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Infectious Diseases

The Biggest Problems We Face Fighting Infectious Diseases

Photo: Courtesy of Mélissa Jeanty

Misinformation, climate change, antibiotic resistance, and plenty of other challenges are forcing public health leaders to innovate in their fight against infectious diseases. We asked our panel of experts to weigh in on how we can overcome these challenges, and work to prevent and cure infectious diseases.

Dr. Tuesdae Stainbrook, DO, MPH

DO, MPH, Owner, TruCare Internal Medicine & Infectious Diseases

What is the biggest problem related to infectious diseases the world is facing now or will face in the future?

Personally, I believe the public’s perception and mistrust of scientists and doctors are the largest problems infectious disease specialists face. Currently, there are many new and significant advancements in the world of infectious disease. There are new antibiotics to combat rising rates of clostridium difficile colitis (C-diff) infections, new antivirals to cure chronic hepatitis c, and new vaccines under development to combat the coronavirus. However, these advancements are tainted by the public’s distrust of the science behind new and proven prevention and treatment. 

In today’s world, conspiracy theories seem to triumph over scientific facts, unreliable sources are valued more than professional insight, and fake facts dilute scientifically proven facts. If the public chooses not to believe in modern medicine, then preventable infectious diseases will continue to harm the public. Refusing preventive treatments such as vaccinations will lessen the effectiveness of new vaccines to minimize the spread of emerging infectious diseases. 

The denial of science has become increasingly evident with the anti-vaccine campaigns and COVID-19 conspiracies. Scientists will not be able to effectively develop new antimicrobials and vaccines to benefit society if society believes developing medicines is harmful. Before any significant advancements can be made, the public’s perception of doctors and scientists needs to be restored as health advocates and experts.

How can the world solve this problem?

One of the best tools we can use to solve this problem is education. The public needs to understand the processes behind developing vaccines and new medications to treat infections. Globally, the COVID-19 pandemic highlighted the importance of preventing, containing, and eradicating infectious diseases. 

In developed countries, cases of smallpox, polio, and a multitude of other diseases have been eliminated because of vaccines and medicines. However, many third-world countries continue to combat many of these infectious diseases. 

If science is to win over misinformation, then education must be at the forefront of gaining public support. The scientific method is a stringent process that is measurable and reproducible, enabling the truth of science. 

The road to success will be educating the public on the benefits of prevention, treatments, and cures. Educating the public can increase trust in the science of diseases and demonstrate advancements in medicine to better society. 

Why is it important to raise public awareness about infectious diseases?

Simple. No one is immune to and everyone is affected by infectious diseases. Public awareness and education is our primary tool to fight infectious disease. As human beings, we must coexist in this world with a multitude of other organisms. Many of these organisms represent an infectious risk to our health and well-being. 

An example is the hepatitis C virus (HCV), which is the most common bloodborne viral illness in the world. Globally, HCV chronic disease infects over 71 million people. It has never been more important to raise public awareness about infectious diseases to educate and involve the public in slowing the spread of these diseases. The public needs to be able to identify risk factors, increase preventive measures, and reduce treatment barriers to infectious diseases. 

Public health education on infectious diseases can and will save lives. It takes public cooperation to stop the spread of infectious diseases. 

What is one thing you wish more people knew about infectious diseases?

There needs to be a greater public awareness about preventive measures that should be incorporated in people’s everyday lives to prevent infectious diseases. Education is the foundation for knowledge, knowledge is power, and empowered individuals can make informed decisions. Improving an individual’s health and well-being starts by using scientific facts and filtering out unqualified opinions. 

Normally, following good hygiene practices on a daily basis helps prevent the spread of infectious diseases. The virulent and rapid spread of COVID-19 identified additional practices initiated to prevent the spread of the disease by staying home when possible, washing hands, wearing masks, and maintaining appropriate social distance. Some infectious disease outbreaks necessitate extreme measures to make a significant difference to protect vulnerable populations and all lives. 

Physicians and scientists cannot stop a pandemic alone, but the entire public working together can slow the spread of infectious disease.

What inspired you to get into the public health/infectious diseases field? 

Early in my medical training, I came to realize that many disease states have an infection as an underlying cause to a medical problem. An infection is, at least in part, a contributing, relating, or exacerbating factor when assessing diseases. The ever-evolving field of infectious diseases is significant, vast, and fascinating. Infectious diseases affect everyone in a variety of ways. 

As I have always been a public health advocate, the field of infectious diseases was a natural partner with my passion for public health. I have always been interested in finding root causes and understanding the complexities of infectious diseases. I was inspired by this ever-changing and advancing field full of challenging issues. As an infectious disease expert, I saw it as the best way to help people, make a difference, and advance public health.

Dr. Mary Jo Trepka, MD, MSPH

Professor and Chair, Department of Epidemiology, Florida International University

What is the biggest problem related to infectious diseases the world is facing now or will face in the future?

Probably one of the biggest problems related to infectious diseases is climate change. The epidemiology of many infectious diseases is affected by ecological changes, and the interaction between humans and animals. For example, some areas will have an increased risk of mosquito-borne diseases such as malaria and dengue fever due to global warming.  

How can the world solve this problem?

This problem has to be addressed in a multifaceted way in that we need to prevent further climate change by changing our lifestyles and having policies to reduce global warming. We also have to prepare for an increased burden of infectious diseases that could result from global warming. For example, we have to identify and test new ways to control mosquito populations.

Why is it important to raise public awareness about infectious diseases?

Many people think infectious diseases are a problem of the past because of the availability of antibiotics, vaccines, and improvements in healthcare. However, each year we are confronted with new infectious disease challenges. 

The obvious one this year is COVID-19, but we recently had the challenge of the emergence of the Zika virus, chikungunya virus, Ebola virus, H1N1 influenza virus, and the reemergence of dengue fever and yellow fever. We also have continued and new problems with antibiotic resistance, making it difficult to treat many infectious diseases like tuberculosis.

What is one thing you wish more people knew about infectious diseases?

Unlike many chronic diseases like heart disease, what we as individuals do affects not only our risk of an infectious disease but the risks of others around us. For example, if I get the influenza vaccine, I am not only protecting myself, but am also protecting the people around me. That is because I decrease the chance that I could infect them.  

What inspired you to get into the public health/infectious diseases field? 

In public health, we have many opportunities to prevent diseases and improve the quality of life for communities. Using the tools of public health science, we can identify new ways to improve the health of the population and guide public policy to make our communities safer and healthier.

Dr. Margaret Andrews, DNP, RN, LNP, WHNP-BC, FNP-BC, CNE, CDP

Interim Assistant Dean of Graduate Nursing, South University

What is the biggest problem related to infectious diseases the world is facing right now or will face in the future?

One of the biggest problems we face with infectious disease is emerging pathogens. These emerging threats are unknown and can cause massive mortality, as well as economic and social unrest before scientists even fully understand their disease process. Another problem we will face in the future, especially in America, is an aging population with higher rates of morbidity, which will, in turn, increase the number of immunocompromised individuals. 

How can we solve this problem?

We can work toward a solution by collaborating with official and unofficial organizations to increase communication and knowledge distribution. Perhaps having one all-encompassing organization to collect, house, and distribute all data related to new emerging pathogens would streamline data related to risk factors, symptoms, diagnostic tests, and medications, and potentially decrease the amount of time spent on inaccurate information.

Why is it important to raise public awareness about infectious diseases?

It is important to raise awareness about infectious diseases because, in general, people view diseases like Ebola, MERS, SARS, COVID-19, etc., as diseases they cannot or will not get. Most people cannot imagine ever contracting an infectious disease that could cause serious morbidity. It is very similar to sexually transmitted infections. Most people think, “Oh, that won’t happen to me. That happens to other people.” 

Awareness of protecting oneself from disease is paramount to decreasing the spread of harmful pathogens. 

What is one thing you wish more people knew about infectious diseases?

I wish that people would know that infectious diseases are not going anywhere. They are here to stay. Just because we have vaccines against some diseases does not mean the disease is gone. It is still there. Vaccines and medications will protect us to an extent, but what if we lose access to these? 

Supplies of medications and vaccines play a huge role in the world of infectious disease. I wish more people would stay home when they are sick, and not go into work and expose everyone, and I wish people would adhere to basic hygiene practices — wash your hands!!

What inspired you to get into the public health/infectious disease field?

I always wanted to work in women’s health, specifically with gynecology and sexually transmitted infections. I was lucky enough to take a part-time job that turned into a full-time position at a local health department. I worked in public health for over five years before transitioning into academia full time. 

Sylvia Garcia-Houchins

Infection Prevention and Control Director, The Joint Commission

What is the biggest problem related to infectious diseases the world is facing now, or will face in the future?

