Global Health is America

1
Global Health is Americas Health and National
Security

• Samuel L. Stanley, Jr., M.D.
• Paul Rogers Global Health Ambassador
• Research!America

2
Infectious diseases know no borders

• The flat, hot and crowded world.
• Jet travel removes the temporal and geographic
  barriers
• Increased population density
• Environmental changes may promote increased
  vector range and disease transmission

3
Infectious diseases know no borders

• Our actions, and the inherent properties of our
  microbial enemies, guarantee new disease threats.
• Expansion and encroachment lead to exposures to
  previously unrecognized microbes
• Microbes are evolution in motionconstantly
  changing their genetic makeup through mutation to
  expand their host range, and resist therapies.

4
Under Siege--Biosecurity

• International public health infrastructure.
• Incentives to produce new vaccines and
  therapeutics for existing and emerging diseases.
• Support for basic and applied research on these
  biological threats.

5
Infectious diseases know no borders

• .

Wisconsin, Illinois, Indiana, Kansas, Missouri,
and Ohio with cases. 72 suspected, 37
confirmed.
6
US Research Responds

• Why did we see such low morbidity and mortality
  with the monkeypox outbreak?
• Virus was from W. Africalacks two key genes
  found in the more virulent Central African
  strainclues to how we fight off these viruses.
• Help us understand and prepare for any future
  poxvirus outbreaks.

7
SARS

• More than 8000 cases and 774 deaths
• Epidemic began in November 2002, exploded
  internationally in March 2003.
• Widespread concern and significant economic
  impact.

8
SARSUS Research Responds

• In just three months
• Virus identified.
• Virus completely sequenced.
• Natural host probably identified.
• Diagnostic tests based on viral sequence
  developed.
• Kochs postulates fulfilled for SARS-CoV
  isolated virus successfully infected monkeys with
  development of SARS-like illness and
  identification of virus in pathological
  specimens.
• Understanding the disease led to some preventive
  measures and no further significant outbreaks
  reported.

9
New Threats

• Chikungunyamutation in virus caused massive
  outbreak in Reunion260,000 cases and 37 cases in
  the U.S.
• 4 deaths in S. Africa from unknown virusnow
  identified as arenavirus.
• Methicillin resistant staphyloccus aureus in the
  United States and the world, requires expensive
  and more toxic antibiotics.

10
Global Research Needs for Biosecurity

• Worldwide research into rapid recognition and
  identification of new disease threats
• Collaboration on new diagnosticslarge scale
  sequencing to identify new pathogenswork between
  U.S. researchers and those in other countries.
• Epitomized by SARS effort, but U.S. must help
  lead the way.

11
Global Research Needs for Biosecurity

• Continue to support research into broad spectrum
  interventionstherapeutics that target whole
  classes of viruses or bacteria.
• Vaccines or drugs that boost the immune system to
  provide response against multiple biologic
  threatsnotion of controlling infection until
  specific measures are available.

12
Global Research Needs for Biosecurity

• Support research on diseases that could spread to
  U.S. but are not present currently.
• Marburg, Ebola, Dengue, Chikungunya.
• Support research on diseases that are unlikely to
  threaten the U.S. but destabilize developing
  countries.
• Malaria, cholera,

13
Global Research Needs for Biosecurity

• Support research on diseases that threaten all
  people worldwide
• Influenza, HIV, tuberculosis, drug resistant
  bacteria and viruses.

14
Final Thoughts

• Near misses SARS, monkeypox
• Ongoing hits
• HIV (present since ?1900)did not have the
  infrastructure to recognize the disease or
  identify the agent before it was too late.
• MRSAdriving increased mortality and cost in our
  health system
• Drug resistant TBextensively drug resistant TB

15
Final Thoughts

• What is next?
• While it does not guarantee success, shame on us
  if we do not make every effort to be prepared for
  the next major threat.
• Preparation means
• Global collaborative research on basic mechanisms
  of infectious diseases and countermeasures
• Support for a worldwide public health
  infrastructure
• Incentives to develop the next generation of
  vaccines and therapeutics.

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Final Thoughts

• Who does this (federal agencies) ?
• NIH
• CDC
• PMI (USAID, HHS, CDC, State, White House)
• Others (DOD, DHS)
• How should it be done?
• Experts identifying major target themes
• Peer reviewed proposals

17
Thanks

• Paul Rogersinspiration for how each of us can
  make a difference in global health.
• NIHthe backbone of biomedical research and a key
  to the discoveries that will address these
  threats.
• You