COVID Near the Congo: Our Conversation with a Disease Ecologist Caught Abroad

Anne Laudisoit photographed in Uganda

Anne Laudisoit is a Belgian explorer, wildlife field biologist and disease ecologist affiliated with the EcoHealth Alliance. She has long tracked emerging and neglected vector-borne zoonotic diseases in a wide range of ecological and social contexts from Tanzania, Madagascar and the Democratic Republic of Congo (DRC) to Kazakhstan.

An award-winning film directed by Caroline Thirion about Anne’s discovery of a hitherto unknown-to-science band of chimpanzees in a remote unstudied forest fragment in the DRC’s Ituri Province in 2015, Mbudha: In the Chimpanzees’ Footsteps, was screened at the 2019 Bioneers Conference.

Since 2015, among other projects, Anne has worked in partnership with Congolese researchers and local villagers to continue exploring this often war-torn area’s flora and fauna and help develop conservation plans for the region.

Bioneers Senior Producer J.P. Harpignies conducted a long-distance interview with Anne Laudisoit via Skype in late April, reaching her on the banks of the White Nile in Uganda, on the Congolese border. Laudisoit had been in the process of returning to continue her work in Ituri Province when the COVID-19 crisis began shutting down borders and forcing quarantines, and violence (which has only gotten worse since then) flared up again in various parts of the country, including the areas she was slated to work in, so she was unable to enter the DRC and was hunkering down as the only guest in an otherwise shuttered eco-lodge.

She was in a little cabin with only a solar lamp as lighting and a wild elephant (frequent visitors) was chewing bushes only a few yards away behind her little cabin during the conversation.

Note: This an edited excerpt of their conversation. View a video excerpt of the conversation here.

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J.P. began by asking Anne what the situation regarding COVID-19 was in Uganda:  

ANNE: Here in Uganda, there have only been 56 known cases as we speak [editor’s note: as of May 11, case count was 121], and they were forced into quarantine facilities. The government imposed very strict rules quickly, including limits on all transport. There is almost no movement whatsoever except for trucks carrying merchandise, but some people escaped from quarantine and tried to cross borders. That’s a major concern everywhere in Africa, the porosity of the borders (which could help spread the virus).

So far there are clearly far fewer cases (than in Europe), but is it because there have been very few tests done, so we don’t have any real idea of the number of cases, or is it because the population in Africa is much younger on average, so less prone to manifesting symptoms or are asymptomatic carriers?

JP: Is it also possible that it’s earlier in the wave there, or that perhaps the warmer weather is less conducive to spreading the virus?

ANNE: It’s difficult to say. The curve here hasn’t seemed to be escalating like in some other parts of the world, so far, and clearly the first cases were imported, and it took time before there was local transmission. Now there is local transmission, but mostly in cities. We will have to see if it spreads to the countryside or if the government lockdown helped prevent that from happening.

In terms of weather, it is not clear at all because you have tropical countries in Southeast Asia that had big numbers. And in hot parts of the U.S. such as Florida, a lot of people live in air-conditioned houses, so that could change the pattern. It is just too difficult to say right now if temperature is a factor.

JP: Do you think it will be safe enough to go back and continue your work?

ANNE: Well, it’s something that you have to monitor on a daily basis. Besides all the guerilla conflicts in the DRC and in the larger region, in many places in the world there has been a lot of stigma towards foreigners. Rumors start that foreigners are the ones introducing the virus, and this has led to violent incidents. I have friends who have been living for 20 years in India and then suddenly they became targets in their village. This is something that’s being seen in many countries.

But of course there’s a history in the DRC because the latest Ebola outbreak had just ended there not long ago, and that already created a lot of distrust and paranoia, and now local people think foreigners are coming back bringing yet another virus. It triggers a lot of hatred and potential violence, so we have to monitor. I can’t say anything right now about the situation, even in two weeks.

JP: Let’s talk a little bit about one of your areas of expertise—zoonotic diseases. Obviously COVID-19 is one in a collection of zoonotic diseases. Could you explain for people who might not have a good understanding what zoonotic diseases are, how important they are, and how COVID-19 fits into that family.

ANNE: A zoonotic disease is a disease that is transmitted from animals to humans. That’s the classical definition. So you have a lot of these historical diseases like plague, and then you have less-known or emerging diseases such as Lassa fever, Ebola, monkeypox (a smallpox-like disease), and all those bat-borne diseases such as SARS and COVID-19.

JP: And all the influenzas, right?

