Microbial Threats - Looking Back and Looking Ahead
December 22, 2012
J. Christopher Daniel
Senior Associate, Global Health Policy Center at CSIS
Earlier this month, I was privileged to attend “Emerging Infections, Microbial Threats to Health, and the Microbiome,” a two day symposium hosted by the Institute of Medicine (IOM) Forum on Microbial Threats. The meeting was an exciting gathering of “movers and shakers” in public health, featuring keynote addresses by Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases (NIAID), Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention (CDC), and Dr. Richard Besser, ABC News correspondent.
The event marked the 20th anniversary of the IOM’s landmark report, “Microbial Threats to Health in the United States,” and the 15th anniversary of the Forum on Microbial Threats (formerly called the Forum on Emerging Infections). As such, the Symposium was an opportunity to reflect on how much has happened during the last 20 years, how much we have learned, and yet how much we still need to know, and perhaps more importantly, to communicate to the broader public.
The past two decades have seen a whirlwind of activity in emerging and re-emerging infectious diseases. As Dr. Frieden stated in his keynote, the period has seen a “perfect storm” of “something old” (tuberculosis and influenza, including H5N1 and H1N1), “something new” (HIV, West Nile virus, SARS), “something that borrowed resistance genes” (e.g., multi-drug resistant TB and methicillin-resistant Staphlycoccus aureus), and “something someone makes to turn you blue” (anthrax and recombinant technologies).
Twenty years ago very few people talked about “One Health,” yet there is now strong consensus about the close links between animal and human health. Although it has been 60 years since Joshua and Esther Lederberg showed us that penicillin-resistant bacteria existed even before there was penicillin treatment, the problem of microbial resistance has accelerated over the past 20 years. And the scientific and public health community has shifted from talking about a “war” against microbes to a focus on better understanding microbial communities and on the interactions between hosts and microbes.
Dr. Fauci highlighted the tremendous strides that have been made in research and development on vaccines, drugs and diagnostics. Detection and surveillance have improved considerably, with recent Ebola outbreaks in Uganda serving as a wonderful example of an effective Global Health partnership between the CDC and that nation.
With phenomenal advances in genomics and other technologies, including social media tools, and with an increasing commitment by nations around the world to enhancing their readiness to deal with public health threats, the International Health Regulations (IHR), as revised in 2005, provides a framework to deal effectively with these threats and a basis for measuring progress in this arena.
In summarizing the first day, forum chair Dr. David Relman noted the simultaneous presence of “unprecedented opportunities” in the midst of “a perfect storm of vulnerabilities.” The US has taken a leadership role in advancing Global Health Security, which directly impacts the health and safety not only of U.S. citizens but also people and economies around the world. IHR compliance outside the US is still very low, particularly in terms of laboratory capabilities and human resources, so much work needs to be done. Clearly, the current global financial situation is a significant constraint.
Perhaps just as importantly, though, as Dr. Besser emphasized while recalling his experiences as Acting CDC Director during the H1N1 epidemic, scientists and clinicians need to step away from the jargon of science and hone their communication skills. In his current position at ABC News, he has the opportunity to speak to millions of people on a wide variety of health topics, 45 seconds or less at a time. The rest of us may not have quite as large an audience. However, in order for the public health community to have much impact, we all need to look for “teachable moments,” to be ready to effectively “tell our story” to politicians and policy makers, our neighbors and indeed the broader public, whether it is about the danger of overusing antimicrobial agents or the continuing value and importance of these efforts.