March 18, 2003 -- American troops may be prepared to go into battle in Iraq, but the nation's public health system is not ready to defend Americans from the threat of deadly infectious diseases, a new report concludes.
As demonstrated by the recent emergence of a deadly and mysterious pneumonia-like illness, the report argues that more aggressive efforts are needed by the U.S. government to prevent, monitor, and respond to disease outbreaks -- whether naturally occurring or intentionally inflicted as an instrument of biological warfare.
"The present reality is that we are inadequately prepared," says Margaret Hamburg, MD, Vice President for biological programs at the Nuclear Threat Initiative in Washington. "We must do more to improve our ability to prevent, detect, and control emerging, as well as resurging, microbial threats to health."
Hamburg co-chaired the committee that prepared the report for the Institute of Medicine of the National Academies, which provides advice to the U.S. government on health and medical issues. The study outlines the nation's readiness to deal with the growing threat of new, old, and yet unknown infectious diseases.
The report comes at a time when public health officials across the globe are struggling to deal with a rapidly spreading respiratory illness that emerged in Southeast Asia and has now spread to Europe and North America, affecting more than 150 people and resulting in at least four deaths. The cause of the condition, called severe acute respiratory syndrome (SARS), is still not known.
"As SARS demonstrates, national borders offer little impediment to such threats," says Hamburg. "One nation's problem can soon become every nation's problem."
The report highlights several major areas of concern, such as poor reporting of infectious diseases by healthcare providers and clinical laboratories to state and local public healthcare agencies, lack of trained epidemiology personnel, underused diagnostic tests to determine the cause of illness, and the growth of drug-resistant bacteria and viruses.
Researchers say the growing problem of drug-resistant bacteria and viruses that no longer respond to once-effective treatments is particularly disturbing because pharmaceutical companies have decreased the development and production of new antibiotics and antibacterial products.
Hamburg says these factors alone are dangerous, but along with the threat of biological warfare, they can create an especially high-risk environment where infectious diseases may easily emerge and re-emerge.
"It's conceivable, in fact, that in certain places microbial 'perfect storms' could occur --convergences of several factors -- and unlike meteorological perfect storms, the events would not be on the order of once-in-a-century, but frequent," says Hamburg.
To counter these threats, the report recommends that expanded efforts be made to educate healthcare providers and consumers about inappropriate use of antibiotics, increase availability and use of rapid diagnostic tests to pinpoint the cause of infectious diseases, and that the FDA ban the use of antibiotics to promote growth in animals if those same drugs are also used in humans.
Patricia Quinlisk, MD, MPH, epidemiologist at the Iowa Department of Public Health, says rural, agricultural states like hers are hit especially hard by the problem of antibiotic resistance. In fact, she says it's now common for Iowans to come down with serious infectious diseases that don't respond to any available antibiotics.
Quinlisk says that problem could be greatly reduced by limiting the use of antibiotics in both animals and humans.
"We have a major job ahead of us in educating the public and healthcare providers on the appropriate use of antimicrobials," says Quinlisk, who also contributed to the report.
"For example, it's absolutely necessary that people understand that antibiotics do not work in treating viral illnesses [such as the common cold] and they should be used only as prescribed," Quinlisk tells WebMD.
In addition, researchers say the nation's pharmaceutical stockpiles should not only include vaccines to prevent and treat potential biological warfare agents such as smallpox and anthrax, but also drugs to treat naturally occurring threats such as pandemic flu.
"We think that Mother Nature can also be a very effective bioterrorist as well," says Hamburg. "We need to have adequate supplies to treat naturally occurring infectious disease threats."