ANNE: They are not as simple. They often combine different pieces of viruses from different animals, but, yes, of course, they are zoonotic diseases.

JP: A fairly high percentage of human diseases are zoonotic in origin, is that right?

ANNE: Yes. Around 70%, more or less. 

JP: Which diseases have you specialized in and where has your research taken you?

ANNE: I’m clearly a specialist of plagues, such as the famous bubonic plague, and I’ve spent more than 10 years of my life trapping rodents around the world and studying their fleas and also studying the dynamics of transmission. But I’ve also studied how people relate to infectious diseases, how diseases are perceived in different communities, so I study diseases and I work with people who are suffering from those diseases. I study how humans and animals interact and the way human behavior affects disease transmission.

I started to work on monkeypox, which is a smallpox-like disease, also a zoonotic disease, but we don’t know which animal is the reservoir yet. It mostly hits the Congo. It’s endemic to Africa but is now (re)emerging in several west african countries. Most of my research has been trying to identify the reservoir of the disease, trying to understand which animals are the carriers and what the relationship of humans to these animals might be: Do they eat them? Do they live close by? Do humans come in contact with them because they encroached a forested environment where these animals live or because they modified the land to grow crops? Those kinds of questions have always been central in my research.

JP: In a way your research combines the scientific lab work and tracking with anthropological or ethnographic work because you’re embedded in the cultures and you’re trying to understand their cultural, personal, and psychological relationship to the diseases as well. Your work is holistic in that sense.

ANNE: It’s interdisciplinary. I’m a scientist but maybe I’m not a traditional scientist in a way, in that I’m not pushing to publish a lot of high-level papers, which might be something that people check on your CV. I’ve always been a field scientist living with the local people, which gives me a very different viewpoint than the researchers who stay in labs and offices – which is part of the work and we need that – but I’ve always realized how important it was to be immersed in the local reality to really understand the way people think and look at diseases.

For example, for diseases, we always picture them as horrible things that attack us, that we have to defeat. We rarely look at the whole human/environment relationship which, if we dealt with it in a positive way, might be a more important path to overall health. That’s the concept of “One Health” that has been emerging in the last 20 years, since the first episode of SARS around 2000, when it became clear there was a need to have a different view to try to bring different disciplines together.

JP: Can you talk about the “One Health” perspective, this idea that to understand disease, one has to understand human relationships to ecosystems and with animals? That approach combines human and veterinary medicine, conservation, and ecology, right?

ANNE: Exactly. It’s an attempt to work toward health for humans, animals and the environment holistically because you cannot disconnect these things. It is sometimes difficult to implement because it might seem very theoretical to people. We scientists have to do a better job to explain more clearly how a one health approach can be implemented.

We are learning more every day about how everything is interconnected, and there is a lot of research and discussion about how to better integrate our scientific, medical, social and conservation efforts because all these separate sectors are working on the same problem but are usually not coordinating. We could get more results with less money spent if we brought them together with coordinated strategies.

JP: In an ideal society in which people took the concept of one health as a guiding principle, would you be sending in teams of people and developing local resources so that people could be studying the ecology while they’re treating diseases, while they’re helping economic development? Would it be something like that, a multi-faceted approach? We’re far away from that, but is that the kind of thing you could envision?

ANNE: That is the kind of model we are working towards. There are projects that have been trying to do that, encouraging people from different disciplines to work together while demonstrating and explaining the benefits of working in interdisciplinary teams.

I can give you a very good example: when you have an outbreak, an epidemic, nearly all the efforts and funds go towards saving human lives, which is understandable, but it’s just dealing with the consequences. Comparatively very few people or resources are devoted to working on the cause, which is the zoonotic source (and the ecological disturbance that led to the transmission). So we are devoting far more energy to consequences than to causes, and there is often a long delay between the time medical teams come in to treat people and the time when biologists and people working on the environmental factors are called in to track down the source. That makes it very hard to understand how and why an epidemic started.

Those of us who work in this field are arguing that we need to get access to the epidemic centers at the same time as the medical teams to give us a better chance of analyzing the source of an outbreak. That would be ideal, but it’s rarely the case now.

JP: Let’s back up for a minute and talk a little bit about previous histories of zoonotic diseases and of epidemics, because obviously human history has been characterized by many episodes of epidemics. Some of them are very famous like the Black Death and others people know less about, such as Justinian’s plague that actually wiped out even more of Europe’s population. More recently we’ve had outbreaks of SARS and Ebola, and people talk a lot about the 1918 episode, which was the last big one that impacted the industrialized world after World War I. What do you see as some of the episodes in previous zoonotic pandemics that might have lessons to teach us about what’s happening now with the COVID-19?

