Download Essentials of Global Health Research

Global Health is America’s
Health and National Security
Samuel L. Stanley, Jr., M.D.
Paul Rogers Global Health Ambassador
Research!America
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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
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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 motion—constantly
changing their genetic makeup through
mutation to expand their host range, and resist
therapies.
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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.
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Infectious diseases know no borders
• .
Wisconsin, Illinois, Indiana, Kansas,
Missouri, and Ohio with cases.
72 suspected, 37 confirmed.
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US Research Responds
• Why did we see such low morbidity and
mortality with the monkeypox outbreak?
– Virus was from W. Africa—lacks two key
genes found in the more virulent Central
African strain—clues to how we fight off these
viruses.
– Help us understand and prepare for any
future poxvirus outbreaks.
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SARS
• More than 8000 cases and 774 deaths
• Epidemic began in November 2002,
exploded internationally in March 2003.
• Widespread concern and significant
economic impact.
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SARS—US Research Responds
• In just three months:
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–
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Virus identified.
Virus completely sequenced.
Natural host probably identified.
Diagnostic tests based on viral sequence developed.
Koch’s 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.
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New Threats
• Chikungunya—mutation in virus caused
massive outbreak in Reunion—260,000
cases and 37 cases in the U.S.
• 4 deaths in S. Africa from unknown virus—
now identified as arenavirus.
• Methicillin resistant staphyloccus aureus in
the United States and the world, requires
expensive and more toxic antibiotics.
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Global Research Needs for Biosecurity
• Worldwide research into rapid recognition
and identification of new disease threats
• Collaboration on new diagnostics—large
scale sequencing to identify new
pathogens—work between U.S.
researchers and those in other countries.
• Epitomized by SARS effort, but U.S. must
help lead the way.
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Global Research Needs for Biosecurity
• Continue to support research into broad
spectrum interventions—therapeutics that
target whole classes of viruses or bacteria.
• Vaccines or drugs that boost the immune
system to provide response against
multiple biologic threats—notion of
controlling infection until specific measures
are available.
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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,
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Global Research Needs for Biosecurity
• Support research on diseases that
threaten all people worldwide
– Influenza, HIV, tuberculosis, drug resistant
bacteria and viruses.
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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.
– MRSA—driving increased mortality and cost
in our health system
– Drug resistant TB—extensively drug resistant
TB
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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
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Thanks
• Paul Rogers—inspiration for how each of
us can make a difference in global health.
• NIH—the backbone of biomedical
research and a key to the discoveries that
will address these threats.
• You
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