Securing the U.S. from its most dangerous invader: infectious disease

Securing the U.S. from its most dangerous invader: infectious disease

{Photo credit: MSH}Photo credit: MSH

This story was originally published by STAT News.

As the Democratic Republic of Congo works to contain the latest outbreak of Ebola, in what could be a test of the world’s ability to contain the disease since the calamitous outbreak in West Africa in 2014 and 2015, it’s a good time to think about the global infectious disease pandemic that happened in May.

In case you didn’t hear about it, that pandemic killed 150 million people around the world, including 15 million Americans, within a year and caused the U.S. stock market to crash. Fortunately, the deaths and economic cataclysm were just on paper — or in electrons — the result of a daylong simulation with a group of high-ranking U.S. government officials that was organized by the Johns Hopkins Center for Health Security.

The simulation revealed just how dangerously unprepared the U.S. and the rest of the world are for a pandemic and provided experiential learning for decision-makers in the Trump administration.

Much can be done to stop outbreaks from becoming epidemics. The U.S. has a major role to play on the global health security stage. But instead of leading, there are indications that we’re retreating from our responsibility to make the world safer from infectious disease — and at the same time endangering the lives of Americans at home.

There has been significant criticism of the Trump administration’s handling of global health security with its proposals to scale back funding for programs designed to keep the world safe from infectious diseases threats. Failing to make necessary investments now will virtually guarantee that a future epidemic will cause great human suffering and be economically disastrous.


It’s possible to measure the economic impact of an infectious disease outbreak on a state-by-state level. For example, an outbreak in Florida could cost up to $112 billion in lost out-of-state visitor spending. If the outbreak was one of avian influenza, add to the loss from tourism an additional $175 million loss to Florida’s chicken industry, one of the largest in the country.

An outbreak far beyond our borders could also be felt in the U.S.

A recent analysis on the effects of a hypothetical infectious disease outbreak on U.S. exports and export-based jobs estimated the losses from an outbreak scenario in Cambodia at between $12.9 million and $63.7 million and put almost 1,500 U.S. jobs at risk. If the outbreak were to spread to eight nearby countries (Laos, Vietnam, Thailand, Malaysia, Indonesia, India, Pakistan, and China), the potential lost value of U.S. exports would increase to between $8.4 billion and $41.4 billion, with almost 1.4 million U.S. jobs at risk.

So what investments must we make to keep America — and the world — safe from infectious disease epidemics?

First, it’s imperative to continue funding the overseas operations of the Centers for Disease Control and Prevention. These investments help conduct disease surveillance of human and animal populations, which is vital in the low-income countries where the next deadly virus is likely to originate. CDC operations also include training frontline health workers, improving laboratory testing for faster detection, and building efficient reporting systems so disease outbreaks can be caught early and at the source, all vital elements in preventing epidemics and responding to them.

Likewise, the U.S. should continue supporting global health efforts, including those that focus on animal health and zoonotic disease threats funded under the United States Agency for International Development (USAID) and the CDC. When Ebola reached Nigeria in 2014, the country stopped the disease in its tracks, thanks in part to previous investments by USAID and CDC to eradicate polio.

Drawing on that public health capacity, when Ebola was diagnosed in Nigeria, CDC-trained epidemiologists traced the contacts of potentially infected individuals, then monitored and isolated them. This limited the spread of Ebola to only 19 people, instead of potentially spreading to tens of thousands throughout the densely populated and heavily travelled city of Lagos, a transit hub of Africa.

During the Ebola crisis of 2014, the U.S. Congress passed emergency legislation to appropriate more than $5 billion for responding to the disease, with a provision that allowed this money to be redirected in the event of another international disease crisis. That provision came in handy during the 2015-2016 Zika outbreak, when the funds were reallocated to respond to Zika both in the U.S. and abroad.

Unfortunately, delays in Congress to redirect these funds meant it was months before the money was actually available to fight Zika. As former CDC director Tom Frieden noted, precious time was lost in mosquito control and in developing diagnostics and a vaccine. It is critical for the U.S. to have sufficient and flexible funding, such as the CDC’s Emergency Response Fund, to deal with emerging threats without requiring congressional approval.

Epidemic preparedness and response takes a strong government with qualified health leadership to combat infectious diseases. The nature of these threats, which can affect every sector of society, demands it. The Global Health Security Agenda — a partnership and action plan for international preparedness to prevent and combat biological threats — is an important initiative that has survived the change in administration and should be supported going forward.

The U.S. should also establish a well-funded, centralized coordinating body for global health security. A version of this once existed in the biosecurity arm of the National Security Council. But it was disbanded after its chief, Rear Admiral Tim Ziemer, suddenly left the administration in May and his position was eliminated.

Whether it’s Ebola or some other lurking killer, an epidemic or, even worse, a pandemic, will lead to vast human suffering, instability, and economic crisis. Only stalwart leadership in the U.S. and in vulnerable countries can keep us safe.