Can a Tufts Professor Finally Stop Lyme Disease?
The ticks are back and cases of Lyme disease are rising throughout New England. Inside the race to eliminate one of nature’s biggest threats (plus what you need to know to keep safe this summer). Tick-tock.
It’s a bright Thursday afternoon, and Sam Telford is rummaging through the back of his white Chevy Silverado pickup truck. Slapped on the tailgate are a pair of bumper stickers: The first asks the age-old question “Got Ticks?” and the other reads “I Brake for Roadkill.” When I ask if the second one is true, Telford raises his dark eyebrows over his glasses and assures me that his bumper doesn’t lie. “I cut their heads off and take their brains,” he says.
Telford, for the record, is not some sort of psychopath who gets his kicks collecting dead animals. He is an esteemed scientist at the Tufts Cummings School of Veterinary Medicine and a key player in the long-standing war against Lyme disease, not to mention a host of other tick-borne illnesses, some of which are significantly worse. That’s why he’s out there scooping up roadkill: Studying it helps him locate and understand the Powassan virus, a terrifying germ that’s spread by ticks, attacks the brain, and kills about 15 percent of people who get it. Though rare in humans—181 cases have been recorded in the United States during the past decade—like so many tick-borne diseases its prevalence has crept upward in recent years, and Massachusetts is a hot spot, logging the second-most cases in the nation with 31. Hoping to stay ahead of the scourge, Telford wants to know how much Powassan might be lurking in the wild. One way to find it is by examining roadkill likely to have been bitten by ticks. Another way is to trap ticks and look for the virus inside the little buggers. He does both, and the bad news is that if he looks hard enough, he says, he “can find it almost anywhere.”
Fortunately, decapitating roadkill isn’t on today’s to-do list. Telford, who’s sporting khakis, a brown pair of wellies, and a quilted blue jacket, has agreed, however, to take me on a walk through the woods near his North Grafton office to see if we can capture some ticks. The weather conditions are far from ideal—low 40s, windy, snow still lingering on the ground—but as Stephen Rich, a UMass Amherst microbiology professor, told me, “Sam could find a tick in a blizzard.” We shall see.
In the centuries-long arms race against ticks, the enemy has always held the upper hand, and now its grip appears to be tightening—the Centers for Disease Control and Prevention estimates that nearly half a million Americans may get Lyme each year, while the population of ticks and the geographic range in which they’re found have grown dramatically over the past half century. Telford has spent his 30-plus-year career studying and developing countermeasures against ticks and the pathogens they transmit, but a step forward has often resulted in several steps backward.
To start with, he has already helped develop the first and only FDA-approved vaccine for Lyme—only to watch it implode and be pulled from market, an early casualty of the anti-vax movement coupled with dubious safety concerns. He’s also conducted a years-long study on the benefits of controlling deer populations, an idea brushed off as ethically and politically fraught. But in our new world, where public health is at the forefront of every conversation and there’s a premium on spending time outdoors, Telford is in a prime position for his battle cries to finally break through the noise.
Given the opportunity, Telford—who is fond of bow ties and exudes a sort of gee-whiz charm—will chat up whomever he can in hopes of getting them to take the threat of ticks as seriously as he does. After all, it’s a threat that gets seemingly more ominous by the year: When Telford started his career, deer ticks and dog ticks—the two most common types in Massachusetts—were confined to a few pockets, mostly on the Cape and Islands. Now they’re found from the Berkshires to backyards in Medford to the Arnold Arboretum in Jamaica Plain.
It’s not just Lyme we need to worry about. Ticks have been described as “nature’s dirty needle” and a “cesspool of pathogens.” The more Telford wades around that cesspool, the more alarmed he grows. Nantucket, Dukes, and Barnstable counties are currently first, second, and third in the nation for rates of babesiosis, a disease often likened to malaria. Anaplasmosis, which can feel like a severe case of flu, and Borrelia miyamotoi disease, which can trigger long bouts of relapsing fever, are also looming threats. “There are five different infections spread just by deer ticks,” he says, “and people are living in places where all five of these things could be in their yard. You’d be horrified to know what’s out in the woods in terms of infectious agents.”
And with that, we make our way toward the trees.
Hunting for ticks is a surprisingly low-tech endeavor. The only specialized tool Telford has today is a roughly 3-foot-long broomstick, on the end of which is tied a big square of fabric that looks and feels like the stuffing inside a teddy bear. Onto it, Telford has stitched two denim pockets that he has filled with handwarmers in hopes of fooling the ticks into thinking his contraption is the cozy torso of a deer. The homemade device is called a “tick drag,” and though it may look reminiscent of a pre-K arts-and-crafts project, Telford has pulled thousands of ticks from the wild with it.
