United Press International - April 18, 2003
Christian Bourge, UPI Think Tanks Correspondent

Dr. Samuel Bozzette, an infectious disease specialist and senior natural scientist at the RAND Corp., told United Press International that the threat of bioterrorism and diseases such as SARS and HIV/AIDS has demonstrated the weaknesses in public health systems worldwide.

"We need to do some serious thinking as a nation and as an international community about how we are going to handle ourselves in the face of threats that are not going to go away, that are going to accelerate," said Bozzette. "The (October 2001) anthrax attack was a wake-up call. HIV is a wake-up call. SARS is a wake-up call. We have to think very carefully and very comprehensively about this problem."

He cited as major concerns the potential for the natural development of new combinations of infectious microbial agents in the environment, and the ease with which immuno-compromised individuals can now easily travel the world by air after being exposed to disease. The potential for crisis is made even worse by the fact that products and services are increasingly sourced internationally in the growing global marketplace. For instance, the spread of West Nile virus to the United States a few years ago is thought to have occurred through the transportation of mosquitoes in imported tires.

The SARS epidemic has again demonstrated the international economic, healthcare and security implications of failing to properly handle the spread of disease in today's porous global community. In addition, the outbreak highlights how the nature of global epidemics has changed, with communicable diseases able to spread around the world much more quickly than ever before.

According to the World Health Organization, 3,389 SARS cases and 165 deaths from the disease have been reported worldwide since November. China, the site of the original outbreak, has been hardest hit, but SARS-infected individuals have been found in many countries, including Australia, India, Singapore, Vietnam, England, Canada and the United States.

The U.S. Centers for Disease Control and Prevention said Thursday that there are 208 suspected SARS cases in the United States, 35 of them probable. The disease is thought to be spread through close person-to-person contact.

The SARS outbreak also illustrates another critical new factor that can worsen global epidemics: dishonesty or incompetence on the part of the health agencies or governments in the countries where the disease originates. China has come under severe worldwide criticism for significantly underreporting the number of SARS cases there, for claiming the disease was under control when Chinese health officials there knew it was not, and for aggressively promoting spring tourism to China during the outbreak while denying the risk that might involve.

Chinese officials only began to publicly acknowledge the extent of China's SARS problem on disease Monday, when Premier Wen Jiabao expressed grave concern over the outbreak. China's actions are thought to have increased and accelerated the international spread of SARS internationally, and have certainly delayed the international community's response to the problem.

Michael Kremer, a senior fellow in economic studies at the liberal-centrist Brookings Institution and a professor of economics at Harvard University, said that South African President Thabo Mbeki's public denials that HIV causes AIDS are representative of the same type of phenomenon -- that is, government irresponsibility or incompetence. Kremer says that the international community needs to work to assure fearful countries that they will get early technical assistance if they are open about such disease outbreaks.

"It is a tendency of bureaucrats everywhere to deny and try to cover up, that isn't unique to the Chinese at all," said Kremer. "But we (the international community) would have been able to get started on this much earlier on if the Chinese would have adopted a more open attitude about the disease."

In addition, by dealing with the problem earlier, the economic consequences of outbreaks of deadly infectious diseases could be reduced. The World Health Organization has estimated that the global economic consequences of SARS could be $30 billion or more if the spread of the disease continues. Asia is taking the brunt of the impact, with business people and tourists worldwide canceling travel to the region. Shops and restaurants in cities like Hong Kong and Singapore -- where infection levels are high -- are experiencing sharp declines in business.

Dr. Donald S. Burke, professor of international health and epidemiology at the Bloomberg School of Public Health at Johns Hopkins University, said that despite the political delays, international scientists have already made tremendous progress exploring SARS. They have not only mapped the genetic code of the agent, but have also discovered that a coronavirus -- related to the virus that causes the common cold -- causes the disease.

Nevertheless, Burke said the SARS outbreak demonstrates the lack of significant investment in the microbiology of infectious disease. It also illustrates the lack of funding for tracking and researching the microbial ecology of the places where the next generations of infectious diseases are likely to come from, such as South Asian rainforests and the Amazon Basin. He added that those in the infectious disease field have been aware for years of the high risks coronaviruses pose to human health, but that investment in exploring the pathogens remains inadequate.

"The investment on the field side -- the places where infectious diseases come from -- is quite modest when compared to the investment in benchmark molecular biology," Burke told UPI. "There are mismatches between what we need to know and where the investments have been made."

Jordan S. Kassalow, an adjunct senior fellow at the liberal-leaning Council on Foreign Relations and a doctor of optometry, agrees that more investment is needed in this arena, both domestically and around the world. Kassalow noted that a relatively small investment in surveillance laboratories at key sites around the world, and in technology that would allow for better dissemination of findings, would be highly valuable.

"Basically what we need is better laboratories in the peripheral parts of the world where you have these health crises," Kassalow told UPI.

On a broader epidemiological level, Burke said that better models of how people spread disease through airline travel, and how disease is spread by international trade, would go a long way toward helping to understand the spread of global epidemics.

Kremer said that another important aspect of the battle is the need to create incentives for the biotech and pharmaceutical industries to focus on emerging diseases. Because these problems tend to originate in poor, developing nations that hold limited prospects for marketing medicines, private research and development dollars are not spent on researching emerging infectious diseases there.

He proposed that the U.S. government and international institutions like the World Bank get involved in the process by providing guarantees to private firms that if they develop a drug that treats an emerging infectious disease, it will be purchased and distributed. This would help ensure a market for any new products, and might aid in stemming the spread of disease beyond the originating region, because outbreaks would be treated early. Vaccines might even be developed to curtail emerging diseases before they become a problem.

Despite his belief that progress can be made in tracking emerging diseases and stemming their spread internationally, Bozzette was not optimistic that the attention brought to the problem by SARS and other outbreaks would have a significant long-term policy impact.

"My sense is that domestically, the threat of bioterrorism and the threat of emerging infectious diseases may stimulate investment and interests," he said. "Whether it is going to be enough to really change how we do business in a fundamental way, I tend to doubt it."

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