Germs Go Global Why Emerging Infectious Diseases Are a Threat to America Jeff Levi, PhD Executive Director Congressional Briefing April 17, 2009

Chief Findings  Risk of new or re-emerging diseases threatens our economy, security, and healthcare system.  Factors contributing to increased threat: globalization, increased drug resistance, climate and weather changes.  Major vulnerabilities exist in current U.S. capabilities to deal with infectious diseases.  Need coordinated federal effort to fight these diseases.

What are EIDs?  New infectious diseases – SARS, HIV/AIDS, HCV  Re-emerging or resurging diseases – malaria, measles  Drug resistant diseases – MRSA, XDRTB  Bioterrorism – deliberate use of new/emerging diseases  Neglected tropical diseases

Threats to the U.S. “Newly emerging and re-emerging infectious diseases will pose a rising global health threat and will complicate U.S. and global security over the next 20 years. These diseases will endanger U.S. citizens at home and abroad, threaten U.S. armed forces deployed overseas, and exacerbate social and political instability in key countries and regions where the U.S. has significant interests.” National Intelligence Estimate 99-17D

Threats in U.S.  High prevalence rates means high costs, such as HIV/AIDS, MRSA, HCV. Resistant staph (MRSA) costs an extra $3,000 to $35,000 per case to treat. HCV costs $15 billion a year – rising to $85 billion without better treatments/prevention.  Infections making a comeback: TB, vaccine preventable illnesses are re-emerging  Foodborne illness on the rise

Factors Contributing to Emergence  Environmental factors Climate change causes movement of insects within U.S. (affects malaria, West Nile, yellow fever, dengue fever, etc.). Flu becomes epidemic in cool weather. El Niño may have helped spread of malaria, cholera. Deforestation coincided with malaria increase.

Factors Contributing to Emergence (2)  Globalization Rapid spread of outbreaks.  Antimicrobial resistance  Social Inequities, Geopolitical Events Poverty (sanitation, overcrowding, water, access to care) War food and water shortages High risk behaviors

Major Vulnerabilities  Surveillance  Diagnostics  Treatment  Vaccines  New Technology

Financial Incentives are Critical  Market forces prevent investment in high-risk products, so incentives are needed.  Public-Private Partnerships  Existing U.S. Government Programs Orphan Drug Act Project BioShield and BARDA Priority Review Voucher for Neglected Tropical Diseases

Federal Recommendations  Develop government-wide, multiyear research agenda  Federal, state and local resources to build public health capacity Enhance surveillance Build standards, rapid communication into health IT Build lab capacity

Federal Recommendations (2)  U.S. leadership in implementing global surveillance system.  U.S. leadership in preventing, responding to threats.  Coordinated effort to decrease inappropriate use of antimicrobials  Recruit and retain public health workforce trained in emerging infectious diseases.  Public health education to prevent spread – including childhood and adult vaccines and antibiotic use.

Congressional Actions  Pass STAAR Act to fight antimicrobial resistance.  Fully fund BARDA (received $275M in FY09)  Amend Orphan Drug Act to address MRSA and development of new countermeasures.  Request professional judgment budget for research agenda

Congressional Actions (2)  Enhance appropriations for EID programs at CDC, NIH, DOD, Agriculture, and DHS.  Grow funds for global surveillance efforts, including increasing CDC’s Global Disease Detection program to $56M in FY10 (received $33M in Omnibus)  Fully fund CDC’s state and local Public Health Emergency Preparedness grants to $1B (received $746M in Omnibus)

Questions?  Please contact: Jeff Levi, Executive Director Rich Hamburg, Director of Government Relations