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Struggles for public and individual health

LED Stories

Elias Hakalehto, PhD, Adj.Prof.

Microbiologist, Biotechnologist

CEO, Finnoflag Oy

Vice President, International Society of Environmental Indicators

First published in 27.10.2020

In today´s world, COVID-19 pandemics has taken up the issue of microbiological preparedness into public discussion. In the last centuries, such wonderful inventions as vaccines, antibiotics or clinical hygiene, have given us more and more hope in the struggle against contagious diseases. During the period of the latest one year from October 2019 to October 2020, our perception of the world we live in has changed essentially. We cannot feel secure any more concerning the epidemics. But what is the difference? Actually, the risks have been there all the time, but now we cannot any more live in the illusion that the societies were prepared for them. As a consequence, the urgent need for microbiological readiness has been conceived by the general public. Since the viral pandemics has spread to all countries and rampaged somewhat out of control, and caused economies to collapse in the private sector, the need for real preparedness has become crystal clear. All the negative consequences could have been avoided or played down by truthful preparations. Moneywise, the cost would have been microscopic in comparison with the results of COVID-19, which is just one newly-emerged and globally spreading microbial disease.

There will come more epidemics which is unavoidable in this world where human activities cause all the time more imbalance in the ecosystem. Ebola virus is much more deadly than the SARS-CoV-2. One reason for the recent outcomes of Ebola in Africa is related to the destruction of forests. Bats are carriers (vectors) of this disease and its viral agent into new areas. If their forest is destroyed, they can fly long distances, and bring the troubling pathogens along.

Indeed, we live in the midst of the universe of microbes. Most of them are benign to us; numerous microbial strains inside our body system, or around us, are beneficial for our health and well-being. In the ecosystems, many micro-organisms are necessary for the circulation of nutrients. The microbes can be used for waste recycling, soil improvement, health management, and for the biorefinery industries. We need their contribution into the food production chains and for our staying-alive and planetary survival. Also, to confine the human effects on the climate, for instance.

However, regardless of the high importance of the microbial kingdom, besides and together with plant and animal kingdoms, there are some deadly pathogens among the viruses, bacteria and others. They cause contagious infections which can develop into epidemics, and sometimes to worldwide pandemics. Such devastating diseases have started spreading several times in human history. Modern medicine has learned to cope with them, but only partially. New diseases do emerge as global transportation is distributing them, or the environmental changes provoke them, or the methods for food production do change, or the microbes modify themselves. We are in a constant battle.

What have we learned as societies from the unfortunate and horrible illnesses occurring now and then? Did we prepare ourselves properly for the inevitable? Were the organisations ready as the alarm was set on? What could have been done more against the invisible enemy, occuring this time in the form of SARS-CoV-2 virus? What if the pathogen would have been still much more dangerous or more readily distributing one?

The answers to the questions above do all the time get cleared to us as the COVID-19 disease is rampaging around the globe, during these tragic days of sad news from all over the planet. But what then could have been done to be more prepared? For restricting or preventing or eradicating the virus from the societies? The answers to these and earlier questions are taught in every university, yet the virus caught us up unprepared. The global and national economies are getting shook up and they calculate their losses now. This is the case, although the precautions could have been immensely cheaper than the losses resulting from the healthcare catastrophes.

We could have developed more testing method platforms and testing capacities in beforehand based on the earlier knowledge on the emerging epidemics. The existing protective measures and technologies could have been implemented more quickly if the plans and preparations to use them were more careful. In the conference "Biotech Japan 2014" in Tokyo that year, the representatives of the Japanese government told the international audience about one critical result of their investigations. Namely, it was found out that the most influential actions to improve public health had been the easing of the regulations which make the approval of new medical devices and techniques unnecessarily slow.

Six years later, in 2020, this conclusion of the crucial Japanese research tells us to be more speedy, but not careless in developing the technologies. The advice is to lower the unnecessary barriers on the way of the implementation of novel technologies, or on the way of commercializing new medical devices, for the benefit of all of us, not just individual companies. We need the corresponding policies of supportive governing to be more prepared for future risks.

During the second world war, two British men arrived in New York having two test tubes of penicillin producing mould cultures in their pocket. The discovery of the antibiotics had been made by Sir Alexander Fleming roughly ten years earlier in 1929. Now it was the matter of industrializing the production of the novel medicine. These men did not have any money with them, and did they not know how to make progress in their case. Regardless of this initial lack of resources, they managed to get things forwards, and already before the end of the war penicillin saved 2 million lives.

The undersigned was a postgraduate student in London (in the Polytechnic of Central London, now the Westminster University and in the University College London, as well as in the University of Kent in Canterbury) in 1984-85. My specialization work for the biotechnology diploma was "Gene cloning in Streptomyces". During the course of this project work of mine, we managed to construct a plasmid vector and transferred the gene of clavulanic acid from Streptomyces clavuligerus into Escherichia coli. The streptomycetes are mycelial bacteria, and they are origins of the industrial production of 95% of the antibiotics manufactured nowadays. Thus the production genes had to be moved into more controllable organisms. The genetic plasmid vector was the first for the transfer of genes between Streptomyces and E.coli. This vector constituted the basis for the industries to carry on such R&D for improved production of the antibiotics. This is an example of the potentials of biotechnology in the industrial production of medical substances or molecular tools.