As Telford high-steps it over some branches, he describes himself as a pragmatic naturalist whose foremost concern is human health. If he could kill every tick in existence, he would. In the great scheme of Mother Nature, he says, nothing needs ticks. They don’t fill any critical niches in the food web or pollinate any flora. If all the ticks disappeared tomorrow, the only thing that would happen is people would stop getting sick. Unfortunately, he sighs, it’s not that easy. “We’re not dealing with a susceptible enemy,” Telford says. “They are extremely ecologically successful.”
One key to ticks’ success, Telford says, is their ability to hitchhike. Left to its own devices, he explains, a tick will travel only about a meter in its life. So it climbs up reeds, twigs, woody stems, and blades of grass, sticks out its front legs, which are equipped with mechanical and chemical receptors, and waits. As a deer, a mouse, or your child plods down the trail, the tick senses the vibrations, picks up on the subtle plumes of carbon dioxide being exhaled, and gets into a “state of excitedness,” as Telford describes it, waving his arms in the air to mimic the tiny creature. “They’ve got Velcro on the ends of their feet and they just latch on” when something brushes up against them.
Ticks come to harbor Lyme by latching onto deer, white-footed mice, or other small mammals that are wellsprings for the bacteria. As a result, Telford tells me, there is a very straightforward way to quickly and significantly reduce the spread of Lyme: kill the deer. “I’ve calculated that one deer can give rise to 2 million [tick] offspring,” he says. “I’ve personally pulled 99 fed female ticks off one deer.”
The number of white-tailed deer in Massachusetts has exploded over the past few decades, and today it’s estimated there are more than 100,000 of them, potentially more in some locations than during Colonial days. Telford’s tone wavers between bemusement and frustration as he ponders the many ways in which people have aided and abetted deer—and thus ticks—to help them flourish. Homeowners hang ornamental plants in their yards that deer love to snack on; wolves and mountain lions that once preyed upon the deer have been eliminated. Meanwhile, towns have stopped clearing the forests that give deer shelter and legislators have deemed large swaths of the state un-huntable. Other than speeding SUVs, there aren’t many risks to being a deer in Massachusetts. “Inside 495 is one of the worst places for Lyme disease because people can’t control the deer population,” Telford says. “You can’t hunt between houses effectively and that’s really the only way of managing their herds.”
Telford isn’t pushing some bloodthirsty or even untested hypothesis. As part of his doctoral thesis, he performed a study on a small peninsula of Cape Cod. The town culled 80 percent of the deer and then Telford trapped ticks on the peninsula from April through October. Every July and August, Telford, who’s also a phlebotomist, collected blood samples from the residents. What started out as a school project extended for 15 years. Prior to the deer reduction, 16 percent of the small community of fewer than 200 people had gotten Lyme. After eliminating the deer, Telford recorded only three cases of Lyme in a decade and the tick population declined by 80 percent. “We know that if we kill deer, we’ll reduce the number of ticks and reduce our risk for Lyme disease,” he says. “We know what needs to be done. People just won’t do it.”
Depending on how you look at it, Telford was practically destined to become a one-man, walking, talking anti-deer public service announcement. The son of a parasitologist with the World Health Organization, he had long been fascinated by animals and the diseases they spread, and from a young age was groomed to take on these types of problems. His family moved frequently, including stops in Panama, Venezuela, Pakistan, Burma, and Tanzania. Telford was the kid who kept venomous snakes as pets while his dad, the world’s foremost expert on lizard malaria, would pay $20 for any lizard that Telford or his siblings trapped that contained a new species of malaria parasite.
Telford yearned to follow in his father’s adventurous footsteps; he considered college and a master’s program as merely a pit stop on his way back to the tropics. But then Lyme exploded and he became consumed with beating it in the Northeast. “I look out my window sometimes and wonder how on earth I’ve survived more than 30 years in this hellhole climate,” Telford jokes, gesturing toward the evergreens and frozen ground.
Lyme disease wasn’t on the radar of many Americans, especially those outside the Northeast, when Telford began working on his Ph.D. in the late ’80s. It had only been properly identified in 1975 after two mothers in Old Lyme, Connecticut, urged state public health officials and Yale Medical School researchers to look into a bizarre cluster of arthritis and juvenile arthritis. It took until 1982 for scientists to pin Borrelia burgdorferi as the cause. In some academic and public health circles, it was brushed off as a yuppie disease. “My fellow graduate students in the department were looking at me like, why on earth would you want to work on a rich man’s disease?” he says. But the disease he was focused on would soon become an issue of major concern throughout New England.
