The United States’ ephemeral attention to the Ebola outbreak last year highlighted serious underlying gaps in the nation’s ability to respond to severe infectious disease threats. Today, these gaps have left the US vulnerable to a range of outbreaks, including antibiotic resistant superbugs, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), foodborne illness, HIV/AIDS and Viral Hepatitis, influenza and healthcare-associated infections.
“Because there was so little preparation, the world lost time … trying to answer basic questions about combating Ebola. In the next epidemic, such delays could result in global disaster. The problem was not the fault of any single institution — it reflects a global failure,” according to a review by Bill Gates in the New England Journal of Medicine.
Consequently, a new report from Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), Outbreaks: Protecting Americans from Infectious Diseases, concluded that the United States must redouble efforts to better protect the country from new infectious disease threats.
The report explained the Ebola outbreak demonstrated how quickly a new threat can arise. Although support and investment ramps up when a major new threat emerges, it often begins to lag as soon as the threat seems contained, leaving the country ill-prepared for the next emerging threat.
“America’s investments in infectious disease prevention ebb and flow, leaving our nation challenged to sufficiently address persistent problems,” said Paul Kuehnert, a RWJF director. “We need to reboot our approach so we support the health of every community by being ready when new infectious threats emerge.”
To help reassess the policies and priorities related to the nation’s ability to protect against infectious disease outbreaks, the report examined a series of 10 indicators in each state that, taken collectively, offer a composite snapshot of strengths and vulnerabilities across the health system.
The report found that more than half (28) of states score a five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks. Seven states–Idaho, Michigan, Kansas, Ohio, Oklahoma, Oregon, and Utah–are tied for the lowest score at three out of 10.
Similarly, last year’s Outbreaks report said half of the states and Washington, DC scored five or lower on the 10-point scale. No state scored higher than an 8.
One of the biggest threats to public health preparedness in the US is overuse of antibiotics and underuse of vaccines. Both antibiotics and vaccines have dramatically improved the nation’s ability to contain the spread of infectious diseases; however, success in fighting these diseases has led to national complacency. Although most diseases are preventable, millions of Americans become unnecessarily sick or die each year.
Moreover, fluctuating resources for core infectious disease prevention put the nation at risk when new threats emerge, such as Ebola or a new strain of pandemic flu.
“The overuse of antibiotics and underuse of vaccinations along with unstable and insufficient funding have left major gaps in our country’s ability to prepare for infectious disease threats,” said Jeffrey Levi, PhD, executive director of TFAH. “We cannot afford to continue to be complacent. Infectious diseases – which are largely preventable – disrupt the lives of millions of Americans and contribute to billions of dollars in unnecessary healthcare costs each year.”
According to the Centers for Disease Control and Prevention (CDC), each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections. Until a concerted global effort emerges to address antibiotic overuse, the rate of infections will continue to rise.
The CDC explained that antibiotics and similar drugs, together called antimicrobial agents, have been used for the last 70 years to treat patients who have infectious diseases. Over the years, these drugs have greatly reduced illness and death from infectious diseases. However, these drugs have been significantly overused for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective. Furthermore, there are very few new antibiotics in the pipeline, since antibiotic research and development is not as profitable as other drugs.
Amid increasing resistance rates, in 2014, the White House released The National Strategy for Combating Antibiotic Resistant Bacteria (CARB) and a related executive order establishing a Department of Defense, US Department of Agriculture and Health and Human Services (HHS) Task Force for Combating Antibiotic Resistance. TFAH recommended funding and rapidly implementing the 2014 Executive Order and CARB.
Additional efforts to curb antibiotic resistance should include reducing overprescribing and overuse in agriculture, creating a limited population antibiotic drug approval pathway, and incentivizing the development of new antibacterial drugs and diagnostics through the Biomedical Advanced Research and Development Authority, the office within HHS responsible for producing countermeasures to emerging infectious diseases.
Furthermore, the National Vaccine Advisory Committee has recommended greater consideration for the role of vaccines in National Strategies to Combat Antibiotic Resistant Bacteria.
Similarly, last year’s Outbreaks report stated, “Antimicrobial resistance presents one of the greatest threats to human health around the world.
Other key findings of the Outbreaks report included:
Foodborne Illness: More than 48 million Americans get sick, 128,000 are hospitalized and 3,000 die from contaminated food annually.
Healthcare-associated Infections: Around one out of every 25 people who are hospitalized each year contracts a healthcare-associated infection leading to around 75,000 deaths a year.
HIV/AIDS and Viral Hepatitis: More than 1.2 million Americans are living with HIV, and almost one in eight do not know they are infected.
MERS-CoV: While there have only been two MERS-CoV cases in the United States as of fall of 2015, it has been spreading from the Middle East to South Korea through international travel, infecting more than 1600 individuals. It is a severe respiratory disease and fatal in more than 30 percent of cases.
Influenza (The Flu): Between 5 percent and 20 percent of Americans get the flu each year. The severity and impact of the flu can range from 3,000 to 49,000 deaths a year, more than $10 billion in direct medical expenses and more than $16 billion in lost earnings.
Childhood Vaccinations: In 2014, there were more than 600 cases of measles and nearly 33,000 cases of whooping cough reported. While more than 90 percent of all US kindergarteners receive all recommended vaccinations, rates are lower in a number of communities and states. More than 28 percent of preschoolers do not receive all recommended vaccinations.
To bring public health preparedness up to a higher baseline, the Outbreaks report featured a number of priority recommendations, including:
- Increase resources to ensure every state can maintain and modernize basic capabilities – such as epidemiology and laboratory abilities – that are needed to respond to new and ongoing outbreaks;
- Update disease surveillance to be real-time and interoperable across communities and health systems to better detect, track and contain disease threats;
- Incentivize the development of new medicines and vaccines, and ensure systems are in place to effectively distribute them when needed;
- Decrease antibiotic overuse and increase vaccination rates;
- Improve and maintain the ability of the health system to be prepared for a range of potential threats – such as an influx of patients during a widespread outbreak or the containment of a novel, highly infectious organism that requires specialty care;
- Strengthen efforts and policies to reduce healthcare-associated infections;
- Take strong measures to contain the rising hepatitis C epidemic and other sexually transmitted infections, particularly among young adults; and
- Adopt modern strategies to end AIDS in every state and city.
Overall, the report concluded that although infectious diseases — most of which are preventable — disrupt the lives of millions of Americans each year, the country does not sufficiently invest in basic protections that could help avoid significant numbers of outbreaks and save billions of dollars in unnecessary healthcare costs.
