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Dr. Joseph Fair: From the Lab to the Field, 'Virus Hunter' Battles Ebola in the DRC

SEP 25, 2019 | ALEXANDRA WARD
Like something out of National Geographic’s “The Hot Zone,” Joseph Fair, PhD, MSPH, has dedicated his life to hunting viruses around the world, from labs in the United States and France to ground zero in Africa.

A virologist and outbreak responder, Fair is a senior fellow at The Scowcroft Institute at the George Bush School of International Affairs, Texas A&M University, who is currently on the ground in the Democratic Republic of the Congo (DRC) where the second-largest Ebola outbreak in history is still raging.

In part 1 of our Q&A with Fair, we talk about his background, education, and experience, and also how the outbreak response to the current Ebola outbreak in the DRC differs from traditional disaster response.

Contagion®: You are a self-proclaimed “virus hunter.” How do you define that title?

Dr. Fair: I say it almost jokingly as many people these days seem to call themselves “virus hunters,” whether they have ever set foot in the field or not. It’s not a real line of training, but the term was coined by the people I and a number of others in the field trained under from prior generations of disease detectives. I would define a virus hunter as a mix between a scientist or clinician (or both) that is equally at home in the lab and in the middle of a forest or a bushmeat market.

For a true virus hunter, it is not enough to remain in a sterile lab working to isolate or sequence a virus; we have a compulsion to be in the field in the search for where and how the spillover event occurred. You cannot do that remotely or by relying on photos and fragmented field reports. We are usually the first on the ground (from the outside) when a disease of unknown origin is reported in a remote village somewhere in the world. Most of us who do this trained under the same virus hunters from the preceding generations—US Centers for Disease Control (CDC) and Army veterans, Pasteurians, and others who laid the path for us that followed. CJ Peters, Jean-Jacques Muyembe, Peter Piot, David Heyman, Preston Marx, Francoise Barre-Sinoussi—these are prime examples of virus hunters and most of them happen to be good friends and people with whom I have worked closely. They were/are fearless, went into the fray without knowing who or what they were going to encounter, and were usually equipped with little more than surgical masks and gloves, and all this before cell phones and laptops. They negotiated with village chiefs and warlords alike…and made some of the greatest scientific findings we still talk about today. They named many of the deadliest pathogens we continue to discuss and fight in the present.

The protective equipment, anti-malaria medications, ciprofloxacin, and a lot of other protective tools and equipment have made it less dangerous, but we still risk our lives every time we go out, and we do so willingly. There is a rush in going into the unknown, being part explorer, part detective, part missionary, but all with an ultimate goal of tracking down the microbe (or not) responsible for whatever chaos that may be present or ensue, and to stop it from spreading by whatever means we can use.
This lifestyle does not come without great costs. It may sound adventurous and adrenaline-filled, and it is, but once you start regularly missing birthdays, anniversaries, and other important life events, and when you seem to be gone during some of life’s most important moments, it takes a toll on both the virus hunter and those they love. Divorces are very common in our small cadre of brothers and sisters. Following 2014-15, I would say post-traumatic stress disorder is also fairly common for those of us who went in first, stayed too long, and watched friends and colleagues die, along with thousands of others.

Can you give us a brief backstory of your career trajectory and your history in the DRC? How did you come to hunt Ebola in an outbreak zone?

I think it’s important to note that I grew up in one of the poorest regions of the United States—Appalachia in a lower middle-income family. I say that because more than half the people who think they want to do this end up coming once or twice and cannot deal with the extreme poverty that exists within disease hotspots. I was fortunate to get out and attended Loyola University, originally envisioning myself becoming a Jesuit scientist and professor. I quickly fell in love with viruses and virology, especially how these biological entities that we cannot see under a microscope can so completely devastate humans and animals and even entire populations and herds. When I first read about the 1918 influenza pandemic, I knew I wanted to be in the fight and spent my undergraduate years studying the mechanisms by which [human T-cell lymphotropic virus] entered in human cells.

Shortly after my graduation from Loyola, I attended a life-changing seminar by Preston Marx, a true virus hunter and someone with whom I am still close today. Preston’s research focused on finding novel simian immunodeficiency viruses in their reservoir hosts in Central and West Africa. I wrote Preston directly and asked if he would be willing to send a recently graduated bachelor’s degree-level microbiologist to Africa for a couple of years to follow my dream of hunting these bugs where they originated. His acceptance of my proposal changed my life completely and I did it for little more than room and board. I had only ever traveled to Mexico prior to leaving, but for the next 2 years I worked as a liaison and laboratory technician for Preston and the Pasteur Institutes in France and Cameroon, and its equivalent in Gabon (called CIRMF). I was highly fortunate for some of that time to work for Francoise Barre-Sinoussi, Nobel laureate and co-discoverer of HIV. With unbridled passion and dedication, I would often end up working in the lab on Sundays, which is not common in France. The only other person there on those days was FBS herself, which gave 1-on-1 personal and professional time that people would fight to get during the week. That greatly influenced my career and philosophy.