ANNE: Of course, with the Justinian plague and other epidemics until the scientific revolutions of the 18th and 19th centuries, it was too early in history for people to know about microorganisms and to know that rats and fleas were the carriers and vectors. But the way people reacted is not as different as we might imagine. The fear of an invisible threat with an invisible enemy is hard for humans to digest and react to intelligently.

One big difference was that there was no social media in these past pandemics, so there was not the same amount of information and disinformation at such speed. People were more fatalistic; they were just waiting for death to come to their households or – if they were well off – to flee far away. They didn’t really know what was happening. They couldn’t explain it. There was no treatment. But they did sometimes seek to blame other groups, so reactions are not all that different today: fears are surging in people’s minds, because it’s an invisible enemy and everybody’s trying to find someone to blame. Many cannot accept the explanation that it just happened because of bats or a virus jumping from an animal to a human. It’s difficult for the human brain to take in, and nowadays we are frustrated when we can’t simply get an immediate answer from a Google search to find an explanation for everything.

JP: We’re in an age where there’s much more information than there would have been, as you said, 100 years ago. There’s an irony there that people are maybe more anxious, but at the same time there’s access to more information. It’s an ironic paradox.

ANNE: I can really talk about that because, given my job, I receive messages about the pandemic constantly. People bombard me with texts, emails and papers and opinions of self-proclaimed gurus on the Internet who have found “the solution,” and I have to navigate through all this and look at the scientific evidence. But the scientific understanding of this epidemic is evolving every day, so it’s not easy, and too much information actually makes it more difficult to deal with and to do your job as a scientist. Doubts come into your mind, and it’s good to have doubts, but it doesn’t help when you have so much information, a lot of it very unreliable, to have to sift through. I am currently working on writing and updating a living paper with scientific facts that we are calling the COVIPENDIUM. I am largely responsible for the animal side of it, and risk of back spillover from humans to animals and back in countries where the virus is circulating.

JP: I’d like to focus on the role of ecological disruption in zoonotic diseases. A common premise suggests that the growing human population along with increasing human incursions into habitats we didn’t normally spend as much time in creates more opportunity for disease transmission, like in the wet markets in Asia. What role does that ecological disruption play and what do you think could be ameliorated to try prevent or reduce these situations?

ANNE: Again, bringing back the one health concept, the fact is that everything is interconnected. If you disrupt one part of the system, you might have unexpected consequences or collateral damage that you didn’t predict. If you have a forest, and you cut that forest and transform that land into crops, what do you do with all the connections between the plants, the trees and the animals living there? Some of that you can see, and some you don’t see, because of course we have all the hidden, microscopic soil interactions and the unassessed consequences on the “micro-biodiversity” once the macro-biodiversity has been evicted. What are the consequences of all those changes?

Especially in forests, where you have a big patch of forest and you start to encroach the edges, then you increase the chances that species will appear in those edges that have never been in contact with each other, and you increase the probability of contact between species that used to be separated. I’m not speaking only about humans. It can be rodents that normally live in your house or in crop fields, and because you bring them closer to rodents that live in the forest, they might actually exchange pathogens or parasites. Those encroachments actually change the interaction between species and might trigger what we call a jump in species and for pathogens to emerge in a new host that might be suitable for that virus, because for a virus, a host is a habitat. Right? We tend to see it as a horrible enemy of ours, but a virus is just looking for a new habitat to breed and to reproduce and expand.

JP: What about the bushmeat trade in Africa? Everyone is talking now about the wet markets in Southeast Asia, because of the probability that that’s how this began, but are some of the zoonotic diseases in Africa transmitted through the bushmeat trade? 

ANNE: It’s, again, a difficult question, but yes, the people most at risk of introducing a zoonotic disease from deep in the forest are probably hunters or people logging who have been in contact with species humans were previously not usually in contact with. But the other way around is also true. If you have disturbed so much habitat that you have only a few remaining trees in an area on your farm, then bats that used to roost deep in the forest will only find those roosts in your plot, and they will come there, and if they are carrying disease, they can introduce that disease to your farm. The transmission is not always straightforward.

