Pasteur’s legacy in 21st century medicine

The Lancet Bid 2022 bye In memory of Louis Pasteur. Born in France on December 27, 1822, Pasteur was a young polymath when he embarked on a path of discovery with profound social relevance. By the age of 40, he was a national hero and an international authority on microbiology, vaccines and immunology. His germ theory of disease laid the foundation for hygiene and sanitation in public and global health. He developed the first vaccine against human rabies in 1885. Along with other great scientists of his time, Pasteur shaped scientific reasoning and communication for the better, creating a legacy that catalyzed advances in human health that has endured for the past 150 years. Yet infectious diseases continue to cause millions of unnecessary deaths. Even before the COVID-19 pandemic, Global Burden of Disease (GBD) data indicated that infection was associated with more than 20% of deaths worldwide. A GBD study on this special themed issue The Lancet indicates that 13·6% of deaths worldwide are associated with just 33 bacterial pathogens.

In all these issues, the obstacles to realizing Pasteur’s legacy in the fight against infectious diseases become apparent. Alison Holmes and colleagues discuss advanced infection control and prevention technologies and strategies in the context of health-care settings. Most hospital-acquired infections are now preventable. Yet infection control remains problematic in low-income countries where basic implementation of common practices is challenging and often unresolved. Bernadette Abella-Reeder and colleagues consider the disproportionate burden of rabies, which still kills one person every 10 minutes in a vulnerable environment, despite effective vaccines to break transmission chains between humans and dogs. Salim Abdul Karim and Izukanji Sikazwe discuss obstacles to Africa’s efforts to develop a Covid-19 vaccine; Giles-Vernick and colleagues discuss disparities and social issues that challenge public health systems. It becomes clear that failure to provide equal protection to all is the result of health disparities promoted by the sociocultural and political environment, civic insecurity, and ineffective messaging and community participation.

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The 21st century is witnessing a changing landscape of infectious diseases. Old and new pathogens are emerging under increasing pressure from anthropogenic forces. Climate change is affecting the distribution and transmission of pathogens. Antimicrobial resistance (AMR) and emerging zoonoses are profound threats now and in the near future. More than a million people – a number set to rise – die each year from bacterial AMR, disproportionately affecting people where health care and sanitation infrastructure is weakest. Pandemics will become more common, yet lessons from COVID-19 are being ignored. To counter such threats, The Lancet On lessons for the future from the COVID-19 pandemic, the Commission calls for socialization, whereby governments and institutions reorient towards a multilateral system that fosters international public health cooperation and solidarity.

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The unstable social and political context in which we live our lives is creating new public health challenges. An infodemic has seen the rapid spread of misinformation that resonates with people in ways that expert advice does not. The vaccine dilemma is now a major obstacle to combating infectious diseases, especially in high-income countries. Many parents are reluctant to vaccinate their children due to concerns about vaccine safety, despite assurances from doctors and public health authorities. This dilemma reflects a widespread breakdown of trust in the state and scientists. As Ilana Lowe and William Bynum note, Pasteur built his public image to bolster support for his research. He understood the power of imparting knowledge, wisdom and information in his relationship with the public. Now, more than ever, the medical research community must acquire creative and authentic science communication and public engagement skills to rebuild trust with a divided society so that their work can save lives.

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“In our century, science is the lifeblood of national prosperity and the living source of progress. Undoubtedly, the tiresome daily discussion of politics seems to be our guide – empty presence! – what really moves us forward are a few scientific discoveries and their application.” These words of Pasteur could not be more poignant in the 21st century, dominated by polarization and health-damaging politics. Pasteur understood that science was fundamental to human health, and his values. – A scientific presence and involvement in public health crises – at the center of efforts against infectious diseases.

(Original caption) France: Children being vaccinated in Pasteur's laboratory.  Lithograph, 1887.

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  • Bacterial pathogens and climate change
    • Although death from infections contributes substantially to global mortality and morbidity, analysis of mortality from bacterial infections is sparse, and often limited to only selected pathogens. Typically, research focuses on disease prevalence based only on sample sizes that are limited in geographic, chronological, and aggregate resolution.1,2 Given the enormous mortality burden associated with bacterial pathogens, a systematic, integrated, pathogen-specific global approach is crucial to provide a comprehensive and comparative perspective to enhance global public health prioritization, resource allocation, and targeted prevention efforts.