The recent E. coli crisis in Germany is the most recent manifestation of a quiet and significantly under-resourced war. Around the globe, public health officials continue the age-old battle against known diseases while nature continues to generate new threats. Novel diseases are emerging at an unprecedented rate, in many cases in a more deadly form than their historic predecessors.
An under-funded war
Consider the recent evaluation by the Centers for Disease Control and Prevention. While incidents of illnesses caused by E. coli O157:H7 have significantly reduced over the past two decades, outbreaks of other strains of E. coli have increased in frequency as have salmonella cases. The emergence of E. coli O104 in Germany is a vivid reminder of nature's adaptability.
In many ways, countering communicable diseases resembles warfare. A pathogen attacks, science and medicine develop countermeasure, and nature responds with modifications to overcome those countermeasures. The difference is human warfare is ultimately a matter of attrition—of manpower, resources, or will—whereas nature's arsenal is infinite.
The public health accomplishments of the past century are noteworthy: improved quality of life, increased life expectancy (by 30 years), reduction in infant and child mortality, and elimination or reduction of many communicable diseases. These significant successes have resulted in a diminishment of the public health footprint. Virtually every state health department is augmented by grant-funded staff. This fills critical gaps, but undermines career progression and programmatic and operational continuity. The Commissioned Corps of the federal Public Health Service could be double its current size and still be unable to support every mission need identified by the executive departments. We typically do not prepare for a threat we do not see. The 2010 Food Safety Modernization Act granted new authority to the Food and Drug Administration to create a food safety system, but a budget reduction for 2012 threatens this FDA initiative. Public health is a victim of its own success.
Yet Legionnaires, Hanta, West Nile, SARS, MRSA, E. coli O104 and others continue to remind us that disease faces no fiscal constraints.
Common commercial practices contribute to avenues of proliferation. Overuse in agriculture, unregulated availability via the Internet and misuse by humans have contributed to growing resistance to antibiotics. Food moves faster and farther than ever before; what was once served only “in season” is now available year round, around the globe. International trade and personal travel are now the norm. The ways for diseases to spread have grown prolifically. The resources to prevent that spread have been reduced to dangerously thin levels.
We return to the military analogy. Fighting a powerful foreign enemy requires a coordinated effort at the federal, state and local levels. History has demonstrated that limited attention to this responsibility produces minimal results. The long campaign against disease demands a like commitment. We acknowledge the need to control healthcare costs, yet overlook the potent preventive resources at our command. A focus on food safety should be a national priority. The next disease outbreak lurks somewhere nearby. We ignore it at our own peril.
Donald Donahue Jr. is the director of the health policy and preparedness program at the Potomac Institute for Policy Studies, Washington.
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