authorities can wreak havoc. More recently, cheap air travel has proved a boon to pathogens keen for a global tour. Fortunately the world has learned from the cases of SARS, H5N1 bird flu (in 2005) and H1N1 swine flu (in 2009). Systems are being put in place to spot potentially pandemic diseases and stop them quickly. These systems, though, are still piecemeal. At present it looks unlikely that either H7N9 or the new coronavirus will become pandemic. But if they do—or if some other powerful new virus or bacterium emerges—it is unclear whether the world will be ready.

SARS and H5N1 gave people a shock, and in their wake a lot of progress has been made—and not only in China. In 2005 the members of the World Health Organisation (WHO) agreed on a new set of International Health Regulations, with rules for responding to outbreaks that are of global concern. For example, all members must alert the WHO to any risky-looking pathogen that might move beyond their borders. The regulations also include measures to dissuade people from imposing unnecessary restrictions on travel and trade. In the past, fear of such bans discouraged governments from reporting outbreaks. Meanwhile individual countries have started making their own plans for dealing with a pandemic. As of 2011, 158 had official provisions in place.

Surveillance has moved on by leaps and bounds, too. ProMED and HealthMap, two online reporting programmes at the International Society for Infectious Diseases and Boston Children’s Hospital respectively, use a range of sources to provide quick information on emerging threats. Google Flu Trends, run by the eponymous internet firm’s charity, monitors flu-related searches to estimate the disease’s prevalence. Such electronic systems complement conventional epidemiology, rather than replacing it (and are not always reliable; in America’s most recent flu season Google Flu Trends overestimated the number of those sickened). But traditional surveillance methods have improved, too.

Improved techniques, for instance, allow segments of DNA to be amplified rapidly, so viruses can be identified quickly. The cost of full genetic sequencing continues to fall. And countries’ surveillance efforts are now better co-ordinated. A model of co-operation can be seen north of Bangkok, where Thailand’s health ministry includes a National Influenza Centre. As one of the WHO’s designated regional laboratories, it tests samples from the whole of South-East Asia. This laboratory has also been supported for the past decade by America’s Centres for Disease Control and Prevention (CDC), an organisation well equipped to identify new medical threats. (It was the CDC that spotted AIDS.)

Many countries are better equipped than before to respond to an outbreak. America leads the way. The authorities have stockpiled 68m courses of antiviral drugs, 18m respirators and 31m face masks, and are investing in research to create better ones. The Biomedical Advanced Research and Development Authority (BARDA), an American government agency, contracts with companies to develop new ways to counteract biological threats. It has 130 products in development, including 45 for influenza.

The world’s biggest cities, often with aid from national governments, have honed their strategies, too. Shanghai watches for 15 categories of infectious disease at more than 5,700 sentinel sites. It has several emergency plans, tailored for outbreaks of different intensities. New York collects data from hospitals, laboratories and even pharmacies, to look for signs of new infections. The city cannot forcibly vaccinate its citizens, but it can order the unvaccinated to stay at home.

Even such extraordinary measures, though, may be ill-matched for a virus. H1N1 proved how much can go wrong. It was contagious but not particularly deadly, so officials were confused about how to convey its risks. Research published in the Public Library of Science on April 15th estimates that half the Tamiflu (an antiviral drug made by Roche) prescribed in England at the time of the H1N1 outbreak went unused, based on an analysis of traces of the drug in sewage. Vaccines took months to deploy, delayed by fundamental problems (the time needed to develop them) and trivial ones (American shipments had to wait for the pallets carrying vaccines to receive a fumigation certificate). An independent committee issued a discouraging review of the WHO’s response. “They made it very clear”, says Keiji Fukuda, the WHO’s top influenza official, “we are not ready for anything big.”

Since then the WHO and others have tried to improve things. In 2011 the WHO’s members created a new framework for sharing flu viruses—in 2006 Indonesia refused to share samples of H5N1 with the WHO out of concern that companies would use an Indonesian virus to develop treatment unaffordable to Indonesians. GlaxoSmithKline is the first company to sign a deal with the WHO under the new framework. The pharmaceutical giant will donate 7.5% of its vaccine production in the event of a pandemic. A further 2.5% will be sold at tiered prices, depending on a country’s income.

There is also new capacity to make the vaccines themselves. Last year BARDA awarded contracts for three new centres, to be led by Novartis, Emergent BioSciences (a firm in Maryland) and Texas A&M University, in collaboration with GlaxoSmithKline. These will develop and manufacture medical countermeasures, including vaccines. In November Novartis won approval for the first flu vaccine made from cultured cells rather than eggs—a technology that will help produce vaccines more quickly. There has also been progress in poor countries. The WHO has given grants to flu-vaccine manufacturers in 14 countries. Four of these are ready to go.

And researchers continue to test new tools that may help. For example, Marta González of the Massachusetts Institute of Technology has modelled how diseases spread by plane. In the early days of an outbreak, such models may help officials decide which routes to cancel to contain a virus. America is paying scientists to patrol rapidly changing environments in Africa, Asia and Latin America, where viruses are prone to hopping from beast to man. The hope is that the scientists will find dangerous viruses early, before they spread.

