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Hurrying Toward Disaster?
by C. J. Peters
 As the world's population continues to grow, as people continue to alter earth's ecological systems, and as globalization spurs increasing travel and transport, the problem of emerging diseases is likely to become more acute. So far, most recently emerging diseases do not pass readily from human to human. But infectious diseases of the future are a big unknown, and pathogens--emerging or reemerging--are likely to bring new surprises. The specter of the return of smallpox through a deliberate act of bioterrorism is a particularly sobering example raised by the Sept. 11, 2001, attacks and their aftermath.
How can we prepare for diseases of the future?
First, we must jump-start the process of developing new anti-infective drugs, vaccines and pesticides. If development is not economically feasible for the private sector, we must involve the public sector in their development. This does not represent a socialization of private enterprise, but rather a recognition that there is insufficient motivation for the private sector and that there is a pressing need to accomplish a common good. Second, we must employ new science more effectively. The huge advances in molecular and structural biology and genomic science have given us tools that have already enlarged our understanding of emerging diseases and the recurring problems of the tropics. Yet we have seen few direct benefits for drug development or vaccines. These will be available only when we address a complex nexus of social, economic and regulatory barriers.
Third, we must devise new strategies to fight and prevent the spread of infectious diseases. We have already seen impressive results from some simple but innovative approaches targeted at critical weaknesses in the propagation of infectious diseases. For example, in tuberculosis treatment, the use of directly observed therapy (DOTS) has been highly effective in increasing cures and limiting the emergence of further antibacterial drug resistance. Insecticide-treated bed nets represent a radical change in the traditional approach to malaria amelioration. While questions remain about sustainability and the development of resistance to insecticides, this approach exemplifies the kind of solutions we need to develop and implement.
We must also find ways of strength- ening public health infrastructure, which is critical to surveillance what s happening with old diseases as well as new ones and to prevention and con-trol. While public health is invisible to most of us, and so gets little attention and inadequate funding, it is critically important to keeping us safe from infectious diseases, including the threat of bioterrorism. Public health infra-structure is weak in almost all countries but is particularly at risk in the devel-oping world. We must find new ways to augment our greatest protection against infectious disease worldwide and particularly in those countries with greatest need.
Other factors loom even larger and will be even more difficult to address. The earth's growing population continually challenges our ability to deal effectively with emerging infectious diseases. Land use, water availability and likely even climate change are driven by population expansion. Moreover, the increasing use of resources leaves us with fewer alternatives to address problems when they inevitably arise. At the least, we must make intelligent choices so that we have the least possible impact on our natural environment.
What to do, in fact, may be less of an unknown than how to accomplish it. The work of physicians, public health officials, government agencies and the private sector must be coordinated. Both professionals and the public must be better educated to attack these difficult problems. Only a coordinated effort sufficiently funded by governments, foundations, scientific establishments and international organizations will allow us to keep infectious diseases of the future in check.
C.J. Peters is professor of microbiology and immunology and pathology at the University of Texas Medical Branch in Galveston, Texas, USA. He was formerly chief of the Special Pathogens Branch at the U.S. Centers for Disease Control and Prevention in Atlanta, Georgia. He is coauthor with Mark Olshaker of Virus Hunter: Thirty Years of Battling Hot Viruses Around the World.
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