At the present time, we have come across with more and more resistance towards antibiotics among pathogenic microbial strains. This has become one of the biggest threats in the healthcare sector. The antibiotic-resistant bacteria are emerging hazardous microbes. After COVID-19 infection, for example, they may cause complications to the patients which are incurable. - The preventive actions against COVID-19 and other microbial epidemics could be taken into account when designing buildings, industrial processes, homes, schools and other public places or the transportation systems, buses, trains and aeroplanes. We could choose right materials for constructing the hospitals and healthcare facilities, too. Various pre-emptive technologies could be installed, such as UVC light devices or gaseous hydrogen peroxide or ethylene oxide. Such devices as well as electrical sterilization equipment could be used for confining or eradicating infectious agents and for preventing microbiological contamination. As a result a safer ambient atmosphere could be established, and the surfaces could be maintained clean and non-infective, as well as the air-conditioning systems, household and waste waters and other streams within the building or outside it. We performed some years ago the screening of Ite hospitals (nowadays Pihlajalinna) in Kuopio and Joensuu for finding out that no MRSA or ESBL strains were hiding in the operational rooms or elsewhere. However, from some specific places which were difficult to get cleaned, we isolated environmental strains that were resistant to the corresponding antibiotics. Consequently, we can say that there always is room for improvement in the clinical hygiene maintenance.

In the Summer 2019  we had a poster in the FEMS (Federal European Microbiological Society) main conference in Glasgow. In that poster, we were able to demonstrate that the short pulses of UVC light could eliminate most hazardous bacteria but did not cause damage to human tissues if used correctly. Moreover, as like the effect of the UVC light can be pinpointed to the objects in the microscopic scale, it is also possible to develop molecular tools for preventing microbiological contagious agents from entering our body. Besides all the desinfecting agents, antibiotics and vaccines, which belong to the most important inventions of the latest centuries, we could take into wider use also the natural means of passive immunization as a prophylactic method against illnesses and infections.

What is passive immunization? It is the same way by which human mothers protect their newborn babies by the breast milk rich in antibodies. Actually, it is already before the birth when these antibodies are given to the fetuses through the placenta in order to harness them against harmful microbes and substances. During the deliveries, infants get their normal flora established, originating mostly from the maternal epithelial microbiome. This newly inoculated microbial community continues to develop after the birth, and it also protects the growing child against invisible hazards together with the antibodies and other human molecular tools. Passive immunization means the implementation or inoculation of outside antibodies onto the human mucosal membranes, where they could form a barrier against specific pathogens, such barrier resembling the protection provided by the breast milk antibodies.

One important source for the antibodies to be used for the passive immunization is chicken egg yolk. In a similar fashion, as the human mother is secreting the antibodies into milk, the birds accumulate them into their egg yolk. There they protect the young developing ones before and after the hatchment. The chicken egg yolk antibodies are called IgY antibodies. They resemble human IgA which is our mucosal antibody in the system. Therefore the IgY could be used as molecular means for prophylaxis, for preventing the contagion be SARS-CoV-2 or any other pathogen whose structures have been injected as antigen into the egg-laying hen. As the egg yolk is collected, it can be used in sweets or sprays or distributed by other means to give 24 hours of protection against infection. The undersigned suggested this approach for blocking the viral epidemics already in 1996. We had a patent application for that purpose which now has  lapsed. Similar protocols for using the IgY antibodies against infective disease have been proposed and developed in many countries; against caries in Japan, against SARS-1 or norovirus or rotavirus in China, against Pseudomonas aeruginosa bacteria in cystic fibrosis in Sweden etc. However, we in Finland were the first ones to suggest passive immunization with IgY chicken egg yolk antibodies for viral prophylaxis 25 years ago. Why has this strategy not been approved in here or in elsewhere?

Why does it take so long to get these improvements accepted as a mainstream method. It is propably the same cluster of reasons which the Japanese had identified 6 years ago as the number one obstacle preventing the public health services and practices from improving. This reason is the hampering of the development and permissions for new medical devices or technologies. If they are serious projects and the R&D work is carried out on a responsible basis, no extra hardships should be caused for their implementation.  So the efforts to establish passive immunization should be boosted as a complementary means aside from the vaccinations for the prevention of epidemics. In fact, the US Institute of Biological Defense has stated that in the prevention of next pandemics it will be the passive immunization, not the vaccination, which is in the front line. It takes only months to establish blockage for spreading of the disease by passive immunization if the permissions and resources were given in a timely manner, not years as it seems to be the case with vaccines. So, together with vaccines the IgY or other passive immunization tools could make a full protection scheme and protocol.

Plentiful of research is needed for the development of older or newer technologies in healthcare. In most countries we, the citizens, have been educated to think that the state should defend its members. This should be true for the individuals as well as for the small innovative companies. However, the faceless "red tape" hits the hardest these basic units, such as citizens, their families and small enterprises. In order to initiate more activities against invisible threats of e.g. the microbial diseases, the state should activate the small units to protect themselves and the society. It is the SME sector, which usually brings about the improvements, notwithstanding the individual innovators. Recognition of this fact would be the key for functioning societies which are not getting closed by a spreading disease or the threat of it. In these small units it is also possible to get the preparations done for the next pandemic waves. The SME companies develop the technologies, and the governments should make up strategies to support their activities. The commercialization could be made together with the large corporations in order to use their expertize for the global distribution. This approach could make the way for preventing next epidemics, not the legalized totalitarism where the state could at worst be used as a weapon against its own innocent or innovative citizens.