Telford was a creative and talented scientist, but equally impressive was his ability to talk about ticks with just about anyone. He could dazzle doctoral students with jargon-laden explanations of transmission dynamics and then walk into a town-hall meeting in Nantucket and talk coolly and calmly with residents who were scared stiff of Lyme. Stephen Rich of UMass Amherst recalls seeing Telford speak for the first time at a conference in the ’90s. “He looked like he was about 13, and he was very bold and very confident and he was waving his hands,” Rich says. “And I thought, ‘Who is this prodigy?’”
Telford’s star continued to rise, and he became so well known in the world of ticks and Lyme disease that when pharmaceutical giant SmithKline Beecham needed to test a vaccine it was developing, he was tapped to help. He managed the vaccine’s Phase 2 study, which mostly meant recruiting patients from the Cape and Islands to participate in the experiment. It wasn’t as easy as Telford thought it would be. “I would put up signs in the liquor stores on the Vineyard and Nantucket saying, ‘Please call or write me if you want to be part of this trial,’” he recalls. “I thought I’d be inundated with replies. And it turns out it was like pulling teeth.”
Telford turned his struggles into one of his proudest accomplishments. It took weeks and a lot of conversations, but he convinced more than 360 people to sign up. Later, at the conclusion of Phase 3 studies, which included nearly 11,000 participants, the data was clear: SmithKline’s vaccine reduced Lyme cases by 76 percent. It wasn’t perfect—and it required three doses—but for residents in hard-hit regions, the vaccine was sure to be a game changer. Telford felt honored to have played a part. In December 1998, the FDA approved LYMErix—a definitive milestone in the fight against Lyme.
What began as a crowning victory, though, soon became Telford’s pit of despair. One year after the vaccine approval, a Philadelphia law firm filed a class-action suit against the pharmaceutical company, alleging that 121 individuals suffered adverse reactions to the shot, including chronic bouts of arthritis, neurological problems, and a range of other ailments. To top it off, the complaint alleged that the company knowingly concealed these risks. The national media ran with the story, describing a series of ensuing federal investigations and public hearings as “raucous and riotous” affairs.
The late ’90s were a tough time across the board for vaccines. Just months before the FDA approved LYMErix, the now-disgraced scientist Andrew Wakefield published an infamous paper in the Lancet falsely drawing a link between autism and vaccines. On top of that, a newly approved rotavirus vaccine to protect children from diarrheal diseases had come under intense scrutiny after reports surfaced of children’s bowels collapsing. News outlets latched on to these stories and framed LYMErix as just the latest example of a vaccine turning otherwise healthy people sick.
In the aftermath, numerous and extensive follow-up studies by the FDA never corroborated any of the safety risks that were alleged in the lawsuit—but it didn’t matter. Clouded by controversy, sales of the vaccine sputtered out of the gate and SmithKline Beecham yanked it from the market.
The saga still stings Telford. He empathizes with people who feel that the vaccine may have hurt them and doesn’t doubt that some of these people are sick—it just has nothing to do with Lyme or the vaccine, he says. From his perspective, the PR campaigns against the vaccine and the lawsuit were acts of great selfishness: A handful of people were so focused on themselves that they never thought about the many people whom the vaccine could have benefited. “Hundreds of thousands of cases of Lyme disease might have been averted had the vaccine continued to have been offered. Something I worked on as a young man could have made an impact,” he laments. “There was no scientific basis for the lawsuit. In fact, there’s still ongoing surveillance of those who were vaccinated and the number of adverse events associated with vaccination are no greater or less than any other vaccine that is commercially available.”
The LYMErix debacle is likely to saddle any future attempts at bringing a vaccine to market. At the same time, Telford says people are too soft-hearted to ever agree to culling deer. None of this has dampened his enthusiasm for looking for new solutions, but it sure has changed his perspective on what his obstacles are. When I asked Telford what great mysteries of ticks continue to plague him, he laughed: “It’s more the mysteries of people that plague me.”
