An estimated 80 million people worldwide suffer from gambling disorders or problematic gambling as a result of the digital revolution’s substantial expansion of the online casino and sports betting markets. Adolescents are the most affected group, according to a recent study by the Lancet Public Health Commission.

The Commission’s research further states that children and teenagers are being exposed to gambling product marketing in previously unheard-of ways. Because of this exposure, they are especially vulnerable to the allure of quick cash and the addictive qualities of online gambling sites.

There is a pressing need for greater knowledge and preventative measures to protect vulnerable people from the dangers of online gambling as the prevalence of gambling problems rises, particularly among younger populations.

The author of the reports said that “gambling is not an ordinary kind of leisure; it can be a health-harming, addictive behaviour. The harms associated with gambling are wide-ranging, affecting not only an individual’s health and wellbeing but also their wealth and relationships, families, and communities, and deepening health and societal inequalities.”

“By examining these harms, the Commission unveils the intersections between the social, commercial, legal, and political determinants of health. The Commission sheds light on the increasingly complex commercial ecosystem for gambling and its digital transformation, which offers unparalleled capacities for gambling,” the report further said.

The Commission calls on governments and policymakers to treat gambling as a public health issue-just as for other addictive and health-harming commodities, such as alcohol and tobacco-and provides recommendations to prevent and mitigate the broad range of harms associated with gambling,” the report further said.

While it’s one thing to acknowledge the limits to our knowledge of the microbial soup we live in, more recent attention has focused on how we might systematically approach future pandemic risks.

Former US Secretary of Defense Donald Rumsfeld famously talked about “known knowns” (things we know we know), “known unknowns” (things we know we don’t know), and “unknown unknowns” (the things we don’t know we don’t know).

Although this may have been controversial in its original context of weapons of mass destruction, it provides a way to think about how we might approach future pandemic threats.

Influenza: a ‘known known’

Influenza is largely a known entity; we essentially have a minor pandemic every winter with small changes in the virus each year. But more major changes can also occur, resulting in spread through populations with little pre-existing immunity. We saw this most recently in 2009 with the swine flu pandemic.

However, there’s a lot we don’t understand about what drives influenza mutations, how these interact with population-level immunity, and how best to make predictions about transmission, severity and impact each year.

The current H5N1 subtype of avian influenza (“bird flu”) has spread widely around the world. It has led to the deaths of many millions of birds and spread to several mammalian species including cows in the United States and marine mammals in South America.

Human cases have been reported in people who have had close contact with infected animals, but fortunately there’s currently no sustained spread between people.

While detecting influenza in animals is a huge task in a large country such as Australia, there are systems in place to detect and respond to bird flu in wildlife and production animals.

It’s inevitable there will be more influenza pandemics in the future. But it isn’t always the one we are worried about.

Attention has been focused on avian influenza since 1997 when an outbreak in birds in Hong Kong caused severe disease in humans. However the subsequent pandemic in 2009 originated in pigs in central Mexico.

Coronaviruses: an ‘unknown known’

Although Rumsfeld didn’t talk about “unknown knowns”, coronaviruses would be appropriate for this category. We knew more about coronaviruses than most people might have thought before the COVID pandemic.  

We’d had experience with severe acute respiratory syndrome (SARS) and Middle Eastern respiratory syndrome (MERS) causing large outbreaks. Both are caused by viruses closely related to SARS-CoV-2, the coronavirus that causes COVID. While these might have faded from public consciousness before COVID, coronaviruses were listed in the 2015 WHO list of diseases with pandemic potential.

Previous research into the earlier coronaviruses proved vital in allowing COVID-19 vaccines to be developed rapidly. For example, the Oxford group’s initial work on a MERS vaccine was key to the development of AstraZeneca’s COVID-19 vaccine.

Similarly, previous research into the structure of the spike protein – a protein on the surface of coronaviruses that allows it to attach to our cells – was helpful in developing mRNA vaccines for COVID.

It would seem likely there will be further coronavirus pandemics in the future. And even if they don’t occur at the scale of COVID, the impacts can be significant. For example, when MERS spread to South Korea in 2015, it only caused 186 cases over two months, but the cost of controlling it was estimated at US$8 billion (A$11.6 billion).

The 25 viral families: an approach to ‘known unknowns’

Attention has now turned to the known unknowns. There are about 120 viruses from 25 families that are known to cause human disease. Members of each viral family share common properties and our immune systems respond to them in similar ways.

An example is the flavivirus family, of which the best-known members are yellow fever virus and dengue fever virus. This family also includes several other important viruses, such as Zika virus (which can cause birth defects when pregnant women are infected) and West Nile virus (which causes encephalitis, or inflammation of the brain).

