US should lead in battling global microbial threats, says IOM
Robert Roos 
News Editor
Mar 18, 2003 (CIDRAP News) – With perfect timing in
view of the current global outbreak of a mysterious respiratory disease, the
Institute of Medicine today released a report calling on the United States to
take the lead in addressing infectious disease threats around the world as well
as at home.
The nation should work to build a global surveillance and
response system for infectious diseases, especially in the developing world,
says the report, titled "Microbial Threats to Health: Emergence, Detection,
and Response."
In a press briefing, authors of the report cited the current
outbreak of "severe acute respiratory syndrome" (SARS) as a great example
of the types of problems the document addresses. The outbreak of an
unidentified influenza-like illness has reached 219 cases, with four deaths, in
China, Hong Kong, Vietnam, Canada, and elsewhere, federal officials said today.
"As SARS so vividly demonstrates, national borders
offer little impediment to such threats. One nation's problem can soon become
every nation's problem," said Margaret Hamburg, vice president for
biological programs at the Nuclear Threat Initiative and co-chair of the IOM
committee that wrote the IOM report.
Ruth Berkelman, MD, a member of the committee, called SARS a
"clear illustration" of needs cited in the report, including early
detection and rapid diagnosis of emerging infections. "The earlier we understand
these diseases, pick them up and investigate what's going on, the earlier we
can do something about them," said Berkelman, a professor of microbiology
at Emory University in Atlanta.
The new report is a sequel to the 1992 IOM report Emerging
Infections: Microbial Threats to Health in the United States, which warned against complacency about infectious diseases
and called them a potential threat to national security. "A decade later
the impact of infectious diseases on the United States has only
increased," states the new report's summary. Since 1992, new diseases such
as West Nile virus encephalitis and hantavirus pulmonary syndrome have emerged,
while old diseases such as measles, malaria, and sexually transmitted diseases persist.
The report includes 21 recommendations. Besides global
efforts, the committee calls for a numerous efforts at home, including:
- A national
strategy to maintain the arsenal of vaccines and antimicrobial drugs
- Several
measures to improve antimicrobial use and control bacterial resistance, including
increased use of diagnostic tests and a ban on the use of antibiotics to
promote animal growth if the drugs are needed in human medicine
- Education
and training of "the microbial threat workforce"
- A
comprehensive infectious disease research agenda
- The
establishment of interdisciplinary infectious disease centers
Hamburg commented, "I think that most of the recommendations
in this report are familiar to those working in this field. . . . It's not that
the message is necessarily that new, but the urgency is increasing."
In a separate press briefing today, James Hughes of the
Centers for Disease Control and Prevention (CDC) hailed the report as a call to
action. Of the 21 recommendations in it, two thirds are directed wholly or
partly at the CDC, said Hughes, who directs the National Center for Infectious
Diseases. He added, "This current ongoing experience [with SARS] drives
home in spades the importance of the recommendations made in this report."
Hughes said the CDC knew of nine suspected SARS cases in the United States
today, down from 14 yesterday.
The report says the secretary of health and human services
should provide for a national vaccine strategy to protect the country from
microbial threats. "Only by focusing leadership, authority, and
accountability at the cabinet level" can the federal government accomplish
this, the report states.
Hamburg said the committee "was deeply concerned about
the current and future arsenal of drugs and vaccines" for combating
microbial threats. The challenges are many and complex, she said, and "until
now, the federal government has neither addressed these challenges at a sufficiently
high level nor provided adequate resources." But the authors did not
suggest specific incentives for the development of drugs and vaccines, regarding
that task as beyond their expertise and charge, Hamburg said.
To ensure appropriate use of antimicrobials, the report
calls for "the increased use of diagnostic tests, as well as the
development and use of rapid diagnostic tests" to identify the causes of
infections. An IOM news release said that "etiological diagnoses have
decreased significantly" in the past decade, resulting in overuse of
broad-spectrum antibiotics and increased microbial resistance.
Iowa State Epidemiologist Patricia Quinlisk, a member of the
author committee, said healthcare providers often don't use available tests to
identify infections. For example, she said, "We recently had a busload of
wrestlers and they all had diarrhea, and not one single diagnostic test was
done."
Another committee member said the call to ban the use of antibiotics
for promoting animal growth was "the easiest recommendation for the group
to come to consensus on," because the evidence regarding the contribution
of this practice to resistance was "quite compelling."
In response to questions, Hamburg said the committee did not
try to estimate how much it would cost to carry out the recommendations in the
report. "Certain of the recommendations are not so much dollar investment
as political and social will," she said. "We are putting them forward
as a potential framework for investment to better prepare our nation for the
threat of infectious diseases."
See also:
National Academies of Science news release describing the
report
http://www4.nationalacademies.org/news.nsf/isbn/030908864X?OpenDocument
National Academies page with links to report summary and
full text
http://www.nationalacademies.org/
Printable Page