Diseases gaining ground: SARS exposes gaps in system that should be addressed

The national security of the United States has long depended on teams of security analysts -- trained to think like the enemy -- who try to find holes in U.S. defenses before the enemy does, and show us how to close the gaps. Today, it is not a team of analysts that is showing up the flaws in our defenses against infectious disease and bio-terrorism; it is a host of microbes.

Severe acute respiratory syndrome (SARS), a life-threatening pneumonia that appears to have originated in China, has spread to more than 7,700 people in more than 30 countries. There is no known effective treatment, and the fatality rate may be as high as 15 percent. The social consequences have been enormous, with economic damage already estimated at $30 billion and rising.

The international response to SARS has been instructive in many ways. Certainly, we are better prepared today because of efforts in recent years by the World Health Organization to strengthen global health, including improved communication to more rapidly report infectious disease and detect outbreaks and expanded lab capacity. Here at home, enhanced programs to strengthen public health in the aftermath of the anthrax attacks in 2001 have facilitated our response to SARS.

Yet there have been numerous gaps, which have helped turn a local outbreak into a global epidemic: China kept life-saving information secret for months. There were delays getting samples to world-class laboratories. Disease reporting has been fragmented. There is no coordinated response to new cases. There are no effective drugs and vaccines, although much work is under way. Medical care and hospital capacity were quickly overwhelmed in some locales.

Additionally, SARS is testing the adequacy of the laws and logistics for enforcing isolation and quarantines.

Other diseases
These gaps that SARS has exposed in our global health system might be less worrisome if the epidemic were an isolated phenomenon. But SARS is only one of a series of deadly infectious diseases whose recent spread has alarmed public health experts.

Decades ago, many believed we were winning the battle against infectious disease. Today, we know we are not. Increases in travel, immigration and trade, shifts in agricultural practice and food distribution, environmental changes, and the resilience and adaptability of the microbes all have put us on the defensive. Conditions are ripe for the convergence of multiple factors to create microbial "perfect storms" that could make SARS look like a soft summer rain.

These threats are ominous enough if we consider natural outbreaks. Unfortunately, the gaps in our global health system leave us every bit as vulnerable to attacks with biological weapons. In fact, a bioterror attack could prove far more destructive than the SARS outbreak -- particularly if terrorists design a bio-agent that would be more contagious and lethal.

Work to head off danger
Against this particular security threat, there should be no debate -- we must take pre-emptive action and work cooperatively with other nations in prevention, detection and response. Experts have long agreed that there are several urgent steps we must take to make our defenses match the danger.

  • Surveillance. Enhance global disease surveillance and increase worldwide capacity to detect and track outbreaks. This includes timely reporting, rapid investigation and better laboratory capacity.
  • Care. Strengthen systems for health care delivery, so they can both meet the demands of day- to-day disease management but also have surge capacity in a crisis.
  • Communication. Improve coordination among public health officials, from the global to the local.
  • Research. Identify priorities for research, including expanded efforts to develop and produce new diagnostics, drugs and vaccines, as well as the examination of additional methods of disease control.
  • Treatment. Assure the prompt availability of existing drugs and vaccines, as well as the delivery of vital disease control services wherever they are needed.

At a time when the United States is facing increasing resentment in many parts of the world, our leadership on international health can build bridges and renew trust and cooperation.

Global health has not been a big priority in the minds of many Americans. It is often seen as sending teams to far-off places to treat diseases from which most of our citizens feel safe. That is a false feeling of safety. In the past decade, the impact of infectious diseases on the United States has increased significantly. Illnesses unknown here a few years ago -- such as West Nile encephalitis and hantavirus pulmonary syndrome -- have emerged to kill hundreds of Americans, and old diseases such as measles and tuberculosis have reappeared, sometimes in epidemic proportions.

Effects are widespread
Infectious disease outbreaks, regardless of their origin, can undermine our security. Disease can disrupt political stability, compromise military forces, stunt economic growth and disenfranchise huge sectors of society -- creating the effects of war without the explosions. More than 16,000 people die every day from HIV/AIDS, malaria and tuberculosis alone -- all preventable diseases.

Simple humanity is reason enough to fight infectious disease; but to that we can now add the cause of security.

We do not shortchange national security when it comes to Pentagon spending. We identify the threats, develop a plan to counter them and spend what it takes to defend the country. We must take the same approach here. We must work together as a community of nations to build a robust, coordinated and accountable system for global public health to protect against disease, whether occurring naturally or caused deliberately. Our security and the security of future generations depend on it.

Sam Nunn represented Georgia from 1972-1996 in the U.S. Senate, where he served as chairman of the Senate Armed Services Committee. He is currently co-chairman of the Nuclear Threat Initiative, a charitable organization working to reduce the global threats from nuclear, biological and chemical weapons. Dr. Margaret Hamburg was the commissioner of health for the city of New York from 1991-1997 and currently serves as vice president for biological programs at the Nuclear Threat Initiative.

May 26, 2003

Published in The Atlanta Journal-Constitution, this op-ed outlines the weaknesses in our global health system that have been exposed through the global response to SARS.

Margaret A. Hamburg, M.D.

Commissioner U.S. Food and Drug Administration

Sam Nunn
Sam Nunn

Co-Chair, NTI