San Francisco Chronicle - Monday, May 19, 2003
Spyros Andreopoulos*

Like al Qaeda, whose operatives our government has decided must be eliminated at their points of origin, so must infectious diseases be fought on a global scale before they eliminate us. Let me explain why we face this predicament:

Forty years ago, U.S. health policy experts concluded that infectious diseases had been conquered and were no longer a major threat. The public and the medical profession accepted this verdict and our national research effort was redirected to the great killers, such as heart disease and cancer.

The reasons for this myth were the development of penicillin and new antibiotics to treat pneumonia and typhoid fever, while new vaccines prevented epidemics of polio, meningitis, rubella, smallpox and hepatitis.

As a result, research support for microbiology and virology declined for many years at the National Institutes of Health. That was reversed in the late 1980s, when the public and medical community were confronted with unexpected plagues, including AIDS and the threat of the Ebola virus. Renewed efforts were initiated to search for effective vaccines and new methods for the prevention and treatment of epidemics.

In spite of books and scientific journal articles warning about the threat of emerging infections, however, policymakers seem to have forgotten that microbes are not idle bystanders. They are waiting for new opportunities offered by human mobility, ignorance or neglect. Microbes possess genetic versatility that enables them to become lethal, to escape population immunity and to become resistant to antibiotics.

In confronting SARS, public health departments are now learning that surveillance alone is not sufficient to detect future plagues or prepare for defense against them. We know very little about how changes in social behavior and customs in Asia or Africa provide opportunities for microbes to produce unexpected epidemics.

A parallel and troubling development is a resurgent anti-immigration sentiment in the United States and abroad, blaming SARS and increasing rates of tuberculosis, hepatitis and malaria in developed countries to immigration from countries. These kinds of associations have led to misplaced policies -- a recent example being the University of California's controversial ban on Asian students attending summer classes.

The practice of associating immigrants with germs is not new. It has occurred in the past at critical junctures in American history. But today we live in a world that is essentially a global village. Ideas, commerce and people can travel long distances in a matter of hours. Microbes do not carry passports, but can easily escape the best-laid plans to block their entry: A highly infectious person can set foot in the United States almost undetected.

So, despite our best efforts, epidemics will not go away completely. Changes in social behavior, customs and hygiene will always provide opportunities for microbes to produce unexpected epidemics. Science cannot halt the evolution of new microbes. For these reasons, public health must be funded to renew research on the epidemiology and biology of microbes, as well as an awareness of the possibility of epidemics.

Surveillance efforts such as those in place at the Centers for Disease Control and Prevention helped identify the epidemic nature of HIV and mode of transmission. These efforts must be expanded both in the United States and other regions of the world.

Health experts worldwide believe the soundest weapon for dealing with epidemics is a global approach. Wealthy nations, organizations and corporations should come to the assistance of poorer nations to contain specific diseases and protect all of the world's citizens.

An example of this is the Global Fund, set up two years ago after a summit organized by the United Nations. In its first year, the fund, an independent public/private partnership, targeted more than $600 million in Africa and other developing nations for specific killer diseases that cause almost six million deaths a year. Included on this list are HIV/AIDS and parasitic diseases such as malaria, which is estimated to kill 2.7 million people a year, 1 million of them children.

But these efforts, including the $15 billion to combat AIDS worldwide passed last week in the Senate, fall far short of what is needed. Existing drugs for parasitic diseases are dogged by recurring problems of toxicity and drug resistant parasites. Of the more than 1,200 new drugs brought to the market between 1975 and 1997, only 1 percent is indicated for treatment of parasitic diseases. The reason for this dearth of drugs is the cost of development, which rules out interest by pharmaceutical companies.

But there is reason for optimism: The deciphering of the human genome has made possible the development of effective drugs targeted to treat neglected diseases of the developing world. New drug development would be expensive, but it could be achieved through:

-- substantial investments from governments of wealthy nations and philanthropic foundations;

-- innovative partnering between the scientific community and private industry; and

-- elimination of patents for predetermined products, such as an HIV vaccine or the sequence of SARS virus, which in private hands CDC officials say might delay the development of a treatment for the contagious pneumonia that has already killed several hundred people.

With an enlightened world community and the necessary medicine, the burden of neglected and emerging diseases would be exponentially reduced. There can be no more noble cause for the United States and President Bush to undertake than declaring war on infectious disease to make the world safer for future generations.

* Spyros Andreopoulos is director emeritus of the Office of Communication and Public Affairs at Stanford University Medical Center. He has edited and contributed to books on health policy, including "Primary Care: Where Medicine Fails."

030519
SC030518

Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .