INFECTIOUS INFECTIOUS INFECTIOUS INFECTIOUS INFECTIOUS DISEASES THE GLOBAL FIGHT global issues NOVEMBER 1996 Volume 1, Number 17 INFECTIOUS INFECTIOUS INFECTIOUS INFECTIOUS DISEASES THE GLOBAL FIGHT global issues NOVEMBER 1996 Volume 1, Number 17 GLOBAL ISSUES NOVEMBER 1996 Volume 1, Number 17 INFECTIOUS DISEASES THE GLOBAL FIGHT Infectious diseases are the single most common cause of death worldwide, 40 years after the introduction of antibiotics. In the United States only heart disease and cancer kill more people. This month, through interviews and in-depth reports, we present the views of a variety of medical and public-health authorities on the problems and issues surrounding infectious diseases. While experts believe that the threat will continue and may even intensify in coming years, they also report that scientists are developing better ways to treat and prevent many infectious diseases that afflict people around the world. table of contents GLOBAL ISSUES An Electronic Journals of the U.S. Information Agency Volume 1, Number 17 November 1996 INFECTIOUS DISEASES: THE GLOBAL FIGHT focus Here To Stay...............................................................................................................................................6 Though progress against infectious and chronic diseases is being made on many fronts, deadly bacteria and viruses will bedevil humankind for a long time to come. An interview with Dr. David Satcher, director of the U.S. Centers for Disease Control and Prevention. New Drugs, New Vaccines, New Diseases......................................................................................10 Basic research is providing new weapons against deadly diseases ranging from tuberculosis to AIDS. An interview with Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Attacking the Root Causes of Disease...............................................................................................14 The administrator of the U.S. Agency for International Development outlines the resources his agency is using to combat the global spread of infectious diseases. By J. Brian Atwood commentary A Paradise for Pathogens — Almost Everywhere.........................................................................16 While diseases like small pox and polio seem to be on their way out, a crowded world and antibiotic resistance are allowing others to take their place. By Judith Randal The Return of Infectious Diseases.......................................................................................................20 The Darwinian law of natural selection is alive and well in the world of bacteria and viruses. By Laurie Garrett information Plan Of Action ........................................................................................................................................27 The World Health Organization has a strategic plan to help countries control emerging diseases. By James LeDuc The Threat of Emerging Infections.....................................................................................................3l A list of emerging infections — their causes, modes of transmission, and suggested treatments. departments Bibliography............................................................................................................................................35 Books, documents, and articles on infectious diseases. Article Alert ..........................................................................................................................................39 Abstracts of recent articles on infectious diseases. Internet Sites ..........................................................................................................................................40 A list of Web Sites for information on government and international health organizations involved in combatting infectious diseases. USIA’s electronic journals, published and transmitted GLOBAL ISSUES worldwide at two-week intervals, examine major Electronic Journals of the U.S. Information Agency issues facing the United States and the international [email protected] community, and inform foreign publics about the United States. The journals — ECONOMIC PERSPEC- Publisher . Judith S. Siegel TIVES, GLOBAL ISSUES, ISSUES OF DEMOCRACY, Editor . John Walsh U.S. FOREIGN POLICY AGENDA, and U.S. SOCIETY Managing Editor . Jim Fuller AND VALUES — provide analysis, commentary, and background information in their thematic areas. Text Editor . Edmund Scherr French and Spanish language versions appear one week Intrernet Editor . Tim Brown after the English. The opinions expressed in the Associate Editors . Guy Olson journals do not necessarily reflect the views or policies of . Wayne Hall the U.S. Government. Articles may be reproduced and Contributing Editors . Jerry Stilkind translated unless there are specific copyright restrictions cited on the articles. Current or back issues of the . Ellen Toomey journals can be found on the U.S. Information Service . Judith Greenspan (USIS) Home Page on the World Wide Web at . Mark Glago “http://www.usia.gov/journals/journals.htm”. They are Reference and Research . Monica Mieroszweska available in several electronic formats to facilitate viewing . Joan Taylor on-line, transferring, downloading, and printing. Art Director . Patricia Gipple Comments are welcome at your local USIS office or at the editorial offices — Editor, Global Issues (I/TGIC), Editorial Board . Howard Cincotta U.S. Information Agency, 301 4th Street SW, . Judith S. Siegel Washington, D.C. 20547, United States of America. You . Pamela H. Smith may also communicate via email to [email protected]. FOCUS Here To Stay An interview with Dr. David Satcher, director, with cerebral malaria, which is the worst kind. U.S. Centers for Disease Control and Prevention So the whole issue of drug-resistant malaria represents what we consider to be part of an A family physician who became the first African- emerging infection. American director of the leading U.S. public health agency, the Centers for Disease Control Then there is Ebola in Africa. Ebola was first rec- and Prevention (CDC), Dr. Satcher is confident ognized in 1976. Before 1976, we had never that we will conquer polio, measles, and guinea heard of or seen Ebola. Then we had cases in worm in the next 20 years, but he warns that the Sudan and in Zaire and sporadic outbreaks we have to reinforce the capability to deal with since, including the 1995 outbreak in Zaire and new diseases and those that are becoming the recent outbreak in Gabon. It’s a severe, resistant to current treatment. deadly virus, killing over 80 percent of the peo- ple who are infected, according to some studies. Though progress against infectious and chronic diseases is being made on many fronts, deadly If you were to ask me, however, what is the bacteria and viruses — not to mention some major emerging infectious disease throughout the unhealthy lifestyles — will bedevil humankind for world, I would say the human immunodeficiency a long time to come. Satcher was interviewed by virus (HIV) that causes AIDS. AIDS was first Contributing Editor Jerry Stilkind. defined as an epidemic in 1981. The virus was discovered in the early 1980s. We now project that, by the year 2000, there may Question: How serious is the problem of new be as many as 40 million people infected and reemerging infectious diseases around the with the AIDS virus. world, particularly in the developing countries? While the area that has been the most severely Satcher: When the Institute of Medicine (a con- affected up to this point has been Africa, the area gressionally chartered research organization) where the virus is most dramatically spreading is defined emerging infectious diseases in 1992, it Southeast Asia and India. AIDS is, without included new diseases that had developed in question, the premier emerging infectious disease. the past two decades, and old diseases that are increasing in number or becoming drug resistant. Q: Not long after you became director of the Centers for Disease Control (CDC) four years When you define it that way, malaria stands out ago, you said that the United States and other in Africa because of its resistance to chloro- countries had become complacent about infec- quine. We are seeing a resurgence of malaria tious diseases, that we had neglected to main- in many places in Africa. We are seeing a lot tain the resources to detect disease outbreaks of children coming into the hospital after their and to respond quickly with diagnosis and parents have attempted to treat them with chloro- treatment. Around the world, has the situation quine at home, and these kids often come in gotten better or worse since then? 6 Satcher: Throughout the world there was an diseases. That includes strengthening domestic attitude for a while that we were making such surveillance and also playing a prevention great progress against infectious diseases role globally. The president recommended that that we could become less vigilant. In a hearing CDC be given more authority and resources before Congress in 1969, the U.S. Surgeon to carry out this mission. General said, “It’s actually time to close the book on infectious diseases.” Q: After the Ebola virus broke out in Zaire in 1995, didn’t some CDC people go there That attitude pervaded Europe, also, although to try to figure out what it was and what was maybe not to the same extent. But all over happening? the world we’re now seeing