Emerging Infectious Disease

Threats

Margaret A. Hamburg M.D.

Foreign Secretary, U.S. National Academy of Medicine

Plagues and History

Leading causes of global deaths from infectious diseases

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

Convergence Model for Infection Emergence

?2003

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

HIV – unknown before 1981US HIV-related deaths per year and

cumulative PLWHA, 1981-2008

23

• 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

34

• 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.

“No country can live to itself in disease prevention …

Failure of one is a failure of all”

Wilbur Sawyer, Presidential Address

American Society of TropicalMedicine and Hygiene, 1944