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Summer 2003 Vol. 3 No. 2

Table of Contents

ŠJoel Nakamura/

A Call to Action Against
Microbial Threats

Meeting the Challenges Posed by Infectious Diseases

Americans have a false sense of security when it comes to infectious diseases. But West Nile, SARS, and bioterrorist threats are giving the nation an alarming wake-up call.

No one wished for a case that would dramatically illustrate the major points of the Institute of Medicine's latest report on tackling emerging infections. Even so, the first major media accounts of the outbreak of severe acute respiratory syndrome, or SARS, coincided with the report's release and hammered home the gravity of its findings and recommendations, particularly its call for a shared, global effort to detect and respond to disease.

The SARS outbreak is just the latest reminder that we are still poorly prepared to combat the potential threats posed by new or re-emerging infectious microbes. In the past few decades, human health has been challenged by dozens, including HIV, Ebola, E. coli 0157:H7, hepatitis C, West Nile virus, and the agent responsible for the brain-destroying variant Creutzfeldt-Jakob disease.

Looming over each new outbreak is the specter of the 1918 flu pandemic, which spread like wildfire and killed at least 24 million people across the globe. Though it has spread more gradually, HIV likely will soon overtake the 1918 flu's death toll. So far, SARS has proved less lethal, but nonetheless, it has severely sickened thousands, killed hundreds, and wreaked havoc on the economies of affected areas.

Reaction to the SARS outbreak underscored the significance of the IOM report's conclusion that an effective national response to infectious diseases must be a global response. In today's easily and well-trafficked global village, infectious microbes can spread quickly to all points of the planet. Reticence or incapacity to tackle outbreaks by any one nation can affect others.

The United States should take a leadership role in promoting a comprehensive global surveillance system to monitor infectious diseases, particularly in the developing world where the burden of infectious illnesses is greatest and resources are most limited. Both technical and financial assistance are needed to ensure that proven public health practices are in place worldwide. The U.S. Department of Defense, Centers for Disease Control and Prevention, and National Institutes of Health should expand and enhance their surveillance programs and actively share diagnostic tools and know-how with other nations to boost their self-sufficiency in disease monitoring and response.

But improvements are not only needed abroad. Efforts also should be made at home to shore up America's own public health infrastructure, which has suffered from years of neglect. Resources must be directed to rebuild and sustain the nation's capacity to monitor and respond to both naturally occurring diseases and bioterrorist threats.

Fortunately, a rapidly expanding understanding of microbiology should allow the development of a large set of new drugs, vaccines, and other countermeasures. But the success of new or current antimicrobials depends on how wisely they are used. Antimicrobial resistance has reached the point that some bacteria are resistant to almost every available drug. Efforts to curb inappropriate use of antibiotics should be expanded, the report urges. For example, the Food and Drug Administration should ban the use of sub-therapeutic levels of antimicrobials to enhance animal growth if those classes of drugs are also used to treat infections in people.

Meeting the challenges posed by emerging and re-emerging infectious diseases is a long-standing concern of the IOM. Since 1997, its Forum on Emerging Infections has focused attention on infectious disease issues and advanced strategies toward solutions. In addition, the National Academies and National Institutes of Health sponsored a workshop in June 2003 to brainstorm new approaches to developing drugs that could block the smallpox virus. It brought together smallpox experts and leading scientists from other fields in the hope that three or four ambitious, new ideas will emerge. If this approach is successful, it could be repeated for different viral and bacterial threats with the goal of accelerating new drug development.
  -- Christine Stencel

Microbial Threats to Health: Emergence, Detection, and Response. Committee on Emerging Microbial Threats to Health in the 21st Century, Board on Global Health, Institute of Medicine (2003, approx. 350 pp.; ISBN 0-309-08864-X; available from the National Academies Press, tel. 1-800-624-6242; $44.95 plus $4.50 shipping for single copies).

The committee was co-chaired by Margaret Hamburg and Joshua Lederberg. Hamburg is vice president for biological programs at the Nuclear Threat Initiative, Washington, D.C. Lederberg is professor emeritus of molecular genetics and informatics and Sackler Foundation Scholar, Rockefeller University, New York City. The study was funded by the Centers for Disease Control and Prevention, National Institutes of Health, Ellison Medical Foundation, U.S. Agency for International Development, U.S. Department of Defense, U.S. Department of Agriculture, U.S. Food and Drug Administration, and U.S. Joint Institute for Food Safety.

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Copyright 2003 by the National Academy of Sciences