Confronting a World of Infectious Diseases

Abstract

GUENAEL RODIER, MDa Bioterrorism and international epidemics are global public health problems. They are international, not just national, issues. Agents that are potential bioweapons and the fight against these agents need to be put into the frame work of the fight against infectious diseases in general. To put things in perspective, we're not dealing with a threat. We're dealing with a reality: the leading infectious killers. We're dealing with diarrheic dis eases, acute respiratory infections, HIV/AIDS, tuberculosis, malaria, and measles. When it comes to diseases that are particularly epidemic prone, it's clear to everyone that epidemics are not new to humankind. They've been around for centuries, certainly, and usually accompany population movements. When it comes to more recent years, I sometimes use the analogy of traffic accidents. They occur everywhere and are not restricted to developing coun tries. The nature of these outbreaks varies between the developing world and the developed world, but epidemics and the threat of infectious diseases occur everywhere. Ebola viral hemorrhagic fever in Uganda, yellow fever in Guinea, foot-and-mouth disease in the UK, Singapore and Malaysia, cholera in South Africa, malaria in Afghanistan, Rift Valley fever in Saudi Arabia and Yemen, and Crimean-Congo hemorrhagic fever in Pakistan: all of these diseases are still occurring, and these are just the main ones to appear since October 2000. When it comes to the issue of how developed countries can deal with exotic agents, realize that, even without day-to-day bioterrorism, it is a day-to-day problem. On a continuous basis, there are some exotic diseases coming into the developed world with which we must deal. All these dynamics of the microbial world constitute a threat to health security, and it's time for global epidemic surveillance and response. We're dealing with epidemics, emerging infections, and drug resistance. The influenza pandemic in 1918 and 1919, the Spanish flu, killed millions. The estimated number of casualties worldwide is more than 40 million. More