Emerging Infectious Disease Threats. Margaret A. Hamburg M.D. Foreign Secretary, U.S. National Academy of Medicine

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1 Emerging Infectious Disease Threats Margaret A. Hamburg M.D. Foreign Secretary, U.S. National Academy of Medicine

2 Plagues and History

7 Leading causes of global deaths from infectious diseases

Infectious disease burden decreasing but still causes almost 20% of all global deaths ~9 million deaths/year worldwide from all infectious diseases Disproportionally

8 Infectious disease burden decreasing but still causes almost 20% of all global deaths ~9 million deaths/year worldwide from all infectious diseases Disproportionally affects low-income countries Cause nearly 2/3 of all child deaths Most from pneumonia, diarrheal disease Influenza pandemics and emerging infectious diseases an increasing concern

9 Global health risks are increasing Recombinant Technologies Anthrax Food Supply XDR TB MRSA Rise of Drug Resistance Intentional Engineering of Microbes Avian Flu Globalization of Travel and Food Supply HIV Emergence and Spread of New Pathogens

10 What are Emerging Infections? They are infectious diseases that recently have become more prevalent or threaten to do so. They include infections of plants, animals, and human beings, naturally or intentionally (e.g., caused by terrorism). Drug-resistance is also a form of emergence. Institute of Medicine, 1992

12 A Perfect Storm Despite progress, we are at greater risk today because of the continuing emergence of new infectious diseases and resurgence of old diseases, often in new, more dangerous forms In addition, advances in science and technology mean that it is easier for people even with limited technical training to inadvertently or intentionally create deadly pathogens in simple laboratories Some disasters we can only prepare for, but many we can prevent Vital to understand the factors that contribute to current infectious disease threats

13 Convergence Model for Infection Emergence 2003?

14 Factors Contributing to Disease Emergence and Re-emergence Human demographics and behavior International travel and commerce Urbanization and crowding Changing agricultural practices and land use Climate change and environmental degradation Breakdown of or inadequate public health measures Healthcare-associated infections Microbial adaptation, evolution and resistance

16 Global aviation network Disease can spread nearly anywhere within 24 hours Note: Air traffic to most places in Africa, regions of South America, and parts of central Asia is low. If travel increases in these regions, additional introductions of vector-borne pathogens are probable.

Enormous costs of AIDS Detection delayed by decades Cases of wasting syndrome not pursued Recognized and formally identified after imported to and

18 Enormous costs of AIDS Detection delayed by decades Cases of wasting syndrome not pursued Recognized and formally identified after imported to and established in US/Europe Epidemic lasting 30 years and counting Some 30 million lives lost $100 billion in costs to lower- and middle-income countries alone

20 Effective evidence-based interventions: HIV/AIDS Prevention by education, safer sex, and circumcision Management with HAART Prophylaxis/treatment of opportunistic infections Mitigation of consequences: orphans, loss of family income Source: UNAIDS/WHO

21 HIV unknown before 1981 US HIV-related deaths per year and cumulative PLWHA,

23 23

24 As of June10, 2016: - 28,616 total cases - 11,310 deaths Ebola s Impact Economic impact: - In April 2015, the World Bank reported that the estimated GDP losses for Guinea, Liberia, and Sierra Leone totaled US$2.2 billion Source: WHO, 2016 World Bank, 2015 US$240 million for Liberia US$535 million for Guinea US$1.4 billion for Sierra Leone

33 Prevent emerging threats Improve global food and drug safety Strengthen laboratory biosafety and biosecurity Reinforce border controls Distribute critical vaccines Enhance early threat detection Strengthen surveillance Expand regional disease detection centers Coordinate reporting and information sharing Train disease detectives Steps to a safer world Improve threat confirmation and characterization Strengthen global laboratory networks Build core capacity to detect deadly pathogens Maintain global repository of laboratory reagents Ensure training and quality management Ensure highly effective epidemic responses Effective medical countermeasures, personal protective gear Build global network of interconnected emergency operations centers Ensure common approaches to crisis management and response communications Standardize global decision-making about travel and trade restrictions Respond to threats domestically and globally

34 Need of a Global Health Risk Framework Global architecture to reduce risk and mitigate next global health crisis Before the outbreak occurs, we need to identify leaders and roles, resources, appropriate times for responding Successful containment of future outbreaks requires timeliness Coordinated response informed by good planning and evidence, not fear or politics Responders need to move as one to avoid mistrust, stigma, or miseducation of communities Need to learn now, before memories fade 34

36 A Three-Pronged Framework to Counter Infectious Disease Crises 1. More effective global and regional capabilities, led by a reenergized WHO, through a dedicated Center for Health Emergency Preparedness and Response, coordinated effectively with the rest of the UN system, and supported by the World Bank and IMF. 2. Stronger national public health capabilities, infrastructure, and processes built to a common standard and regularly assessed through an objective, transparent process fully consistent with international legal obligations under the IHR. 3. An accelerated programme of R&D, deploying USD 1 billion per year and coordinated by a dedicated pandemic product development committee.

37 Key Messages Infectious disease crises pose a significant threat to global security to human lives and to economic well-being We have neglected this threat Ebola and other outbreaks revealed significant shortcomings in almost every aspects of our defenses The case for investing more in pandemic preparedness is compelling USD 4.5 billion per year would significantly reduce the risks to human lives and livelihoods Investing in preparedness and prevention is far more cost-effective than reacting when outbreaks occur The Commission's recommendations constitute a coherent framework for countering the threat of infectious disease crises: Reinforcing the first line of defense public health capabilities and infrastructure at a national level Strengthening capabilities and coordination at a regional and global level Accelerating R&D We must act with urgency and we must monitor implementation. We all have a shared interest in making the world safer.

38 No country can live to itself in disease prevention Failure of one is a failure of all Wilbur Sawyer, Presidential Address American Society of Tropical Medicine and Hygiene, 1944

THE GLOBAL HEALTH SECURITY AGENDA. We have to change our mindsets and start thinking about biological threats as the security threats that they are.

THE GLOBAL HEALTH SECURITY AGENDA We have to change our mindsets and start thinking about biological threats as the security threats that they are. President Barack Obama September 26, 2014 1 Global Health