Microorganisms (e.g., bacteria, viruses) have the ability to replicate very quickly. Replication allows them to adapt and change in ways that will ensure their survival. Infection control professionals have seen this with bacteria that have evolved resistance to antibiotics in a relatively short time, as well as with coronaviruses. Humans need the ability to mount a rapid and coordinated response to these emerging pathogens. 

How can the world solve this problem?

We need to be able to make quick assessments about emerging pathogens and institute containment measures as early as possible. That is why organizations like the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) are so important to global health and safety. We need to take their efforts to the next step. 

In comparing the disparities in mortality rates amongst U.S. cities during the 1918 influenza pandemic to what is happening now with COVID-19, it seems clear that our failure to agree on basic infection prevention and control measures cost lives then — and is costing lives now.

In 1918, the influenza pandemic took days to move around the world — now microorganisms can move undetected around the world in hours. Containment and response should not be a political issue, or we face putting the world at risk. World leaders need to agree on basic infection prevention and control strategies for containment and response. They all need to commit resources and regulations to implement basic strategies. 

It is not a matter of IF but WHEN the next global threat will emerge. 

I believe basic infection prevention and control measures taken by all countries represent “Level 1” prevention. We all have a responsibility to make sure even the poorest countries can implement “Level 1” prevention. When there is an emerging pathogen, like coronavirus, we move to preset “Level 2” prevention and subsequent levels, implementing predetermined actions as information evolves and is reviewed. This allows us to allocate resources, training, drilling, and scalable responses.

Why is it important to raise public awareness about infectious diseases?

There are so many misconceptions about how microorganisms are spread, and basic infection prevention and control. People are being bombarded with information that sounds or looks correct, but is not. Who can the public believe if there is no background foundation — a news reporter? Social media? An aunt or a pastor? If everyone had the same basic knowledge of how microorganisms are spread, they would know how to stay safe.

What is one thing you wish more people knew about infectious diseases?

As with most disease processes, it is all about prevention. If disease does happen, we all need to know how best to break the chain of infection. 

If a disease is spread by touch, we need to clean and sanitize surfaces, and perform hand hygiene. If a disease is spread by droplets, we need to prevent droplet dispersal (e.g., wearing masks) and maintain physical distancing (usually six feet apart). If a disease is spread through the air, we need to contain the air around infected individuals or evacuate it into a safe location (like blowing the air out of a bedroom window so others in the house are not exposed). 

Antibiotics, antivirals, and other medications can help individuals recover if administered in the correct situations, but medications are not the answer to keeping people safe. Infection prevention and control is a basic survival skill that needs to start in infancy, and be nurtured and sustained throughout our lives.

What inspired you to get into the public health/infectious diseases field? 

I was between my junior and senior year in college and had the opportunity to work for the Infection Control Program at University of Chicago Hospitals. I was supposed to work as their lab support for the summer while their regular laboratory technologist was on maternity leave. 

That was a life-changing summer! I finished up a project for the hospital epidemiologist that involved collecting water samples from hospital workers’ home showers and testing for Legionella pneumophila, which causes Legionnaires’ disease. Every sample I obtained tested positive for at least low levels of the organism. 

Then things got really exciting when a patient was diagnosed with a strep infection within his surgical wound. Strep is an organism that usually causes strep throat, so the case was very unusual. I was able to help with the investigation and quickly identified a healthcare worker in the operating room who was a vaginal carrier of group A strep. I was challenged with proving that she was the source. 

I had her walk around in a very small office with settle plates on the floor, desk, and a high shelf. She was sent home for appropriate treatment and the plates were incubated overnight. Subsequently, all settle plates tested positive for group A strep. This discovery made me become hooked on the incredibly challenging and fascinating field of infection control – one that allows me to learn something new every day.

Martina Kovac, M.D.

Vice President of Global Product Development, Vaccines, PPD, Inc.

What is the biggest problem related to infectious diseases the world is facing now or will face in the future?

The reactive nature of drug and vaccine development is a persistent hurdle to preventing infectious disease outbreaks.

COVID-19 has placed a spotlight on how interconnected the world has become and how this creates an environment for the rapid spread of infectious diseases, such as the 2019 novel coronavirus. 

However, when it comes to drug and vaccine development we often are not connected. Moreover, there has historically been a reactive mindset toward infectious disease threats. Rather than preparing for the next pandemic, we are reacting to the latest “shiny object.”

These factors create an uncertain public health environment, which can lead to a loss of government and industry funding for drug and vaccine clinical trials in favor of more visible projects, a lack of continued and sustained investment in pre-clinical development for the prevention and treatment of potentially dangerous pathogens, and the lingering potential for sidelined diseases to become the next pandemic (e.g., Zika, SARS, MERS, influenza).

