Post on 04-Apr-2018
Emerging Infectious Disease
Threats
Margaret A. Hamburg M.D.
Foreign Secretary, U.S. National Academy of Medicine
Infectious disease burden decreasing… but still causes almost 20% of all global deaths
• ~9 million deaths/year worldwide from all infectious diseases
• Disproportionally affects low-income countries
• Cause nearly 2/3 of all child deaths
• Most from pneumonia, diarrheal disease
• Influenza pandemics and emerging infectious diseases an increasing concern
Global health risks are increasing
Emergence and Spread of New Pathogens
Globalization of Travel and Food Supply
Rise of Drug Resistance
Intentional Engineering of MicrobesFood Supply
XDR TB
MRSA
Anthrax
Recombinant
Technologies
HIV
Avian Flu
What are Emerging
Infections?
They are infectious diseases that recently have become more prevalent or threaten to do so. They include infections of plants, animals, and human beings, naturally or intentionally (e.g., caused by terrorism). Drug-resistance is also a form of emergence.
Institute of Medicine, 1992
A “Perfect Storm”
• Despite progress, we are at greater risk today because of the continuing emergence of new infectious diseases and resurgence of old diseases, often in new, more dangerous forms
• In addition, advances in science and technology mean that it is easier for people – even with limited technical training – to inadvertently or intentionally create deadly pathogens in simple laboratories
• Some disasters we can only prepare for, but many we can prevent
• Vital to understand the factors that contribute to current infectious disease threats
Factors Contributing to Disease
Emergence and Re-emergence
• Human demographics and behavior
• International travel and commerce
• Urbanization and crowding
• Changing agricultural practices and land use
• Climate change and environmental degradation
• Breakdown of or inadequate public health measures
• Healthcare-associated infections
• Microbial adaptation, evolution and resistance
Global aviation networkDisease can spread nearly anywhere
within 24 hours
Note: Air traffic to most places in Africa, regions of South America, and parts of central Asia is low.If travel increases in these regions, additional introductions of vector-borne pathogens are probable.
Enormous costs of AIDS
• Detection delayed by decades
• Cases of “wasting syndrome’ not pursued
• Recognized and formally identified after imported to and established in US/Europe
• Epidemic lasting 30 years and counting
• Some 30 million lives lost
• $100 billion in costs to lower- and middle-income countries alone
Effective evidence-based
interventions: HIV/AIDS
Source: UNAIDS/WHO
Prevention by education, safer sex, and circumcision
Management with HAART
Prophylaxis/treatment of opportunistic infections
Mitigation of consequences: orphans, loss of family income
• As of June10, 2016:
- 28,616 total cases
- 11,310 deaths
• Economic impact:
- In April 2015, the World Bank reported that the estimated GDP losses for Guinea, Liberia, and Sierra Leone totaled US$2.2 billion
US$240 million for Liberia
US$535 million for Guinea
US$1.4 billion for Sierra LeoneSource:
WHO, 2016
World Bank, 2015
Ebola’s Impact
Steps to a safer worldPrevent emerging threats
• Improve global food and drug safety
• Strengthen laboratory biosafety and biosecurity
• Reinforce border controls
• Distribute critical vaccines
Enhance early threat detection
• Strengthen surveillance
• Expand regional disease detection centers
• Coordinate reporting and information sharing
• Train disease detectives
Improve threat confirmation and characterization
• Strengthen global laboratory networks
• Build core capacity to detect deadly pathogens
• Maintain global repository of laboratory reagents
• Ensure training and quality management
Ensure highly effective epidemic responses
• Effective medical countermeasures, personalprotective gear
• Build global network of interconnected emergency operations centers
• Ensure common approaches to crisis management and response communications
• Standardize global decision-making about travel and trade restrictions
• Respond to threats domestically and globally
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• Global architecture to reduce risk and mitigate next global
health crisis
• Before the outbreak occurs, we need to identify leaders and
roles, resources, appropriate times for responding
• Successful containment of future outbreaks requires
timeliness
• Coordinated response informed by good planning and
evidence, not fear or politics
• Responders need to move as one to avoid mistrust, stigma, or
miseducation of communities
• Need to learn now, before memories fade
Need of a Global Health Risk Framework
A Three-Pronged Framework to
Counter Infectious Disease Crises
1. More effective global and regional capabilities,
led by a reenergized WHO, through a dedicated
Center for Health Emergency Preparedness and
Response, coordinated effectively with the rest of
the UN system, and supported by the World Bank
and IMF.
2. Stronger national public health capabilities,
infrastructure, and processes built to a common
standard and regularly assessed through an
objective, transparent process fully consistent with
international legal obligations under the IHR.
3. An accelerated programme of R&D, deploying
USD 1 billion per year and coordinated by a
dedicated pandemic product development
committee.
Key Messages• Infectious disease crises pose a significant threat to global
security – to human lives and to economic well-being
• We have neglected this threat – Ebola and other outbreaks revealed significant shortcomings in almost every aspects of our defenses
• The case for investing more in pandemic preparedness is compelling
• USD 4.5 billion per year would significantly reduce the risks to human lives and livelihoods
• Investing in preparedness and prevention is far more cost-effective than reacting when outbreaks occur
• The Commission's recommendations constitute a coherent framework for countering the threat of infectious disease crises:
• Reinforcing the first line of defense – public health capabilities and infrastructure at a national level
• Strengthening capabilities and coordination at a regional and global level
• Accelerating R&D
• We must act with urgency – and we must monitor implementation. We all have a shared interest in making the world safer.