commentary
IMPROVING THE NATIONAL INFECTIOUS DISEASE STRATEGY
BY DAVID LAKEY, MD We know danger- ous infectious diseases are coming, or coming back, and they have the po- tential not just to cause tragic loss of life and health but to threaten public safety and order. We often forget they have the potential to change history. It might be an influenza pandemic
caused by a human-adaptive avian flu or a hemorrhagic fever virus such as Ebola. Or it could be something totally unexpected, as Zika virus was last year. There’s no question. We’ll be con-
fronting serious infectious disease threats in the near future. History, bi- ology, epidemiology, political science, and common sense all point to it. Transcontinental flights occur mul- tiple times a day. The 7.4 billion people on this planet are expanding into pre- viously uninhabited areas and being exposed to potentially new infectious diseases. A large outbreak anywhere in the world is a direct threat to the United States. Our primary tools to control infectious disease are either overused (antibiotics) or underused (vaccines). We have to expect that new and harder-to-treat bacteria, viruses,
and fungi will emerge and will be rap- idly transported worldwide. What can we do to better prepare? Good answers to that question in- clude more research on vaccines and diagnostics, more refined models for tracking and predicting the spread of disease, reducing the unnecessary use of antibiotics and increasing immuni- zations, better training and guidelines for health care workers who are on the front lines of treating infectious disease, and better support of the es- sential public health infrastructure. None of these answers, however,
address the political and organization- al challenges of being able to respond faster than the disease spreads. One lesson I have learned from being in the middle of multiple recent events is that our federal, state, and local response systems do not ramp up as quickly as needed. We saw this with U.S. Ebola cases in 2014, and we saw it last year with Zika. Without the ability to rapidly invest in targeted preven- tion, our response against infectious disease outbreaks will remain too slow. Politics at multiple levels frequently
prevents this rapid, targeted response from occurring. I agree with U.S. Centers for Dis- ease Control and Prevention Director Tom Frieden, MD, and many other public health officials that it is time for a Federal Emergency Manage- ment Agency (FEMA)-like resource for rapid responses to rapidly emerg- ing infectious diseases of national con- sequence. FEMA, which assists states in responding to natural disasters, has proven an invaluable structure for dealing with potentially catastrophic events that require responses that are fast, efficient, and massive. FEMA isn’t perfect, but it’s a good
starting place for imagining a better structure for managing our national response to infectious diseases of national consequence. FEMA has streamlined the ability for states to request and receive aid from the fed- eral government in a natural disaster, and it has taken a lot of the partisan politics out of the equation. Funds are made available early enough to miti- gate and respond effectively to the event, and controls are in place at the state and federal levels to ensure this resource is not abused. As a nation, we’ve recognized that
exceptional circumstances call for exceptional processes and structures and that natural disaster doesn’t have a party or an ideology.
We know dangerous infectious diseases are coming, or coming back.
February 2017 TEXAS MEDICINE 11
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