The WHO’s blueprint for epidemics aims to consider threats from different classes of viruses and bacteria. It looks at individual pathogens as examples from each category to expand our understanding systematically.

The US National Institute of Allergy and Infectious Diseases has taken this a step further, preparing vaccines and therapies for a list of prototype pathogens from key virus families. The goal is to be able to adapt this knowledge to new vaccines and treatments if a pandemic were to arise from a closely related virus.

Pathogen X, the ‘unknown unknown’

There are also the unknown unknowns, or “disease X” – an unknown pathogen with the potential to trigger a severe global epidemic. To prepare for this, we need to adopt new forms of surveillance specifically looking at where new pathogens could emerge.

In recent years, there’s been an increasing recognition that we need to take a broader view of health beyond only thinking about human health, but also animals and the environment. This concept is known as “One Health” and considers issues such as climate change, intensive agricultural practices, trade in exotic animals, increased human encroachment into wildlife habitats, changing international travel, and urbanisation.

This has implications not only for where to look for new infectious diseases but also for how we can reduce the risk of “spillover” from animals to humans. This might include targeted testing of animals and people who work closely with animals. Currently, testing is mainly directed towards known viruses, but new technologies can look for as yet unknown viruses in patients with symptoms consistent with new infections.

We live in a vast world of potential microbiological threats. While influenza and coronaviruses have a track record of causing past pandemics, a longer list of new pathogens could still cause outbreaks with significant consequences.

Continued surveillance for new pathogens, improving our understanding of important virus families, and developing policies to reduce the risk of spillover will all be important for reducing the risk of future pandemics.

This article is part of a series on the next pandemic.

Allen Cheng, Professor of Infectious Diseases, Monash University 

This article is republished from The Conversation under a Creative Commons license. Read the original article.

U.S. Surgeon General Dr. Vivek Murthy.
| Photo Credit: AP

The U.S. Surgeon General on June 25 declared gun violence a public health crisis, driven by the fast-growing number of injuries and deaths involving firearms in the country.

The advisory issued by Dr. Vivek Murthy, the nation’s top doctor, came as the U.S. grappled with another summer weekend marked by mass shootings that left dozens of people dead or wounded.

“People want to be able to walk through their neighbourhoods and be safe,” Dr. Murthy told The Associated Press in a phone interview.

“America should be a place where all of us can go to school, go to work, go to the supermarket, go to our house of worship, without having to worry that that’s going to put our life at risk.” To drive down gun deaths, Dr. Murthy calls on the U.S. to ban automatic rifles, introduce universal background checks for purchasing guns, regulate the industry, pass laws that would restrict their use in public spaces and penalise people who fail to safely store their weapons.

None of those suggestions can be implemented nationwide without legislation passed by the Congress, which typically recoils at gun control measures. Some state legislatures, however, have enacted or may consider some of the surgeon general’s proposals.

Dr. Murthy said there is “broad agreement” that gun violence is a problem, citing a poll last year that found most Americans worry at least sometimes that a loved one might be injured by a firearm. More than 48,000 Americans died from gun injuries in 2022.

His advisory promises to be controversial and will certainly incense Republican lawmakers, most of whom opposed Dr. Murthy’s confirmation — twice — to the job over his statements on gun violence.

Dr. Murthy has published warnings about troubling health trends in American life, including social media use and loneliness. He’s stayed away from issuing a similar advisory about gun violence since his 2014 confirmation as surgeon general was stalled and nearly derailed by the firearm lobby and Republicans who opposed his past statements about firearms.

Dr. Murthy ended up promising the Senate that he did “not intend to use my office as surgeon general as a bully pulpit on gun control”. Then-President Donald Trump dismissed Dr. Murthy in 2017, but President Joe Biden nominated Dr. Murthy again to the position in 2021. At his second confirmation hearing, he told senators that declaring guns a public health crisis would not be his focus during a new term.

But he has faced mounting pressure from some doctors and Democratic advocacy groups to speak out more. A group of four former surgeon generals asked the Biden administration to produce a report on the problem in 2022.

“It is now time for us to take this issue out of the realm of politics and put it in the realm of public health, the way we did with smoking more than a half century ago,” Dr. Murthy told the AP.

A 1964 report from the surgeon general that raised awareness about the dangers of smoking is largely credited with snubbing out tobacco use and precipitating regulations on the industry.

Children and younger Americans, in particular, are suffering from gun violence, Dr. Murthy notes in his advisory called “Firearm Violence: A Public Health Crisis in America”. Suicide by gun rates have increased significantly in recent years for Americans under the age of 35. Children in the U.S. are far more likely to die from gun wounds than children in other countries, the research he gathered shows.

In addition to new regulations, Dr. Murthy calls for an increase on gun violence research and for the health system — which is likely to be more amenable to his advisory — to promote gun safety education during doctor visits.