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Editorial Epidemics & Pandemics: A Global Responsibility It’s that time of year again in the Northern Hemisphere: barbecue smoke laces the air, cold beverages run with sweat and the kids beg for a trip to the pool or beach. Hot fun in the summertime indeed - except for the mosquitoes. For us they’re a nuisance, but for others, they’re deadly. Not so with many (re)emerging infectious diseases, which are so powerful, public health systems could collapse in the face of them. Take the specter of an avian flu pandemic for example: according to the World Health Organization’s (WHO) influenza program, if this super flu takes hold, the death toll could top 7.4 million people (with up to 30% of the global population becoming ill). Cases have already appeared in South Korea, China, Vietnam and Indonesia. The strain known as ‘highly pathogenic avian influenza,’ (or H5N1), can have a mortality rate of almost 100%, infinitely more deadly than another recent epidemic, SARS (Severe Acute Respiratory Syndrome). Direct economic effects of such a pandemic - tens of billions of dollars - would be crippling. Public health systems in the developing world, many of which are already overburdened by tuberculosis and HIV/AIDS epidemics, would be incapable of confronting such a scenario. Even in industrialized countries, inequalities mean limited flu vaccines would be available only to a minority. With such alarming rates and paths of transmission (some diseases jump directly from animals to humans), it’s no wonder epidemiologists talk in military terms regarding infectious and emerging diseases: a global war against epidemics for which everybody must be recruited. However, the main battle remains political, as many governments lack the will to develop sustainable epidemiological surveillance and vaccination programs, essential to curtailing the spread of disease. Not only have the UN Millennium Development Goals (MDGs), designed to reverse the incidence of HIV/AIDS, malaria and other diseases by 2015, failed to hit five-year targets, but the Roll Back Malaria initiative is also in a tailspin. To reach the goal of halving worldwide malaria incidence by 2010, it recommends US$3.2 billion annually to fight malaria, but the Global Fund to Fight AIDS, Tuberculosis and Malaria, for instance, only allocates US$450 million for malaria control.[1] Among the least developed countries (LDC) receiving this funding is Gambia, (disbursements as of April 2005 were just over US$3 million),[2] where Cuban cooperation in research and the field has boosted capabilities for confronting the disease (Dusk to Dawn: Fighting Malaria in Gambia). Yet, even with limited resources, disease can be thwarted. Through several epidemics including neuropathy, dengue and meningococcal disease, the Cuban model (Cuba’s Epidemic-Fighting Model) has proven adept at both containing and preventing disease even in a resource-scarce setting, prompting the focus of this month’s MEDICC Review. The sudden emergence in Cuba of a national neuropathy epidemic during the economic free-fall of the early 1990s (International Workshop on Neuropathy Epidemic in Cuba: Report Summary) underscored the need for a better coordinated surveillance system that integrated knowledge and information-gathering both across disciplines and between all sectors of society (Training an Eye on Epidemics: Cuba’s National Health Surveillance System). Since its founding, that system has played a critical role in monitoring and controlling a variety of epidemics from dengue and malaria to HIV/AIDS (Approaches to the Management of HIV/AIDS in Cuba: Case Study; and Malaria Surveillance of International Travelers Living in Havana City, 2000-2001). Since Cuba’s tropical climate provides the ideal environment for the Aedes aegypti vector, dengue is a perennial concern (Beefed Up Measures Aim to Prevent Dengue and Dengue IgM Detection UltramicroELISA Test with Ready-to-Use Reagents). Indeed, dengue and infectious disease research and clinical trials for flu, cholera and other vaccines (Cuban Cholera Vaccine Headed for Clinical Trials) are central to the work at Cuba’s Pedro Kourí Institute of Tropical Medicine. As such, we are pleased to present to MEDICC Review readers the director of that 68-year old institute in MR Interview: Gustavo Kourí, MD, PhD. Our news coverage this month explores some new initiatives (UN Proposes Havana-Based Disaster Prevention Network) and Beefed-Up Measures Aim to Prevent Dengue. Meanwhile, heavy weather combines with political will to bring some relief from Cuba’s water woes, this month’s Top Story (Rain & New Initiatives Ease Drought). The combination of international travel and trade, overcrowded cities and overburdened public health systems led the WHO to observe that “the occurrence of the next pandemic is just a matter of time.” It’s about time then, that cooperative, global solutions are forged for this complex, global problem. The Editors References
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Mosquito-borne illnesses such as dengue and malaria infect millions annually and are full-blown epidemics in many developing countries. Dengue alone - the world’s most prevalent arbovirus – infects 50 million a year, and dengue hemorrhagic fever (DHF) is the leading killer of children in many countries. Meanwhile, malaria kills over a million worldwide, mostly children under five. These are frightening numbers, especially since most of these are preventable deaths.