First responder

Alex, head of disease control and bioterrorism at the Counter Terrorism Unit, is having a terrible day. An infectious disease is killing hundreds across the city, with experts insisting it is flu. Yet Alex knows it is too early in the season for the virus and wonders if it is a genetically engineered strain of avian flu?

His boss is sceptical. “What if I promise to wash my hands and cover my mouth when I cough?” the boss sneers dismissively.

This is a scene from Pandemic, the five-part bioterrorism drama shortlisted for four awards in Melbourne’s 2016 Web Film Festival. And note the credit line on the final episode: Story by Raina MacIntyre, David Heslop and David Muscatello. 

“I already had the story for Pandemic in my head,” explains Professor MacIntyre, UNSW’s School of Public Health and Community Medicine head. 

The Professor of Infectious Disease Epidemiology is an international leader in emerging infections and biosecurity. She conceived the series as a teaching aid for her online course on Bioterrorism and Health Intelligence, which launched in 2015. It’s part of a new suite of programs offered by the PLuS Alliance, a formidable partnership between three of the world’s top universities – Arizona State University (ASU), King’s College London (KCL) and UNSW.

Pandemic may be a dramatisation, but its threats are real. And MacIntyre understands their magnitude. Biosecurity is at the heart of many of her 280 peer-reviewed papers.

Around 2014, she began using the phrase “biological winter” to refer to “a world full of man-made infections happening too fast to be controlled by drugs or vaccines”. It was a warning that biosecurity breaches could be just as catastrophic as nuclear war.

MacIntyre devised a risk-priority scoring system for the most severe (category A) bioterrorism agents, which won her the 2007 Sir Henry Wellcome Medal and Prize from the Association of Military Surgeons of the United States. It was a rare honour for a non-US citizen, or military member. 

Her interest in bioterrorism stems from concerns around dual-use research that is done “with the intent of helping humanity, but which can also harm – either by deliberate misuse or by accident”.

The issue exploded on the international stage in 2011 when two research groups wanted to publish their findings on how to modify an avian influenza virus so it could be transmitted between people. The researchers claimed this might enable the development of vaccines and drugs. 

“That really split the scientific community,” MacIntyre recalls, who has a stance on the matter. “The risk is too great. Firstly it’s not that helpful for developing new drugs and vaccines. Second, the track record in biosafety in laboratories is not good.

Photo: South Korean rescue workers wearing chemicalprotective suits participate in an anti-terror drill as part of a disaster management in Seoul, 2016. JUNG YEON-JE/AFP/Getty Images

“We have biological technology now that is mind-blowing in its capability. We have gene-editing that is accessible. You can engineer humans, animals, plants or pathogens or create a virus in a lab.” What’s more worrying is governments are struggling to keep pace. “Our systems, legislation and mechanisms for dealing with these advances are stuck in the last century,” she says. 

When we meet at UNSW’s Sydney campus, MacIntyre has just returned from a conference of PLuS Alliance Fellows in Phoenix, where ASU is based. She was presenting the details of a new project investigating H5N1 avian influenza, and the risk factors for human-to-human forms of the highly pathogenic virus. 

Carcasses of dead turkeys killed by a bird flu outbreak at Kibbutz Holit, Israel, 2006. Shutterstock

It’s among the first PLuS Alliance projects to be given seed funding and is led by Matthew Scotch, an associate professor in ASU’s Department of Biomedical Informatics. MacIntyre and Dr Kathleen Steinhöfel from KCL are also collaborators.

Scotch says in MacIntyre he has found someone “who truly complements my work in the historic and geographic distribution of viruses and public health informatics”.

Part of the allure is her research impact across four areas: biosecurity, responses to emerging infectious diseases, vaccinology and personal protective equipment (PPE) for frontline health workers. “Most researchers work on one, or maybe two, of these scientific areas,” Scotch says. “Raina focuses on all four and has tremendous impact.”

Scotch and MacIntyre are among the first scholars to be named PLuS Alliance Fellows. There are now around 120, drawn equally from the three universities. Fellows are encouraged to form research and education partnerships, meet frequently, and take advantage of the cross-pollination of ideas and information that comes from the partnership.

Born in Sri Lanka in 1964, MacIntyre moved with her family to Sydney, at  age nine, sponsored by her uncle who was an associate professor at UNSW. At 15, she wanted to be a police officer. At 16, a chemical engineer. At 17 she wanted to be an artist. But with school’s end looming MacIntyre doubted she could make a living creatively, so enrolled in medicine at the University of Sydney.

From her first year, MacIntyre was drawn to public health: “I was interested in whole populations. But I also wanted to do my physician training.” After graduating in 1988, MacIntyre did 10 years’ training and practice with the aim of becoming a cardiologist. But that ambition was sidelined by a fascination with epidemiology and infectious diseases, which led to a research position at the National Centre for Immunisation Research and Surveillance (NCIRS) at the Children’s Hospital in Westmead.

During her 15 years with the NCIRS, she focused on vaccines and vaccine trials. She also developed a special interest in vaccination of the frail and elderly, culminating in a 2013 study that demonstrated the protective effect of the flu vaccine on preventing heart attacks. 

MacIntyre has written about “the disconnect” between academia and public health practice and wants to bridge that gap. “What you are doing academically has to be relevant to … improving the health of people.”

Perhaps surprisingly, MacIntyre’s most controversial research concerns the protective equipment worn by front-line health workers dealing with infectious diseases. When Ebola re-emerged in West Africa in 2014 the world was unprepared, and hospitals paid a heavy price – with about 60% of patients and one in 10 medical staff succumbing. When the virus began turning up outside Africa – carried to the UK, Europe and the US by travellers and first-responder doctors and nurses – an otherwise ambivalent world took notice.  

A burial team carries the body of a suspected Ebola victim for burial, Disco Hill, Liberia, 2015. UNMEER/Martine Perret

MacIntyre was astonished that as late as 2009 there had been no clinical trials to test the efficacy of the equipment given to medical staff. 

There was a huge discrepancy between the paper and cloth masks issued to staff in hospitals and field clinics, and the full-mask respirators worn by laboratory researchers. She embarked on her own study.

The findings, from four published clinical trials, changed conventional clinical practice and hospital guidelines: Paper masks offered minimal protection from the respiratory aspects of infectious disease compared with fully sealed respirators worn in labs. Even more worrying, the research showed cloth masks could increase the risk of infection.

The findings raised eyebrows because they challenge long-held dogma. But in late 2014 during the Ebola epidemic, the Atlanta-based Centers for Disease Control and Prevention changed its guidelines to recommend respirators rather than masks.

MacIntyre is now focused on cross-disciplinary problems in the new centre she leads on Epidemic Response. One of these is lack of adequate PPE for paramedics and law enforcement officers. 

First responders with little protection interact with others in full biohazard suits in Dallas in 2014. Chip Somodevilla/Getty Images

“If police do a raid on a property these days … they should also be thinking about [the presence of] biological agents. We’ve made small inroads into raising awareness of biosecurity among first responders.

But there’s a long way to go.”