434 - Infection Disease Threats

| The Surgical Tech nologist | FEBRUARY 2020 62 Bloom and Cadarette Responding to Infectious Disease Threats INTRODUCTION In 1918, as the First World War was winding to a close, a mysterious disease that left victims blue in the face and gasping for air tore through the trenches crisscrossing Europe and traversed the oceans, stowed away on war ships. By the time the so-called Spanish flu had run its course in 1920, the pandemic had infected more than a quarter of the world’s population and resulted in some 30 million to 100 million deaths ( 1 , 2 ). In comparison, the two World Wars are estimated to have killed roughly 77 million combined ( 3 ). By any measure, the 1918 flu pandemic was one of the worst catastrophes of the twentieth century. In the 100 years that have passed since the Spanish flu first besieged the world, no pandemic has approached its magnitude of fatality over such a short period. Humanity’s relative good fortune with respect to infectious disease can be attributed, in part, to the elaborate global health system the world has gradually developed as a bulwark against infectious disease threats, both known and unknown. This system consists of various formal and informal networks of organizations that serve different stakeholders; have varying goals, modalities, resources, and accountability; operate at different territorial levels (i.e., local, national, regional, or global); and cut across the public, private-for-profit, and private-not-for-profit sectors. Despite its track record, whether the global health system as currently constituted can provide effective protection against an expanding and evolving array of infectious disease threats has been called into question by recent outbreaks of Ebola, Zika, dengue, Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and influenza, as well as the looming specter of rising antimicrobial resistance (AMR). Taken together, these diseases—along with a slew of other known and unknown pathogens— jeopardize not only human health, but also various forms of social and economic well-being. Of particular concern is the lack of a single entity that has a sufficiently high- level and comprehensive view of the full range of potential threats—whether naturally occurring, accidental, or due to intentional biological attack—and of the network of organizations tasked with their surveillance, prevention, and mitigation. To address emerging global challenges with regard to infectious disease and associated social and economic risks, we propose the formation of a multidisciplinary Global Technical Council on Infectious Disease Threats. The Council, which may be self-standing or housed within an existing organization, would strengthen the global health system by doing the following: (1) improving collaboration and coordination across relevant organizations; (2) filling in knowledge gaps with respect to (for example) infectious disease surveillance, research and development (R&D) needs, financing models, supply chain logistics, and the social and economic impacts of potential threats; and (3) making high-level, evidence-based recommendations for managing global risks associated with infectious disease. BACKGROUND Increased longevity is among the most remarkable aspects of human progress. Global life expectancy has increased by 24 years since 1950 ( 4 ). Large numbers of people are now living into their eighth and ninth decades ( 4 ), and life expectancy is projected to exceed 85 in several countries (and 80 in many more) in the second half of this century ( 5 ). These advances reflect precipitous declines in infectious disease mortality, for which we can thank improvements in sanitation, hygiene, the availability of clean water, nutrition, vaccination, antibiotics, medical practices, and health systems, as well as income growth. While infectious diseases and associated mortality have abated, they remain a significant threat throughout the world. In the twenty-first century, we continue to fight both old pathogens—like the plague—that have afflicted humanity for millennia, and new pathogens—like human immunodeficiency virus (HIV)—that have mutated or have spilled over from animal reservoirs. Some infectious diseases—like tuberculosis (TB) and malaria—are endemic to many areas, imposing substantial but steady burdens. Others—like influenza—fluctuate in pervasiveness and intensity, wreaking havoc in the developing and developed worlds alike when an outbreak (a sharp increase in prevalence in a relatively limited area or population), an epidemic (a sharp increase covering a larger area or population), or a pandemic (an epidemic covering multiple countries or continents) occurs. Table 1 details some of these most prominent cases of the last 100 years. Perhaps the greatest challenge of anticipating and responding to epidemics is the vast array of possible causes, including pathogens that are currently unknown. In May 2016, the World Health Organization (WHO) published a list of epidemic- potential disease priorities requiring urgent R&D attention ( 26 ). That list has since been updated twice, most recently in February 2018 (see Table 2 ) ( 40 ). The Blueprint list of priority diseases “focuses on severe emerging diseases with potential to generate a public health emergency, and for which no, or insufficient, preventive and curative solutions exist” ( 41 ). It was developed through an expert consultation involving both the Delphi method and multi-criteria decision analysis. The top prioritization criteria considered were (in order) potential for human transmission, the availability of medical countermeasures, the severity or case fatality rate, the human/animal interface, other factors (not defined), the public health context of the affected area, potential societal impacts, and the evolutionary potential. Beyond the included pathogens, diseases that are currently endemic in some areas, but could spread without proper control to others, represent another category of threat. Tuberculosis, malaria, and dengue are examples, as well as HIV. Pandemic influenza also merits special attention; indeed, the WHO has developed a separate Pandemic Influenza Preparedness Framework ( 42 ). Meanwhile, the very drugs that helped produce miraculous declines in infectious disease mortality over the second half of the twentieth century are now beginning to lose their effectiveness. AMR is on the rise throughout much of the world, and Frontiers in Immunology | www.frontiersin.org 2 March 2019 | Volume 10 | Article 549