With an ongoing Ebola outbreak in Africa, an epidemic of measles that has spread across the U.S. and around the world and what may be another bad flu season fast approaching, the American infectious disease community has not rested easy in recent months, a top U.S. official said.
"Actually, I sleep like a baby," said Robert Kadlec, assistant secretary for preparedness and response at the U.S. Department of Health and Human Services. "I wake up every two hours screaming."
On Aug. 1, the Democratic Republic of the Congo will mark one year since the Ebola outbreak started in that country, where more than 1,700 people have now died.
Ebola healthcare workers
The World Health Organization declared the outbreak a public health emergency of international concern July 17 after a person in Goma — a city of about 2 million people that borders Rwanda — was diagnosed as having the virus. A second case in Goma was confirmed July 30.
While the Ebola outbreak has U.S. health officials concerned, Kadlec told S&P Global Market Intelligence his greater worry was the potential for another worldwide influenza pandemic.
"That's the one thing that keeps my secretary up at night," he said, referring to HHS Secretary Alex Azar.
Kadlec noted that Congress recently renewed the 2006 law that established the nation's biodefense enterprise for responding to potential pandemics and chemical, biological, radiological or nuclear threats.
The 2019 Pandemic and All-Hazards Preparedness and Advancing Innovation Act, signed into law June 24, reauthorized the Bioshield Special Reserve Fund, which is used to procure medical countermeasures for stockpiling.
The fund was initially established in 2004 with $5.6 billion to be spent over 10 years. In 2013, however, lawmakers chose to authorize the fund on a year-by-year basis through the congressional appropriations process.
But the 2019 law put the fund back on a 10-year track, authorizing $7.1 billion through 2028, Kadlec said.
The law also reauthorized the Biomedical Advanced Research and Development Authority, which supports the transition of medical countermeasure candidates from the early stages of development to the advanced phase and toward U.S. approval and potential procurement by the government.
While the U.S. has made significant progress in developing new drugs and vaccines to treat and protect against diseases like Ebola and influenza, Kadlec said more and better products must be pursued.
Flu executive order
Kadlec said he is hoping an executive order being prepared by the White House National Security Council would help drive more funding toward efforts long underway to develop a better flu vaccine.
The order would be an about-face for President Donald Trump, who has long sought to cut funding for vaccine programs and has questioned the value of immunizations.
Former Senate Majority Leader Tom Daschle, D-S.D., who now runs a lobbying group in Washington, told S&P Global Market Intelligence that he hoped the pending executive order represented a turnaround in Trump's attitude about vaccines.
"I do believe it sets the right tone for creating the kind of environment we need to get the funding necessary," Daschle said.
The former South Dakota lawmaker said he had no doubt there would be more health crises that challenge the U.S. biodefense capabilities, including a potential flu pandemic.
While viruses like Ebola and pandemic flu rank high among the diseases the infectious disease community is most concerned about, more worrisome is the unknown, "what we call disease X," infectious disease expert Krutika Kuppalli said in an interview.
There are about 167 million unknown viruses on the planet, with an estimated 827,000 having the capacity to infect humans, said Kuppalli, affiliated assistant clinical professor in the Division of Infectious Diseases and Geographic Medicine at Stanford University School of Medicine and a member of the Infectious Diseases Society of America Global Health Committee.
As deforestation continues and humans are coming more and more into contact with animals, the likelihood grows even greater that an unknown infectious disease will emerge, said Kuppalli, who served as the medical director for an Ebola treatment unit in Sierra Leone during the 2014-2015 Ebola outbreak in West Africa.
"That's why it's important to invest in the scientific community and healthcare infrastructure and research so we can continue to identify the pathogens and continue to develop therapeutics for those pathogens and be ready," she said.
Unfortunately, Kuppalli said, the U.S. tends to be more reactive than proactive when it comes to addressing infectious diseases.
"If we were more proactive in preparedness and planning and how we wanted to manage a potential pandemic, that would be much better than when it does happen, because we know it will happen," she said. "It's just a matter of when it's going to happen and what it's going to be."
Also troubling is the lack of research and development into new antimicrobial medicines, Kuppalli said.
"In the next 20 to 30 years, antimicrobial resistance is going to be one of the leading killers of people," she said.
There has also been a growing trend in parents not getting their children vaccinated, which has resulted in a resurgence of vaccine-preventable diseases, like measles, Kuppalli said.
"It's heartbreaking," she said.