Our misplaced disease preparedness priorities

For years, infectious-disease specialists have warned public health officials to begin preparing for unexpected outbreaks of microbial infections due to climate change. The spate of outbreaks this summer is a stark reminder to the political leaders, who control the government's purse strings. The time for ignoring these warnings is past.

The prolonged drought in California has triggered a major outbreak of West Nile virus, where there have been nearly 200 documented cases this year and at least three deaths attributed to the vector-borne disease. Droughts drive birds, which carry the virus, and mosquitoes, which spread it, to mingle at a reduced number of watering holes, which under drought conditions are often found only in crowded urban and suburban settings where people also happen to gather.

Dengue fever, another mosquito-borne virus that was eliminated in the U.S. over 70 years ago, has been reintroduced here with outbreaks reported in South Florida, along the Mexican border and in Hawaii. Incidence of the painful disease is booming across the globe, according to the World Health Organization, with between 50 million and 100 million cases and 12,000 deaths reported in 2012, a 30-fold increase over the previous year.

Malaria has long been one of the major scourges devastating the poorer sections of the developing world. A global campaign to eradicate the disease has made major inroads in recent years using new drugs, bed nets and other public health and mosquito-control measures. But the disease is now showing up in parts of the world—such as the highlands of East Africa—where it had never appeared before.

No one has tied the African Ebola outbreak, or the sudden reappearance of enterovirus D-68 after a half century hiatus, to climate change. But in the latter case, there may be a correlation with the spike in pediatric hospitalizations because of the disease.

Asthmatic children infected with EV-D68 are most at risk of severe breathing problems that can lead to emergency department visits and hospitalization. The incidence of asthma has increased by 17% over the past decade and now affects 1 in 12 Americans. Many experts attribute rising asthma incidence to the increase in airborne pollutants from fossil fuels and higher pollen levels, which are the cause and an effect of climate change.

Given this spate of infectious disease outbreaks and the growing resistance of “superbugs” to our aging armamentarium of antibiotics, it's clear the U.S. needs to beef up its public health infrastructure to prepare for an era when major and minor pandemics are more common. Yet that is not where the government's main attention has been focused.

Last week, the nation paused to remember 9/11, which led to a permanent war on terror. Less remembered from those days is the nation's reaction to an anthrax attack that followed the twin towers attack within weeks and turned out to be the work of a rogue scientist whose motives remain unclear (he took his own life in 2008 as the FBI closed in on solving the case).

But that domestic terrorism incident had its own enduring legacy: the nation's war on bioterror. Since the early 2000s, Congress has authorized more than $8 billion to procure drugs and vaccines to counter potential bioterror agents, including $5.6 billion for stockpiles to fight diseases including anthrax and smallpox, which have been largely eradicated except in chemical labs.

Last year, Congress reauthorized spending another $2.8 billion over the next five years on those and similar targets. The list of priorities was dominated by countermeasures aimed at anthrax, botulism, smallpox, cyanide, nerve gas and nuclear agents.

While the legislation also allowed for spending money on fighting “emerging infectious diseases,” the only two listed in a Government Accountability Office review of the program issued this year were pandemic flu and viral hemorrhagic fever. It was this element of the program that funded research into the few experimental drugs that are now being tested on Ebola patients.

HHS' overall “preparedness and response” budget, meanwhile, totaled about $1 billion, with nearly half for countermeasure development and only $382 million for hospital preparedness. The Centers for Disease Control and Prevention was given just $228 million to spend on maintaining its “early warning system to rapidly identify new infectious disease threats.”

The government doesn't have to go deeper in the deficit hole to substantially improve its response to emerging infectious diseases. It needs only to rebalance its priorities by ending spending on nonexistent threats and concentrating on real ones.

Follow Merrill Goozner on Twitter: @MHgoozner