Emerging Infections Microbial Threats to Health in the United States (1992) / Chapter Skim
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EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
Pages 1-15
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From page 1... ...
The committee's report, which is summarized here, describes key elements responsible for the emergence of infectious diseases; it also presents recommendations that, if appropriately implemented, should allow the United States to be better prepared to recognize and respond rapidly to these public health threats. What are the factors, operating both singly and in combination, that are contributing to the emergence of such pathogens?
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disease could have been limited if there had been an effective global infectious disease surveillance system in place in the late 1960s or early 1970s. However, without such a system in place, we would have little chance for early detection of emerging diseases in the future.
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. Approaches for consideration could include simplifying current reporting forms and procedures, establishing a telephone hotline by which physicians could report unusual syndromes, and using electronic patient data collected by insurance companies to assist in infectious disease surveillance.
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Much of this information, however, is not readily accessible. There is currently no single database from which a physician, researcher, health care worker, public health official, or other interested party can obtain information on disease incidence, antibiotic drug resistance, drug and vaccine availability, or other topics that might be relevant to infectious disease surveillance, prevention, treatment, and control.
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government agencies remain largely uncoordinated and in need of a strategy to focus them in appropriate areas, such as emerging diseases. The committee recommends that international infectious disease surveillance activities of U.S.
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There has been no effort to develop and implement a global program of surveillance for emerging diseases or disease agents. The committee believes that an effective global surveillance network on emerging infectious diseases is an essential element in efforts to combat microbial threats and that it should have four basic components: a mechanism for detecting (using clinical presentation as the criterion)
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INTERVENTION The recognition of an emerging infectious disease is the first component of response, but what follows that recognition may, in fact, determine the final impact of an emerging disease on the public's health. Effective intervention against such diseases necessitates coordinated efforts by a variety of individuals, government agencies, and private organizations.
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From page 8... ...
or foreign scientists, have a broad or narrow focus, all of these programs contribute to the international capability to recognize and respond to emerging infectious diseases. The Rockefeller Foundation's International Clinical Epidemiology Network trains junior medical school faculty from developing countries in the discipline of epidemiology.
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, which places field-oriented epidemiologists in countries that need to develop and implement disease prevention and control programs. Current and former EIS officers and FETP graduates are important sources of information on emerging diseases and constitute a personnel nucleus for a global surveillance network.
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The committee recommends that Congress consider legislation to fund a program, modeled on the National Health Service Corps, for training in public health and related disciplines, such as epidemiology, infectious diseases, and medical entomology. Vaccine and Drug Development Vaccines and antimicrobial drugs have led to significant improvements in public health in the United States and in many other nations during the latter half of this century.
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To bring a new vaccine rapidly from the research laboratory into general usea necessary criterion if one hopes to prevent or control an emerging infectious disease-will require an integrated national process that · defines the need for a vaccine, its technical requirements, target popu lations, and delivery systems; · ensures the purchase and use of the developed product through purchase guarantees and targeted immunization programs; · relies as much as possible on the capability of private industry to manage the vaccine development process, through the use of contracted production, if necessary; · utilizes the capacity of the NIAID to manage and support basic, applied, clinical, and field research, and of the CDC and academia to conduct field evaluations and develop implementation programs; · is centrally coordinated to take maximum advantage of the capabilities of the public and private sectors; and · is prepared for the possible rapid emergence of novel disease threats, such as occurred in the 1918-1919 influenza pandemic. The committee recommends that the United States develop a means for generating stockpiles of selected vaccines and a "surge" capacity for vac
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The assigned mission of these new facilities would be vaccine development for future infectious disease contingencies. ANTIMICROBIAL DRUGS The usefulness of antimicrobial drugs can be ensured only if they are used carefully and responsibly, and if new antimicrobials are continually being developed.
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The committee recommends that the Environmental Protection Agency develop and implement alternative, expedited procedures for the licensing of pesticides for use in vector-borne infectious disease emergencies. These procedures would include a means for stockpiling designated pesticides for such use.
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Even when scientists and public health officials rely on and encourage education and behavioral change to prevent or limit the spread of infectious disease, the public may not be convinced of its necessity. Although scientists may see emerging microbes as a very real threat to public health, the average citizen may be unaware of the potential danger or may consider those dangers to be less important than other health risks, like heart disease and cancer.
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These efforts will help to ensure that we will be better prepared to respond to emerging infectious disease threats of the future. 2Figures are in 1992 dollars.
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