Thanks in part to his growing fame throughout the scientific community, Telford never seems to run out of projects to work on, no matter how far-out they might seem. Take, for instance, the idea of medicating wild animals. In 2020, the National Institutes of Health in December awarded nearly $4 million to Telford and Linden Hu, a professor of immunology at Tufts’ Graduate School of Biomedical Sciences, to start working on a study that involves coaxing mice into eating bait laced with antibiotics that kill the Lyme bacteria. The vast majority of Lyme cases in the United States are treated with doxycycline, a broad-spectrum antibiotic that’s been around since the 1960s and is remarkably effective at killing Borrelia burgdorferi, whether it’s in a human, deer, or mouse. But scientists can’t just bomb doxycycline into the woods without creating a host of new issues related to drug resistance, so Telford and Hu are studying whether the approach might work with newer compounds that aren’t used in humans.
On the more controversial side, Telford is advising on a project to release scores of genetically modified mice into the fields and tall grass of Nantucket and Martha’s Vineyard. A few years ago, Telford met Kevin Esvelt, a young assistant professor at MIT and a CRISPR and gene-editing wiz. Esvelt’s big idea was to genetically alter white-footed mice—one of the biggest Lyme reservoirs in Massachusetts—so they naturally produce antibodies that kill the bacteria. This immunity could be passed down generation to generation, eventually removing one of the bacteria’s most cherished hosts from these areas.
Telford, of course, was the perfect person for Esvelt to bring onboard. Throughout his career, Telford had participated in dozens of community meetings in parks and backyards to talk about the dos and don’ts and myths and facts of ticks. For a while he penned a humorous column in the Martha’s Vineyard Times called “Telford Talks Ticks,” in which he dispensed advice on how to stay safe and shared eye-opening anecdotes, including one about a friend who needlessly burned a tick off his penis using a lit cigarette (tweezers would have been safer and more effective, he sagely advised). And he has worked closely with nearly every local health official and policymaker to try to tackle the issue. “Everyone who deals with tick-borne disease on the islands knows who Sam is,” Esvelt says.
Currently, there’s no firm timeline for the so-called Mice Against Ticks program. It could be two, five, or 10 years before people feel comfortable enough moving forward with genetically modified animals roaming the hills. So far, though, there’s strong public support for the approach and a sense that residents are willing to once again put their faith in science, which gives Telford hope that all is not lost in the battle against ticks.
After completing a loop along the edges of the woods, we finally circle back to the Tufts parking lot. In Telford’s pocket is a pair of tweezers for plucking ticks off the drag and a rubber-capped vial to store them. He pulls the white fabric taut, carefully scans it for our quarry, and…nothing. Telford: 0; Ticks: 1. It’s not the first time the scientist has been bested by ticks, and it won’t be the last. But he’ll never give up or yield an inch to his nemesis.
Before heading out, I had one more question for Telford—the same one on most everybody’s mind as we head into summer.
“Is this year going to be bad for ticks?” I asked.
Telford, of course, could expound at length about research indicating that humidity levels in late May and early June might have population-level effects on ticks—but not today. Instead, he simply tells me, every year is a bad year for ticks.
Ticks aren’t the only disease-carrying creature lurking outside this summer. Here’s what else you need to look out for when enjoying the great outdoors.
The Carrier: Mosquitos
The Disease: Eastern equine encephalitis (EEE)
Why You Should Worry: Rare but scary, EEE kills roughly one-third of people who get it. Research suggests it comes in three-year cycles, with Massachusetts’ most recent bout kicking off in 2019, when 12 human cases were recorded. Last year was quiet, though, a trend that experts are hoping holds steady through this summer.
The Carrier: Rats
The Disease: Leptospirosis
Why You Should Worry: A nasty blood infection nicknamed “rat fever” that can infect humans and dogs alike, leptospirosis is spread through rat urine. Veterinarians have attributed a recent spike in Boston-area canines falling ill with it to the city’s booming rat population, and a few years ago a Jamaica Plain worker got sick from the disease.
The Carrier: Seagulls
The Disease: E. coli
Why You Should Worry: A splat of seagull poop on your beach blanket isn’t just a nuisance—it’s also full of dangerous germs, including potentially drug-resistant E. coli bacteria. Given our increasingly close (and sometimes contentious) relationship with these seabirds, it’s a situation worth monitoring.
The Carrier: Bats
The Disease: Rabies
Why You Should Worry: Cases are few and far between, but the risk remains very real, and rabies is almost always fatal if not treated swiftly. More than 5,000 animals have tested positive for rabies in Massachusetts since 1985, including raccoons, skunks, woodchucks, and foxes. Bats are especially good at transmitting the virus, claiming responsibility for seven in 10 rabies deaths in the U.S., according to the CDC.