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INFECTIOUS
DISEASES

By David Lakey, MD

know dangerous infectious diseases are coming, None of these answers, however, address the political and or-
We or coming back, and they have the potential not ganizational challenges of being able to respond faster than the
just to cause tragic loss of life and health but to
disease spreads. One lesson I have learned from being in the mid-
threaten public safety and order. We often for- dle of multiple recent events is that our federal, state, and local
get they have the potential to change history. response systems do not ramp up as quickly as needed. We saw
It might be an influenza pandemic caused by a human-adaptive this with U.S. Ebola cases in 2014, and we saw it last year with
avian flu or a hemorrhagic fever virus such as Ebola. Or it could be Zika. Without the ability to rapidly invest in targeted prevention,
something totally unexpected, as Zika virus was last year. our response against infectious disease outbreaks will remain too
There's no question. We'll be confronting serious infectious dis- slow. Politics at multiple levels frequently prevents this rapid, tar-
ease threats in the future. History, biology, epidemiology, political geted response from occurring.
science, and common sense all point to it. I agree with U.S. Centers for Disease Control and Prevention Di-
Transcontinental flights occur multiple times a day. The 7.4 billion rector Tom Frieden, MD, and many other public health officials that
people on this planet are expanding into previously uninhabited it is time for a Federal Emergency Management Agency (FEMA)-
areas and being exposed to potentially new infectious diseases. A like resource for rapid responses to rapidly emerging infectious dis-
large outbreak anywhere in the world is a direct threat to the United eases of national consequence. FEMA, which assists states in
States. Our primary tools to control infectious disease are either responding to natural disasters, has proven an invaluable structure
overused (antibiotics) or underused (vaccines). We have to expect for dealing with potentially catastrophic events that require re-
that new and harder-to-treat bacteria, viruses, and fungi will emerge sponses that are fast, efficient, and massive.
and will be rapidly transported worldwide. FEMA isn't perfect, but it's a good starting place for imagining a
better structure for managing our national response to infectious
What can we do to better prepare? diseases of national consequence. FEMA has streamlined the ability
Good answers to that question include more research on vac- for states to request and receive aid from the federal government
cines and diagnostics, more refined models for tracking and pre- in a natural disaster, and it has taken a lot of the partisan politics
dicting the spread of disease, reducing the unnecessary use of out of the equation. Funds are made available early enough to mit-
antibiotics and increasing immunizations, better training and igate and respond effectively to the event, and controls are in place
guidelines for health care workers who are on the front lines of at the state and federal levels to ensure this resource is not abused.
treating infectious disease, and better support of the essential pub- As a nation, we've recognized that exceptional circumstances call
lic health infrastructure. for exceptional processes and structures and that natural disaster
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