Commentary — February 2017
Tex Med. 2017;113(2):11-12.
By David Lakey, MD
We know dangerous infectious diseases are coming, or coming back, and they have the potential 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 confronting serious infectious disease threats in the future. History, biology, epidemiology, political science, and common sense all point to it.
Transcontinental flights occur multiple times a day. The 7.4 billion people on this planet are expanding into previously 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 rapidly transported worldwide.
What can we do to better prepare?
Good answers to that question include 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 immunizations, better training and guidelines for health care workers who are on the front lines of treating infectious disease, and better support of the essential public health infrastructure.
None of these answers, however, address the political and organizational 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 prevention, 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 Disease Control and Prevention Director Tom Frieden, MD, and many other public health officials that it is time for a Federal Emergency Management Agency (FEMA)-like resource for rapid responses to rapidly emerging infectious diseases of national consequence. 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 federal 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 mitigate 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.
In the case of infectious disease, we should do the same, perhaps with even more urgency and more hope. Potential epidemics are sensitive to human response. If the response is quick and effective, the disease can be contained. If the response is lacking, the result may be an actual epidemic, with rates of transmission and spread that are exponential.
Infectious diseases have been major actors in the course of human history. Words like plague, smallpox, consumption, and pestilence strike a deep fear inside us. We like to think of those diseases as something of the past. We feel protected by modern sanitation, vaccines, and antibiotics. But inside us that fear remains.
There are a few things we can do with that fear. We can suppress it and hope for the best. We can be its victim and jump from crisis to crisis, developing ad hoc responses and finding scapegoats when the responses fall short. Or we can put the fear to good use and think constructively and with foresight about how to manage future threats.
David Lakey, MD, is associate vice chancellor for population health and chief medical officer for The University of Texas System. He served as commissioner of the Texas Department of State Health Services during 2007–15.