There is a lot of bushmeat harvesting and, because the animals have been so overharvested and exploited, they are mostly smoked when they reach many cities in Africa. Now we can see there is a trend for these wild species like monkeys or even pangolins, for that matter, to reach the urban markets smoked, because due to deforestation and overhunting the poachers have to hunt them further and further out and travel long distances to bring them to market. So they smoke them in the bush and there is less risk of transmission, but there are some instances, even in New York, in which illegal bushmeat was found in the luggage of travelers from Africa at the airport, and some herpes viruses and simian foamy virus were found in the meat. Whether or not this was infectious, we don’t know, because DNA or RNA is not a proof of infection, but still, this definitely should raise alarm bells. However bats live everywhere and are nearly always sold fresh at such markets, so the best option there is to raise awareness regarding risks and how to avoid  becoming infected (e.g. through outreach campaigns such as the Living Safely with Bats publication published in English and Mandarin). 

JP: What do you think are some of the strategies that the human species should employ to try to prevent or better manage these types of outbreaks? Do you think further outbreaks are inevitable, and do you want to venture a guess as to which of the candidates of diseases might be the next one? I realize that’s just speculation, but what do you think would be good strategies that we can adopt that are achievable that might help prevent such situations or at least mitigate them?

ANNE: There are a lot of people doing research, asking those sorts of questions right now. There are lots of papers coming out advocating less competitive, more collaborative scientific approaches to addressing these crises. Science is often competitive because people want to be recognized, to publish important papers, etc., so sometimes it’s actually hindering collaboration, but there is a real call now for sharing information much more openly. If we share what we have already done in our labs, what we have learned in the field about potential pandemic diseases, (especially in terms of DNA/RNA sequences, proteins), that will allow everybody to actually assess what is already out there that we know of, and what people have been working on, and not to waste time and effort, so more progress can be made more quickly.

We are already well prepared in some ways. There is a repository of all known DNA sequences (Genbank hosted by NCBI-NIH), a big library that gathers all the known sequences of living beings that is already accessible and public. For the current outbreak, people are using it to track the evolution of the SARS-COV-2 as sequences become available (see the interactive site here). Yet as regards the research being done on particularly dangerous diseases, clearly not everything is published. One reason not to publish such material is that badly intentioned people, such as terrorists or rogue governments, might use that information to make bio-weapons (more here).

In terms of preparedness, warnings were there for this outbreak. There were scientists we worked with who had been studying and warning about the risks of bat-transmitted viruses in Wuhan five years ago, but it just wasn’t taken seriously enough. The attitude seemed to be: it can’t happen to us.

The West African Ebola outbreak should have offered a warning and triggered a high level of preparedness everywhere in the world, but because it was so well contained, and it hit so few people, and, I have no problem to say, because it hit so few white people that once the outbreak was contained governments didn’t take it or other potential outbreaks seriously as a real risk to their people. The narrative was: It was well contained; we managed; we were heroes (US troops were sent in to help contain the outbreak), and we prevented it from coming to us, so why spend too much for an unlikely future threat? That was a wasted opportunity, a big mistake, in my opinion. We need to be prepared, and everywhere in the world I think we can see that nobody was prepared.

JP: It reminds me a little bit of nuclear power, because nuclear power is the kind of thing that, every rare once in a while, with a Chernobyl or Fukushima, there’ll be an accident, and the consequences of that accident are absolutely devastating. In the case of both of those we’re still seeing dire repercussions today, but because it happens infrequently, then everyone forgets about it and they don’t worry about it until the next one comes. It almost seems, in a very different sphere of human activity, that this is the same thing: because we haven’t had an outbreak as big since 1918 that was really this global, no one was ready even though it was inevitable that something like it would happen.

You are a fellow with EcoHealth Alliance. Didn’t the U.S. government cut that vital organization’s funding radically just recently for reasons that appear largely related to an unfounded conspiracy theory?

ANNE: Yes, it was stopped.

JP: So a lot of the people who were at the leading edge, the forefront of exactly the kind of research that is desperately needed in this kind of situation, those budgets have been seriously cut or zeroed out in the U.S. by the Trump administration. Cutting the funding of an organization doing such cutting-edge work on the sources of pandemics as EcoHealth Alliance has long done at a time like this seems nothing short of insane to me.

ANNE: It’s true that scientific grants are finite. You get a grant for five years, you renew it, and sometimes it doesn’t get renewed, but cutting funding for EcoHealth Alliance makes no sense. As I mentioned, my colleagues had been publishing about coronaviruses already seven years ago, saying that some coronaviruses closely related to SARS were reproducing in China in bats, and more recently that some people in China were testing positive for coronaviruses. All the ingredients were there to show there was a danger. It was all published and vulgarized in scientific magazines years ago. It was there for all to see, but maybe our species has to hit the wall a number of times to learn the lesson.

