U.S. Disease Scientist Cites Three Threats to Global Health

Dr. Tom Frieden visits a vaccine research and development laboratory in Cape Town, South Africa.

Washington — Three major vulnerabilities threaten people’s health worldwide, said the director of the U.S. Centers for Disease Control and Prevention (CDC), and the agency is working around the clock to decrease the threats.

Dr. Thomas Frieden outlined his concerns in a Washington speech September 10, characterizing them as “the three coughs” that might be heard around the world.

The first cough is emerging diseases. They are a twofold threat, Frieden said, because medical professionals never have seen them before and humans, never exposed to them, have no natural immunity. He cited Middle East respiratory syndrome (MERS), first identified just last year; the H7N9 avian influenza flu strain; and severe acute respiratory syndrome (SARS), which swept the world in 2003.

Since that time, Chinese health authorities have acknowledged that they could have done more to better control SARS as it emerged. The international community has taken great strides in ensuing years to prevent a similar far-reaching outbreak. SARS sickened more than 8,000 people and killed almost 800 in 26 countries within a matter of months.

Frieden said the world has had 10 years of building trust among international health agencies and 10 years of improving skills in the face of unknown disease. That investment proved its worth in early 2013 when the H7N9 flu strain emerged in China.

“From the first hours after they identified the organism, [Chinese health authorities] have been absolutely transparent,” Frieden said. “They have posted that organism’s genome onto the Internet.”

That action — wide distribution of the genetic profile of the disease-causing organism — allowed better diagnoses for patients who showed up in clinics anywhere with symptoms unfamiliar to health care professionals.

“The second cough is the cough of drug-resistant tuberculosis,” Frieden told his audience at the National Press Club. “We are all connected by the air we breathe.” Frieden spent some early years working in a TB clinic.

Today, according to the World Health Organization (WHO), more than 75 countries worldwide have reported at least one case of extremely drug resistant TB (XDR-TB). With fewer than 700,000 cases identified worldwide, it is still considered rare, but it is very difficult to treat because first-line medications are ineffective. Other drugs with some degree of effectiveness against XDR-TB are scarce and expensive.

Frieden also warned about the appearance of other microbes that are developing a high level of resistance to medications that were once very effective. Such organisms are a mounting risk, especially in hospitals and group homes for elderly people or others with already damaged immune systems.

An opportunity to stop these organisms still exists, Frieden said, but doing so will require extensive collaboration within the U.S. health care system and with others around the world.

The third looming threat to world health that worries Frieden is highly infectious microbes that could be developed and deployed as bioweapons.

In the face of these threats, Frieden said, the global health community must work together to “find, stop and prevent” these potential outbreaks. Rapidly and properly identifying emerging diseases is a critical step, the CDC director said.

“A blind spot anywhere in the world, it’s a risk to us everywhere in the world,” Frieden said. The medical capability to detect emerging organisms has advanced rapidly in recent years, but the science must be pushed still further. Epidemiologists must become more successful, Frieden said, at spotting disease-causing organisms, discovering their properties and developing treatments and cures.

The CDC is working to get more trained “disease detectives” deployed, Frieden said. “We’ve done that not only in this country, but in more than 40 countries around the world where we’ve trained about 3,000 of them.”

These three major threats to global health demand attention, but the CDC director said an “unfinished agenda” remains in public health activity. Enormous advancements have been made in increasing populations of children who are vaccinated against common diseases worldwide, but more must be done, he said.

Measles is returning as a childhood health threat because of complacency about vaccination. The highly infectious nature of this particular disease demands ongoing vigilance, Frieden said.

The United States helps to promote stability and advance economic development in the world by supporting public health improvements globally. But a moral imperative is also involved, he said, recalling a meeting with a Nigerian mother holding twin infants.

“She said to me, ‘I’m HIV-positive, but my babies are HIV-negative because of PEPFAR [the President’s Emergency Plan for AIDS Relief],’” Frieden recalled. The 10-year-old U.S. program has saved the lives of 5.5 million people by getting antiretroviral medication to people living with AIDS around the world.