The DAMA protocol

The coronavirus pandemics affecting the entire population of our planet clearly shows that the crisis of emerging infectious diseases (EIDs) poses a national security and existential threat to all countries.

Habitat loss, urbanization, climate change, global tourism and trade create ecological situations that help many pathogens to settle in new places and new hosts, thus stimulating disease emergence in both humans and domestic animals. As we cannot stop or reverse the phenomenon, it is essential to do everything we can to prevent it, to prepare for its major effects, and to develop a defense strategy. Our main objective is to implement a proactive national program to predict and prevent EID outbreaks in the future.

Our work builds on specific evolutionary and ecological knowledge about pathogens. Based on this, the specialized capacities that allow disease-causing organisms to persist in one place give us insights into how they will behave in new conditions. This means we can anticipate the arrival of pathogens and their behavior once they have arrived; and that we can mitigate their impacts on society. In order to do this, however, we must “find them before they find us.”

The four phases of DAMA:

  1. Documenting the existence of disease-causing organisms actually or potentially residing in Hungary is fundamental. Many are known as a result of largely independent research, but undoubtedly many as yet unknown pathogens exist in the country. You cannot cope with disease-causing organisms unless you know who they are, where they occur, and who they are likely to infect. We can take advantage of what we know of the ecology and natural history of disease-causing organisms to focus our search. We know that most, if not all, disease-causing organisms in humans, crops, and livestock reside in at least one host that is not diseased. Such reservoir hosts are often known or suspected, allowing us to focus on a manageable subset of all the species of plants and animals living in Hungary. As well, those reservoirs most often live in different habitats adjacent to places where humans, their crops and their livestock live. Disease transmission occurs in the interface between reservoir hosts in their preferred habitats and humans and economically important plants and animals in their habitats. This knowledge allows us to focus on specific places within Hungary, thereby saving time and money. And finally, the means by which disease-causing agents are transmitted from host to host are highly specific for each disease-causing organism – some are transmitted in food, some in water, some by contact between infected hosts or surfaces that have been in contact with infected hosts. Many are transmitted by other species, called vectors; commonly known examples are mosquitoes and ticks that will be in our specific fucus.
  2. All disease-causing organisms encountered in the documentation activities are subjected to Assessment. This triage process shows us their relative importance similarly to the sorting of patients so as to determine the order in which they will be treated in medical practice. We also apply what we know about the evolutionary history (phylogeny) of each species we find, similarly to human genetic diseases where closely related family members need bigger attention. Thus we can quickly ask if the species is known to cause disease in another place or if it is a close relative of a species known to cause disease in another place. Species that fall into those categories are targeted for special attention (risk alanlysis). All others are archived for future reference if new information implicating them with disease becomes available. The assessment procedure allows us to focus on species of particular interest. In addition to prioritizing what is found within Hungary, we can use what we know of climate change, habitat disturbance, migration, and trade connections to anticipate the likely arrivals of disease-causing organisms not encountered in documentation activities.
  3. Assessments produce recommendations about Monitoring pathogens of significance, and actions to mitigate their impact or making their arrivals less certain. Thus, within a selected habitat interface we can look to elements in common between reservoir hosts and those of interest to us to focus our search even more. We are looking for change – in geographic distribution, in host range, in transmission dynamics, in geographic variation, in what is there, and early signs of arrival of anticipated pathogens.
  4. The results of our monitoring activities must be translated into effective Action as rapidly as possible when necessary. We think the best way to achieve this is through an Action Council including representatives of all relevant government agencies – public health, veterinary health, plant protection, disaster preparedness, tourism – and members of the scientific community. Such a council would be well-suited for making recommendations determining effective courses of action and coordinating their implementation. This council should meet regularly from the beginning to share information and provide advice to help develop the program.

This program integrates activities ranging from the local, boots on the ground contributions of citizen scientists led by ecologists to the most sophisticated technologies of machine learning, bioinformatics, molecular biology, microbiology and satellite surveillance. Implementing this program is a direct investment in the future ensuring that Hungary will maximize disease security for its citizens, and that it will take the lead in EID preparedness internationally, setting an example that we hope other countries will copy.

Brooks, D.R., E.P. Hoberg, W.A. Boeger. 2019. The Stockholm Paradigm: Climate Change and Emerging Disease. Chicago: Univ. Chicago Press.

Daniel R. Brooks: Focusing the DAMA Protocol. lecture at the 4th European Blue Sky Conference