Whither Research on Infectious Diseases

Abstract

WHITHER RESEARCH ON INFECTIOUS DISEASES THOMAS H. WELLER* In meeting with you it is appropriate to acknowledge the debt ofcontemporary science to the press. The debt is profound in the field ofhealth, because an informed public provides resources for the support ofresearch and eagerly anticipates the benefits accruing therefrom. Present-day anticipation of the benefits of medical research must be attributed to the widely publicized advances in the control of the infectious diseases over the past three decades, a period ofdramatic development that encompasses the appearance ofeffective antibacterial drugs, ofresidual insecticides, and of specific vaccines for viral diseases such as yellow fever, poliomyelitis, and measles—truly a period ofbrilliant accomplishment. These signal successes, together with the progress of the sciences of public health, have made some ofthe notorious killing diseases uncommon in the developed areas ofthe world (i.e., poliomyelitis is now a rarity in the Scandinavian countries and in the United States). As a consequence, there has been a sharp diminution in interest in research on the infectious diseases. Indeed, some scientists and publicists even speak ofthe infectious diseases as conquered and now trumpet an attack on degenerative conditions , heart disease, and cancer which are presented as the major diseases of mankind. Parenthetically, in such presentations, little attention is paid to the age at which most hearts cease to beat or at which cells undergo malignant change. Instead, there is evoked an image aptly termed by René Dubos as the "Mirage ofHealth," namely a Utopia in which humanhearts beat indefinitely and cells perpetually escape the processes of senescence. Another category ofscientists and ofpublicists rightfully considers the population explosion as the major problem facing mankind. Population specialists possessing knowledge ofthe underdeveloped areas ofthe world are frank to admit that for some 2.5 billions of people the synergistic ill * Department ofTropical Public Health, Harvard University, Boston, Massachusetts 02115. This paper was presented at the conference on "Whither Medical Research," a meeting ofthe International Press Institute, Geneva,June, 1967. Publication in Perspectives is supported by a grant from the trustees ofthe Foundation for Microbiology. 255 effects of infectious and ofnutritional diseases persist essentially unabated and constitute the major cause of premature death and of morbidity. In such regionslifeexpectancyat birth maybeunder fortyyears, and ofevery five children born two or three may be expected to die before reaching the age of six years. If the focus is only on control of human reproduction, there is grave danger that the relationship between acceptance oflimitation ofhuman reproduction and the control ofpremature death may be overlooked. In this preamble to a discussion of "Whither Research on Infectious Diseases," I have indicated certain considerations that tend to de-emphasize the continuing impact of the infectious diseases. Yet, there is ample evidence supporting the need for an expanded program of research on infectious agents. "Whither" is an appropriate theme for this conference, implying as it does "to what point, degree, end, conclusion, or design?" An infectious agent is but one element in an ever changing ecological complex that includes the parasitized host and the environment. To a biologist, an infectious disease reflects a dynamic rather than a static process. For a static process, we might expect that the advent ofa highly specific drug would—ifwe had the means to treat all cases ofthe disease—permit a final victory. Actually, all elements in the ecological complex, that is, the agent, the host, and the environment, are in a state ofconstant change. For example, during World War II meningococcal meningitis responded rapidly to treatment with sulfonamides. In the past four years drugresistant strains ofmeningococci have emerged. As a consequence, serious outbreaks of meningitis with high mortality are occurring in several parts ofthe world. It is now clear that bacterial pathogens are constantly changing and that the treatment ofbacterial diseases with available therapeutic agents is becoming ever more difficult. Alteration ofthe human host occurs in a variety ofways, and, as man changes, a new spectrum of infectious diseases may be anticipated. For example, the continued insult ofa polluted urban atmosphere is producing new types ofchronic infections ofthe lung. Another example is found in the unexpected infectious complication recently recognized following surgical transplantation ofhuman organs. Recipients ofkidney transplants receive drugs designed to...