Infectious disease outbreaks pose ongoing threats to health: US, global systems urged to take action
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* Natalie McGill

From multistate outbreaks of diseases such as measles among U.S. kids, to the deadly impact of Ebola in West Africa, infectious disease outbreaks pose an ongoing threat to human health. Unfortunately, gaps remain in protecting populations in the U.S. and beyond from those risks, according to experts.

![Figure1](http://www.thenationshealth.org/https://www.thenationshealth.org/content/nathealth/46/2/1.3/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/46/2/1.3/F1)

A teacher checks the temperature of a student in Seoul, South Korea, in June during an outbreak of Middle East respiratory syndrome. New assessments show U.S. and global health systems need to do more to prepare for pandemics.

Photo by Chung Sung-Jun, courtesy Getty Images

Failing to prioritize research and development of vaccines and antibiotic overuse are just a few of the issues that have left U.S. public health systems vulnerable in addressing outbreaks, according to the 2015 edition of “The Outbreaks: Protecting Americans from Infectious Diseases,” a report of Trust for America’s Health and the Robert Wood Johnson Foundation.

Released in December, the outbreaks report evaluates states and the District of Columbia on 10 indicators to measure their capacity for infectious disease prevention and control, such as whether a state vaccinated at least half of its population against seasonal flu and having a working biosafety professional in a state laboratory. More than half of the states plus the District of Columbia — 28 — met five or fewer indicators, the report said.

Most states — 43 states plus the District — met the indicator of requiring the reporting of all CD4 white blood cell counts and HIV viral loads to their state HIV surveillance programs. However, only nine states met the indicator of reducing the standardized infection ratio — a number used to track progress on preventing health care-associated infections — for central line-associated blood stream infections between 2012 and 2013.

Health care-associated infections, which can involve infections of central lines such as catheters, kill 75,000 Americans annually, the report said. Additionally, one out of every 25 people get an infection after being hospitalized.

“We definitely are not seeing enough progress in the areas of curbing the overuse of antibiotics and in reducing rates of health care associated infections — both of which are contributing to the rise of superbugs,” said Laura Segal, director of public affairs for Trust for America’s Health. “For instance, last year, we found 10 states improved in the standard infection rates for (health care-associated infections) and this year dropped to nine, which is headed in the wrong direction.”

Delaware, Kentucky, Maine, New York and Virginia achieved eight indicators, the highest number met in the most recent report. The lowest number met was three indicators, met by Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah.

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Dulce Daniela Elizalde Aguilar is baptized in Mexico City in May 2009 during the H1N1 influenza pandemic as her parents wear masks for her protection. Pandemics threaten lives but also have financial costs, with $60 billion in annual predicted losses.

Photo by Joe Raedle, courtesy Getty Images

Among the seven indicators Kansas missed were having at least half of the population vaccinated against the flu from fall 2014 to spring 2015 and a law that either excludes philosophical exemptions for vaccinating schoolchildren or requires parents to get an affidavit to get a philosophical or religious exemption, the report said.

“We narrowly missed the influenza vaccination rates required — 55 percent of children under 18 received influenza vaccinations, but only 45.6 percent of adults received an influenza vaccination,” said Sara Belfry, communications director for the Kansas Department of Health and Environment. “We have policies and powers in place surrounding vaccination requirements and excluding children from school with a communicable disease. Kansas just doesn’t have a statewide policy about excluding children from school if they do not have their vaccinations. Those are done at the school district level.”

## Global pandemic preparedness key

The outbreaks report makes 10 recommendations to improve infection prevention and control, such as recognizing how climate change fuels outbreaks and updating surveillance technology to track diseases. One of those recommendations is to create incentives for research and development of medical devices and medicines to fight pandemics, which overlaps with a global priority of investing money into vaccines, equipment and more in “The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises,” a new report from the Commission on a Global Health Risk Framework for the Future.

Released in January, the global security report said the annual expected losses due to potential pandemics is $60 billion and that it would cost up to $3.4 billion annually to improve public health systems of low- and middle-income countries.

The report suggests an annual $4.5 billion investment to strengthen infrastructure and public health capabilities in such countries as well as to boost global coordination and response capabilities. The investment also includes a proposed annual $1 billion for product development that would be overseen by an independent committee formed by the World Health Organization.

“No one can tell when a potential pandemic will occur, but the underlying dynamics of infectious disease emergence and of contagion factors suggest they are if anything more likely than in the past,” Peter Sands, chair of the report commission, told *The Nation’s Health.* “Moreover, even if we do successfully control future outbreaks, one thing we know for certain is that it is much more expensive — on both lives and dollars — to respond reactively to infectious disease crises than to prevent and prepare for them.”

To get other countries on board, WHO officials and WHO member states must develop a set of standard public health practices for countries’ health systems to follow based on the International Health Regulations, the report said. Coordinated by WHO, the regulations are a series of guidelines agreed upon by nearly 200 countries on how to improve global public health security.

The report also suggests these countries, by the end of 2016, agree to an independent assessment of how well they are following these practices, and that any potential monies they receive to improve their public health infrastructure should be contingent on agreeing to an assessment.

Making sure countries are able to comply with International Health Regulations guidelines is one of several priorities in the Centers for Disease Control and Prevention’s Global Health Strategy 2012-2015. Strengthening the ability of health systems to address emerging diseases and outbreaks is one of the strategy’s four goals. Within that goal, CDC also aims to improve laboratories’ capacity to accurately identify and detect “unusual pathogens” as well as give technical assistance in tracking diseases that affect vulnerable populations, according to the strategy.

“The health of Americans is integrally connected to the health of the rest of the world,” wrote the authors of CDC’s Global Health Strategy report. “Governments and organizations must work together to strengthen public health programs and increase the ability of countries to respond to and address disease threats on a global scale. Strengthening health security contributes to healthy, stable and productive societies.”

For more information on the reports, visit [www.healthyamericans.org](http://www.healthyamericans.org) and [www.nap.edu](http://www.nap.edu).

*   Copyright The Nation’s Health, American Public Health Association