CELL WALL

Health security is as important to America’s future as border security

The US government rightly spends many billions of dollars to protect the nation from terrorism and other security threats. But it’s just as important to guard against another category of threats—infectious diseases—which cause enormous loss of life and damage our economy. Research into new therapies and funding for global health programs are essential for keeping our citizens healthy and reducing illnesses that destabilize other nations and create refugee crises.

There are a number of serious US health-related issues and threats—from the opioid crisis to health care reform—that will require resources and funding. Some of these issues are chronic and defined by tragic addiction. Infectious diseases, though, can emerge rapidly with the potential to put our country at risk, and bring our health care system to its knees. This article will focus on fast moving infectious disease and potential treatments.

As the Trump Administration and the Republican-led Congress begin discussing their next fiscal year federal budget, they have an opportunity to either reduce or increase the risk of infectious diseases. We can’t eliminate all disease, but through a combination of preventive care and long-term preparedness, we could dramatically lower the cost in both money and lives.

Here are five of the biggest current threats from infectious disease:

1. Zika

The United States will see increasing numbers of birth defects caused by the Zika virus. The number of pregnant women who have been infected with Zika is rising, with 2,549 cases reported to the CDC in the last 16 months. One in 12 pregnancies with confirmed Zika infection resulted in the birth of a baby with Zika virus associated defects. While the dramatic damage Zika causes to an infant’s head size at birth is well documented, Zika-virus associated defects and other injuries are not always apparent at birth and may become manifest as these children progress through the first years of infant development. Defects seen at birth may just be the tip of the iceberg. Furthermore, the mosquito-borne illness could expand rapidly this spring following heavy rains in the southeastern US. Increased funding for Zika research could help diagnose and mitigate the damage from this disease. Decreased funding to the NIH and CDC will dramatically stall these needed studies and effect the health and well-being of thousands of infected mothers and their unborn children.

2. Flu epidemic

Millions of people get the flu each year, and thousands die as a result. We can expect a major flu outbreak or pandemic every four or five years. The last major epidemic came in 2014-2015, when one of the current flu viruses mutated until it no longer matched the available vaccine. According to data from the Centers for Disease Control and Prevention (CDC), US flu-related deaths spiked to 56,000 that year, from 12,000 the year before. In a typical year, the flu vaccine is about 50% effective, which is far lower than many other vaccines. It can be expected that another year of “mismatch” between the circulating virus and the vaccine will occur in the next four years.

Additional research funding for the National Institutes of Health (NIH) and product development funding for the Biomedical Advanced Research and Development Authority (BARDA)—arms of the Department of Health and Human Services—could help develop more effective and more universal flu vaccines as well as cutting edge research to better identify these new strains before they cause pandemics. Reduced funding to NIH, BARDA, and the CDC will mean we will be less prepared to face the next outbreak and more lives will be lost to this common but devastating disease.

3. The unexpected epidemic

Infectious diseases know no borders and new threats emerge on a regular basis. This includes recent epidemics like HIV, SARS, Ebola, and Zika. US funding can help reduce the risk of outbreaks by supporting public health systems in poor countries, which often get overwhelmed by these crises. Additional research into vaccines can help prepare for the next unforeseen outbreak. Commercial drug companies have little incentive to develop drugs or vaccines until after an outbreak occurs; therefore public funding can help shorten the response time by supporting clinical trials before an outbreak.

Indeed, a recent global effort termed CEPI, for the Coalition for Epidemic Preparedness Innovation, has been launched to support the early development of vaccines for viral threats that may turn global, such as Middle Eastern Respiratory Syndrome (the MERS virus), Lassa fever virus, and Nipah virus. CEPI is also looking to support novel technologies that could allow for rapid vaccine production upon the identification of a new threat. CEPI was launched with support of the Bill & Melinda Gates Foundation, the Wellcome Trust, the European Commission, and the governments of Norway, Germany, Japan, and India. The US government is notably absent. Increased funding for global health infrastructure through USAID for diagnostics, drug and vaccine development at NIH and BARDA, as well as participation in CEPI could reduce the risk of global threats to our health security. As proposed in the administrations 2018 budget, reductions of 33% in USAID funding and nearly 20% in NIH funding would put at risk the progress we have made in better preparing for new global epidemics.

4. Drug resistant bacteria

Continual use of antibiotics to treat infections has fueled the growth of drug-resistant illnesses, which defy current treatments and pose an extreme health risk. The CDC estimates that there are over 2 million cases of drug resistant infections causing 23,000 deaths every year in the US. In January, a women in Reno Nevada died due to infection by a carbapenem-resistant strain of the common bacterium, Klebsiella pneumonia. Upon testing at the CDC, it was found that this strain was untreatable with any available antibiotic. Such untreatable infections are on the rise worldwide. Strains of tuberculosis, for example, increasingly show “extreme drug resistance.” XDR TB is far more dangerous than typical TB, and requires much more expensive treatments, with more side effects.

The current administration can take steps to stem the rise of antimicrobial resistance: reduce antibiotic use as a growth promoter in the food industry, promote responsible human use of our precious antibiotic arsenal (antibiotic stewardship), and support research for new drugs and therapies against these pernicious pathogens. Alternatively cuts to USDA, CDC, and NIH funding would slow or halt these programs and support the rise of these “superbugs” in the US and abroad.

5. Under-vaccination

Vaccines have all but eliminated some of the worst killers in history—notably measles, polio, and smallpox. The latter killed more people than World Wars I and II combined. But a mix of complacency and false reporting about side effects has reduced the number of children vaccinated against measles, leading directly to a rise in illnesses and deaths due this preventable disease.

Ironically, our success against these diseases has reduced public perception of how these illnesses impact people. Many physicians don’t even remember what a measles case looks like; members of the younger generations have never seen a person crippled by polio. But the dangers are still very real, particularly to very young children. US support can help make vaccines available in developing countries, while better education of our own citizens can close the vaccination gap here at home, keeping at bay diseases with known preventative vaccines. Conversely, flirting with those that spread misinformation regarding the safety and efficacy of these tried and true life-saving injections can decrease vaccination rates and put more of our country’s children at risk of fatal disease.

Protecting our borders is an important goal for our new government. But, even if the United States completely halted immigration, we’d still be at risk for epidemics and health crises that could shut down the country as quickly and have an even greater economic impact than a major terrorist attack. Just as we provide funding to secure our population from terrorism, we need to find ways to secure our health, through continued funding of research and public health programs, both here and abroad.

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