NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Tuesday, January 5, 2016

No one predicted the Ebola epidemic before it burst forth in 2014 and continued to claim lives throughout 2015. And so, as 2016 begins, readers might well wonder what biological culprits — parasites, bacteria and viruses — are lurking out there, ready to unleash another outbreak of something terrible on an unsuspecting world.

We put the question to four infectious disease experts: What are your best educated guesses about the big global health stories in 2016?

Before making any predictions, Dr. Dyann Wirth, chair of the Department of Immunology and Infectious Diseases at the Harvard School of Public Health, wanted to take an optimistic look back. Three researchers shared the 2015 Nobel Prize in Physiology or Medicine for their work in discovering treatments for malaria, river blindness and lymphatic filariasis, also known as elephantiasis. “We’re at a very interesting time in global health,” says Wirth. “That these diseases were recognized by the Nobel Committee raised awareness in the public eye.”

In the future, relatively unheard-of diseases could emerge from the shadows. Some experts are already looking suspiciously at a mosquito-borne culprit that had been a relatively small player in global health but is now alarming health officials in Brazil — the Zika virus. The incidence of Zika infection has been low but has shown signs of increase in South America and other areas of the world. And in November, chilling reports out of Brazil have health experts worried that the Zika virus might be connected to an upsurge in microcephaly in infants — a condition in which the infant’s brain is smaller and less developed than normal. “This virus might be causing birth defects in Brazil,” says Dr. Michele Barry, dean of Global Health and director of the Center for Innovation in Global Health at Stanford University. More research is needed, but similar reports of increased Zika virus coinciding with increases in brain and spine malformations in French Polynesia have health officials worried.

A challenge in 2016 will be to hold on to hard-won health advances in an unstable world. For example, Wirth said, during the Ebola crisis, malaria treatment fell lower on the priorities list in the affected countries and fewer protective bed nets were available. The result was a rebound in cases of malaria. One study estimated the number of cases of and deaths from malaria in Guinea, Liberia and Sierra Leone. The study found a probable increase of 3.5 million malaria cases in those three countries during the Ebola epidemic, resulting in 10,900 additional deaths.

Disease doesn’t respect borders, and cross-border infection of malaria is a big problem in Africa, says Dr. Peter Agre, director of the Johns Hopkins Malaria Research Institute and a Nobelist in chemistry in 2003. “It’s like crab grass. You can take care of it, but if your neighbor doesn’t, it comes right back,” says Agre. Factors having nothing to do with health-care systems can be at play in disease spread: chaos, war, natural disasters, economic downturns and refugees on the move. “In sub-Saharan Africa, malaria, HIV and TB could be rapidly re-established,” says Agre.