Next candidate…

There remains, nevertheless, much to be done. Many countries now have plans to prepare for a pandemic, but it is unclear which are operational. Dr Fukuda estimates that the world has the capacity to make enough vaccine for about 2 billion people—an improvement, but still short of what might be needed. Adding to the problem, governments are hardly flush with cash. The WHO has an influenza budget of $7.7m, less than a third of what the city of New York devotes to public-health emergencies. The main question is whether progress will continue, and whether it will pre-empt a more serious threat.

It is hard to say if either H7N9 or the new coronavirus will be pathogens that put the world to the test. The coronavirus in particular is still poorly understood. Ron Fouchier of the Erasmus Medical Centre in the Netherlands was the first to sequence its genome. He annoyed Saudi Arabia by patenting the result (though gene patents are a controversial area anyway—see “Natural justice” at the end of this section). He argues that the Saudi government should be more forthcoming with information. Saudi officials say they are working as quickly as possible and are collaborating with foreign epidemiologists.

The work around H7N9 has been relatively transparent. China has already shipped samples of the virus to laboratories all over the world. But the virus itself is still spreading in China, and people continue to die. Vaccines, once developed, may be ineffective. “H7” and “N9” refer to particular types of two proteins, haemagglutinin and neuraminidase, that help influenza viruses invade host cells. Other H7 vaccines have not created a strong immune response, according to Michael Osterholm of the University of Minnesota. It is also unclear if the virus may become more contagious—at the moment it does not seem to jump from person to person. Last year two groups of scientists, one led by Dr Fouchier, described specific mutations that might make H5N1 transmissible from human to human. H7N9 contains mutations implicated in this switch. If the virus mutates further, it might become airborne. And if that did happen, the world’s pandemic-protection system might be put to the test quite suddenly.

From the print edition: Science and technology

Metal body parts from cremations recycled into road signs–hips-leg-screws-skulls-used-in-lamp-posts-car-parts-112558907.html#S4ukGX5

Steel hips, plates and screws from legs and skulls are being used in lamp posts and car parts under a Dutch company’s recycling scheme in Britain.

Some of the metal objects retrieved from crematoriums – including metal body parts – which are then used as road signs. (SWNS)

Metal body parts from the dead are being recycled into road signs, lamp posts, car parts and aircraft engines.

Steel hips, plates and screws from legs and skulls are collected after cremation and sent off for recycling as part of a nationwide scheme.

Even metal plates from false teeth and tiny fragments from fillings can be recovered and re-used, together with metal fittings on coffins.

The money-saving scheme came about as some crematoriums easily fill a large recycling bin with metal body parts every month.

High value metals which survive the 1000-degree cremation are then sold for use in the automobile and aeronautical industries.

Road signs similar to this one are made with the help of recycled metal body parts (SWNS)

They include cobalt and titanium, found in some implants and dental work, with cobalt used in aircraft engines.

But other less valuable metals are melted down and sold for more general use – including road signs, motorway barriers and lamp posts.

The metal salvaged from cremations is put in large wheelie bins at the crematoriums and collected by contractors who take it to specialist plants for recycling.

Money made is donated to charity and almost £1million has been raised for good causes since the project began in Britain in 2004.

The Dutch company behind the recycling says around half Britain’s 260 crematoriums have signed up to the scheme which is generating 75 tonnes of metal a year.

Relatives are asked if they want to keep metal parts of loved ones before cremations by the centres taking part in the scheme.

The vast majority say they have no need for them and sign a consent form agreeing to the recycling.

When the cremation is over the ashes and other remaining items go into a compartment in the cremator and then into a special cremulator machine which separates any metal from remaining pieces of bone.

One of the crematoriums in the scheme is at Weston-super-Mare in Somerset, which has an average of four to five services a day.

Around one large bin a month is filled with the unwanted metal body parts for recycling.

The crematorium at Haycombe in nearby Bath has around 2,000 cremations a year and also recycles unwanted metal body parts.

A spokesman for the council-owned crematorium said: “We subscribe to a not-for-profit recycling scheme for all metals recovered from the cremation process.

“Applicants may opt to retain the metals but they must take them away and they cannot be returned afterwards.”

The recycling schemes are governed by strict criteria set down by the Institute of Cemetery and Crematorium Management.

Bristol City Council, which operates two cemeteries, is considering joining the scheme.

Currently metal body parts are buried in the grounds of the crematoria but new legislation means this will no longer be possible.

Ruud Verberne (corr), owner of OrthoMetals (corr), the Dutch company behind the recycling, said: “Metals reclaimed from cremations are being increasingly re-used.

“High value metals such as cobalt go into the aircraft or automotive industries.

“Others are sold to smelters and foundries and it is possible that they end up as roadsigns or motorway barriers – there’s no way of knowing.

“What is important is that the metals are being recycled, and this is a growing business both in Britain and elsewhere in Europe.”

Europe’s cap-and-trade program is in trouble. Can it be fixed?

