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Explore the interconnected global health challenges affecting America's security. Learn about infectious diseases, biosecurity threats, US research responses, new disease threats, and global research needs for biosecurity.
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Global Health is America’s Health and National Security Samuel L. Stanley, Jr., M.D. Paul Rogers Global Health Ambassador Research!America
Infectious diseases know no borders • The flat, hot and crowded world. • Jet travel removes the temporal and geographic barriers • Increased population density • Environmental changes may promote increased vector range and disease transmission
Infectious diseases know no borders • Our actions, and the inherent properties of our microbial enemies, guarantee new disease threats. • Expansion and encroachment lead to exposures to previously unrecognized microbes • Microbes are evolution in motion—constantly changing their genetic makeup through mutation to expand their host range, and resist therapies.
Under Siege--Biosecurity • International public health infrastructure. • Incentives to produce new vaccines and therapeutics for existing and emerging diseases. • Support for basic and applied research on these biological threats.
Infectious diseases know no borders • . Wisconsin, Illinois, Indiana, Kansas, Missouri, and Ohio with cases. 72 suspected, 37 confirmed.
US Research Responds • Why did we see such low morbidity and mortality with the monkeypox outbreak? • Virus was from W. Africa—lacks two key genes found in the more virulent Central African strain—clues to how we fight off these viruses. • Help us understand and prepare for any future poxvirus outbreaks.
SARS • More than 8000 cases and 774 deaths • Epidemic began in November 2002, exploded internationally in March 2003. • Widespread concern and significant economic impact.
SARS—US Research Responds • In just three months: • Virus identified. • Virus completely sequenced. • Natural host probably identified. • Diagnostic tests based on viral sequence developed. • Koch’s postulates fulfilled for SARS-CoV– isolated virus successfully infected monkeys with development of SARS-like illness and identification of virus in pathological specimens. • Understanding the disease led to some preventive measures and no further significant outbreaks reported.
New Threats • Chikungunya—mutation in virus caused massive outbreak in Reunion—260,000 cases and 37 cases in the U.S. • 4 deaths in S. Africa from unknown virus—now identified as arenavirus. • Methicillin resistant staphyloccus aureus in the United States and the world, requires expensive and more toxic antibiotics.
Global Research Needs for Biosecurity • Worldwide research into rapid recognition and identification of new disease threats • Collaboration on new diagnostics—large scale sequencing to identify new pathogens—work between U.S. researchers and those in other countries. • Epitomized by SARS effort, but U.S. must help lead the way.
Global Research Needs for Biosecurity • Continue to support research into broad spectrum interventions—therapeutics that target whole classes of viruses or bacteria. • Vaccines or drugs that boost the immune system to provide response against multiple biologic threats—notion of controlling infection until specific measures are available.
Global Research Needs for Biosecurity • Support research on diseases that could spread to U.S. but are not present currently. • Marburg, Ebola, Dengue, Chikungunya. • Support research on diseases that are unlikely to threaten the U.S. but destabilize developing countries. • Malaria, cholera,
Global Research Needs for Biosecurity • Support research on diseases that threaten all people worldwide • Influenza, HIV, tuberculosis, drug resistant bacteria and viruses.
Final Thoughts • Near misses: SARS, monkeypox • Ongoing hits: • HIV (present since ?1900)—did not have the infrastructure to recognize the disease or identify the agent before it was too late. • MRSA—driving increased mortality and cost in our health system • Drug resistant TB—extensively drug resistant TB
Final Thoughts • What is next? • While it does not guarantee success, shame on us if we do not make every effort to be prepared for the next major threat. • Preparation means • Global collaborative research on basic mechanisms of infectious diseases and countermeasures • Support for a worldwide public health infrastructure • Incentives to develop the next generation of vaccines and therapeutics.
Final Thoughts • Who does this (federal agencies) ? • NIH • CDC • PMI (USAID, HHS, CDC, State, White House) • Others (DOD, DHS) • How should it be done? • Experts identifying major target themes • Peer reviewed proposals
Thanks • Paul Rogers—inspiration for how each of us can make a difference in global health. • NIH—the backbone of biomedical research and a key to the discoveries that will address these threats. • You