In terms of nuclear threats, I think again even though some of us perceive it as a global threat because we have one atmosphere, so one health, most people saw each incident as a local event. People in other countries were not directly hit by the problem. It remains something far away from you and you don’t relate to it. As long as it doesn’t hit you very close, the human brain is like that. It’s necessary protection on one level: you can’t be worried about everything happening in the world, but clearly, we tend to overlook and ignore those threats because they’re happening far away. When it hits you right in the face, then you start understanding the definition of an epidemic. That’s what I’ve been saying since the beginning – now people finally understand what it means to be quarantined, to be restricted in your movement and basic freedoms. We will have a lot of lessons to learn from this crisis, for sure.

JP: Well this one certainly has been hitting everyone enough that if there’s ever going to be a lesson learned about “one health” and global interconnections, this is one that should finally do it. If this doesn’t do it, I don’t know what will.

What do you think are just a few of the main strategies that should be implemented? What would your recommendations be? You talked about trying to coordinate the research and to use a one-health approach, but are there any other things you think should be implemented that would be helpful, besides obviously more funding for the research, more coordination? 

ANNE: I think what is often missing – and we have been seeing it even in the projects we’ve been doing – is effective communication. We need to be better at communicating what the real risks are likely to be in a way people can understand. During the crisis there are so many different messages and so much noise that people are unable to understand what’s happening. We need to get society’s major communication channels diffusing the same accurate information, so contradictory messages don’t completely confuse the public. But obviously, politics can get in the way, and we’ve seen a lot of erroneous ideas and information in this epidemic that have made the situation much worse. Communication is key in dealing with epidemics. It’s not only about the science, studying the risk factors and how it emerged, but being able to communicate what we know already and what the best policies and practices are.

JP: Do you worry that eventually if and when we develop a vaccine that we might again go into forgetfulness? I know the 1918 epidemic was pretty rapidly forgotten; it wasn’t even taught about in history classes in schools when I was young. Do you think there’s a risk that they’ll just think now we have the vaccine, so we can forget about this and it will disappear from public discourse?

ANNE: That’s definitely a risk. If we fail to learn our lessons, society, except for the experts, will forget again. We won’t prepare, and then the next one will come along (and it will come along). If we develop a vaccine for this virus, my boss always reminds us that there are probably somewhere around 1.7 million other viruses out there, and you cannot develop a vaccine for every single one that will emerge as a threat. Of course the ideal situation would be to have a vaccine that protects against a whole family of viruses. In this case it would be a pan-coronavirus vaccine, so it could immunize us from all the members of the Coronavirus family. That would be ideal, but it doesn’t exist, and it might not be possible.

JP: Do you feel that there’s been any advancement in terms of getting a concept like one health or ecological medicine, an ecosystemic view of health, in the medical community? Has that penetrated very much? I get the impression you don’t hear a lot from the medical community about this concept. I know at Bioneers we have pushed the idea of ecological medicine for decades, and some people get it, but it hasn’t penetrated very deeply into the medical establishment as far as I can tell.

ANNE: Maybe “establishment” is the right word in terms of human medicine. Human medicine has long been narrowly focused on the health of humans. It has inherited, just like the rest of society, this anthropocentric view that we humans are the best, most noble creatures on Earth, the only ones who really matter, so it has been difficult to work with many doctors, to get them to see that people’s health is linked to the health of animals and of ecosystems, and that’s why we have to work together to prevent habitat and species loss rather than only focusing on trying to save human lives to the exclusion of the larger context. We need to find a way to reframe the issue so they can understand it better, but they are not trained to think about ecology.

Still, there has been progress. In some countries a “one health” approach is getting well accepted, and wherever a one-health approach has been adopted, it’s been beneficial. However, worldwide there is virtually near to zero budgeting for epidemiological surveillance of wildlife, which is key to the “one health” approach. Clearly it is something that will take time to integrate. But the medical establishment isn’t the only problem. Often the conservation/environmental sector doesn’t know how to integrate human health issues into its language and programs, so those organizations need to evolve in their understanding and develop better strategies to factor in questions of health into their work as well.

JP: I think we can end it there. Thank you so much, Anne, for being on the frontlines, doing such critically important work. I hope that you and your colleagues can get more funding and will be listened to in advance rather than after the epidemics begin in the future. And thank you so much for doing this interview. Good luck with the rest of your stay there along the White Nile, and say hi to all the elephants for us.

ANNE: Thank you.

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