20 April 2013
By Brad Plumer
The Washington Post
The European Union has long prided itself on taking the lead in tackling climate change. But, this week, the continent’s flagship program — a cap-and-trade program for carbon-dioxide emissions — ran into serious trouble. So can it be fixed, or is the situation hopeless?
Not sure what’s going on here, but it’s a dramatic Europe-related image. (Michael Probst/AP)
Let’s start with some background. The E.U.’s Emissions Trading Scheme works by setting an overall cap on carbon emissions for about half of Europe’s industries. Companies get a certain number of pollution permits that they can trade among themselves. As the cap ratchets down each year, the number of permits is supposed to dwindle and the “price” on pollution keeps rising.
Over the last few years in Europe, however, there has been a glut of permits. Policymakers initially gave too many away, and then there was a huge recession. So Europe’s emissions are well under the cap and permit prices had been hovering below $9 per ton since 2011. Companies have little incentive to make any drastic changes. Polluting is cheap:
The European Parliament wanted to change this by delaying a scheduled release of new permits. This policy, known as “backloading,” would have been the first of several possible reforms to the ETS. But backloading failed by a vote of 334 to 315 this week. Immediately after, the price of carbon plunged to around $3.40 per ton and analysts were calling the trading scheme “completely toothless.” The prospect for further reforms is uncertain.
So what can we learn from all this? Basically, the E.U.’s climate policy seems to be somewhat confused. There are a couple big things going on here:
1) From one angle, the cap-and-trade program is working — emissions are down. Since the ETS came into existence, Europe has been meeting its emissions goals. Yes, that’s partly because the continent has been grinding along in an economic depression, but emissions are still far lower than one would otherwise expect:
This is, essentially, how cap-and-trade is supposed to work. When meeting the targets is easy (and it’s much easier when the economy is in the toilet), then the price of carbon goes down. If the euro zone ever recovered from its pit of endless despair, then the price of polluting would presumably rise again.
Poland has made this point often, as FT Alphaville’s Kate Mackenzie points out — and this was the Polish delegation’s reason for voting against the backloading proposal: “Growth will return and the price will find its equilibrium again. No administrative meddling is needed or else we might create the impression that such measures are standard practice.”
Now, Poland’s position is arguably too sanguine. Europe’s cap-and-trade program has a number of other flaws that may need fixing — such as the fact that policymakers gave away too many permits initially. Still, there’s an argument that low prices aren’t inherently a problem.
2) Yet many people in Europe want a high price on carbon. Many politicians and analysts weren’t satisfied with simply staying under the cap. They wanted a high price on carbon that would drive big changes to the continent’s energy supply. And, it’s true, the ETS wasn’t providing that. As a recent report (PDF) from the International Energy Agency points out, Europe would need prices to rise to $65 per ton before power plants would switch from coal to natural gas. Instead, prices have been at $7 per ton.
David Hone of Shell had been making a similar argument. In his view, carbon capture and sequestration (CCS) for coal plants is an essential technology for tackling climate change. And since CCS is a difficult technology to develop, utilities need to start working on it now, or they’ll never be able to deploy it in time to cut emissions sharply by 2050. Yet the price on carbon isn’t nearly high enough to spur CCS development.
Even for people who aren’t fans of natural gas or CCS, the same argument holds. Companies aren’t going to develop complicated clean-energy technologies of the future without a much higher price on carbon.
3) What’s more, Europe is undermining its cap-and-trade system with “complementary” policies. German economist Hans-Werner Sinn has made this point often. In addition to cap-and-trade, Europe also has a renewable energy mandate and an energy-efficiency mandate. Since utilities and companies already are already required to meet those, they have a much easier time meeting their pollution targets. So, naturally, that puts downward pressure on carbon prices in the trading scheme.
4) So it’s worth asking, should Europe just get a carbon tax instead? When you add these all up, it’s hard to escape the idea that many people in Europe seem to want a carbon tax. A carbon tax that rises slowly over time would keep the price of emitting greenhouse-gases stable — and the price would remain high even if European policymakers wanted to tack on renewable mandates and other policies.
Oxford’s Hans Dieter has used this graph to make the point:
Yes, a carbon tax is less flexible to changes in circumstance — it would keep energy prices high even during a recession. But many policymakers seem to find that flexibility in cap-and-trade a problem.
Trouble is, there’s no reason whatsoever to think a carbon tax would be politically easy. For one, any major change to the E.U.’s climate policy would take many years to negotiate and approve. All 27 countries would need to take a vote. And countries like Poland, for one, seem quite happy with the current low pollution prices.
That means Europe is likely stuck with trying to reform its cap-and-trade program. According to Point Carbon, further big changes aren’t likely to happen until 2016 at the earliest.
In any case, Europe’s experience will certainly provide a lesson to other countries. Australia is currently preparing its own cap-and-trade system (assuming that the Liberals don’t come to power and scrap it), and a cap in California just went into effect. So there are a lot of lessons here in how to design — or how not to design — a climate policy.
© The Washington Post Company