From Paris I went onto work in Cameroon and in Gabon. In the latter, just as I was getting ready to leave, an outbreak of Ebola occurred in 2001 and that is where I met the great CJ Peters or CJP. CJP is, for me, the virus hunter of our times and I still try to emulate his life and career. It was also at this time that I met another very famous virus hunter and co-discoverer of Ebola, Professor Muyembe. He was famous even then and was impressed to meet a very young American on the ground who spoke fluent French. We are very close in life and I often recall the moment CJP asked me to come with him to the University of Texas Medical Branch, where he had just accepted a new faculty position. I jumped at the occasion. I spent a few years there with him, but he strongly encouraged me to get my PhD, which led me back to New Orleans and to Tulane, where I was the first student to jointly pursue a PhD from the School of Medicine alongside an MSPH from the School of Public Health.

I worked in a retrovirology lab but was allowed to come up with my own project on Lassa fever and built a consortium of partners I had known from my previous life working with CJP. The project was a huge success and I was, at the same time, accepted into the pilot year of a US Department of Defense (DoD) program called the SMART program, which allowed me to be a government employee and a grad student at the same time. More importantly, it allowed me to skip a post-doc and move directly into a staff scientist position at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID).

The Lassa project that I came up with was funded by the National Institutes of Health (NIH) on a Friday; Hurricane Katrina hit New Orleans on Sunday. If it were not for my position at the DoD, the NIH had indicated it would not have been able to invest millions of dollars to a university that may never reopen. Thus, 9 days later I showed up in the lab of my true PhD mentor, Dr. Connie Schmaljohn. I conducted all of my PhD work in her lab and with collaborators in the DC area over the next 2.5 years and left USAMRIID after that time, upon my graduation.

I did not actually start working in DRC until about 12 years ago through a collaboration with UCLA and, over these past 12 years, I ended up managing multiple US government projects focused on the DRC. I executed DoD, United States Agency for International Development, US Department of State, and Google.org and Skoll Foundation research programs during that time and worked throughout to build capacity in the DRC to identify and respond to outbreaks of Ebola and diseases like it within the country’s own borders. I wrote programs that put in place liquid nitrogen generators, sequencers, renovated labs, as well as installed lots of equipment into Professor Muyembe’s laboratories, continually making them more and more self-sufficient and less dependent on the West to come to rescue each time a disease popped up in their own backyard. 

Why is Ebola continuing to spread in the DRC?
 
There is no simple or easy answer to this question. First and foremost, this outbreak is taking place where a silent genocide has slowly occurred over the past 2 decades. The population is highly traumatized and highly skeptical of why Westerners are all of a sudden interested in helping them, so they are not lining up for help without a healthy amount of resistance. If we did not care about them getting shot or raped en masse, how could we possibly care about something they can’t even see? They also see huge injections of money and resources and almost none of that is benefiting them or their economy, leading to further resentment and the term “Ebola business.”
 
Secondly, the paradigm of outbreak response for the United States changed following the outbreak in West Africa. Rather than the CDC leading the response and other agencies playing support roles, outbreaks are now managed by the Office of US Foreign Disaster Assistance and response management and disaster area response teams, with other agencies called in as needed by those teams. CDC-led outbreak responses had public health experts in the driver’s seat, often with extensive Ebola and other dangerous disease experience. Working directly with public health experts from DRC and the system worked extremely well for 40 years, [but] CDC now has a minor role and disaster response experts have replaced them. Outbreaks are not like other natural disasters that happen, [where] the work is in the recovery operations. Outbreaks are like living adversaries and require specific expertise in infectious diseases and outbreak dynamics. Disaster response teams work far less directly with their local counterparts and rarely depend on subject matter experts to help with decision-making and instead use the West African Ebola outbreak as their benchmark for most decisions.
 
Lastly, DRC is not West Africa and we tend to forget that fact. It is nearly half the size of the USA and has myriad development issues with its health care system, especially in areas affected by conflict. There are different languages, tribalism, and lack of access to basic health care due to poverty and mistrust. The conflict occurring in eastern DRC between government and rebel forces has greatly hindered operations. 

For the most recent Ebola case counts, check out the Contagion® Outbreak Monitor, and be sure to check back next week on ContagionLive.com to read part 2 of our Q&A with Dr. Joseph Fair.
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