How can the world solve this problem?

Increased government and industry commitment to product development investment.

The global COVID-19 pandemic is changing how vaccine development is undertaken and will serve to teach us how to deal with future infectious diseases outbreaks. We have seen great examples of collaboration, innovative technologies, and partnerships that will enable faster initiation and execution of clinical development, and can be used as a model going forward.

Large pharma manufacturers are coming together in partnerships to expedite the development of vaccines and therapies. This momentum of global collaboration – and connectivity – between large pharma, biotech companies, government, and academia has created communities where know-how, expertise, tools, and databases are shared and enhanced by artificial intelligence and digital platforms. Integral to this progress has been the rapid issuance of clinical trial guidance, regulatory review, and approval processes on a global scale.  

Collaborative partnerships between private and public sectors and government are increasing, which is enabling scientific dialogue, accelerating clinical development, and providing agility to scale up production. 

For example, the Biomedical Advanced Research and Development Authority (BARDA) and the Coalition for Epidemic Preparedness Innovations (CEPI) have secured investments for vaccine research, clinical testing, and manufacturing in response to the current outbreak.

Operation Warp Speed (OWS) is driving development of a more efficient approach to vaccine development, and Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV), a National Institutes of Health (NIH)-led initiative, is testing multiple inpatient and outpatient COVID-19 therapeutics with a streamlined trial design. Both of these initiatives have required unprecedented collaboration between government and industry. 

Technology and telemedicine also are part of the solution, playing a larger role due to the travel restrictions and social distancing requirements that have been imposed in response to COVID-19. The use of digital technology in trials is creating effective adaptations through virtual participant visits, in-home care, wearable devices to monitor participant safety, and more. 

The COVID-19 experience will transform the way we conduct clinical trials in the future. Digital capabilities will continue to evolve as an essential strategy beyond the current pandemic to help increase access to clinical trials for more participants and reduce the burden of clinical trials, while simultaneously providing new opportunities for investigators to capture more consistent data.

These collective efforts represent a new era in global mobilization, connectivity, and preparedness for mitigating risks to public health. The hope is that this will continue with the updating of existing government policies and the creation of new ones to support public health and international cooperation. 

Why is it important to raise public awareness about infectious diseases?

The new product development process is an integral part of ongoing U.S. and global public health efforts. An educated public can help drive changes that prioritize proactive public health preparedness and product development – both from government and industry. 

During an infectious disease outbreak, the value of drug and vaccine development takes on greater clarity when lives are at risk. The role of public awareness is vital to ensuring visibility persists until we have truly conquered the threat. Public support for drug and vaccine development efforts can help contain the spread, reach various socio-economic groups, prevent new outbreaks, and prepare the world for the next unknown pathogen.  

Most people don’t realize that truly eliminating a disease takes a concerted effort over an extended period of time. For example, the eradication of smallpox, touted as the biggest achievement in international public health, took a concerted global effort over more than 20 years.

Furthermore, grassroots activism in the HIV space of the late 1980s greatly empowered patients, was critical to mobilizing the government and industry to prioritize HIV, and led to expedited research and treatment breakthroughs. Giving the public a voice through education and awareness will help us achieve the right level of investment in research and clinical trials to prevent and treat infectious diseases, eliminate the current COVID-19 threat, and prepare us for the next novel pathogen. 

What is one thing you wish more people knew about infectious diseases?

In vaccine development, the safety of vaccine recipients is paramount. 

While the vaccine development arms of industry and government can seem cumbersome and opaque, much of this infrastructure is in place to ensure patient safety. Global efforts to identify an effective COVID-19 vaccine involve tens of thousands of healthy volunteers. This helps ensure the safety of the vaccine across a wide variety of groups of people with diverse characteristics, such as age, ethnic background, gender, and underlying medical conditions. 

Vaccines are given to millions of healthy people — including children — to prevent serious diseases, so they are held to very high safety standards. Even after a vaccine is licensed and recommended for use, health agencies still continue to monitor its safety and effectiveness.

A typical vaccine study consists of assessment of safety, reactogenicity (i.e., an adverse reaction to the vaccination such as pain at the injection site), immunogenicity (i.e., the desired antibody response to the vaccination), and efficacy (i.e., percentage reduction of disease in vaccinated people).  

Vaccine trials are typically shorter than drug trials, with most of the data collected at somewhat standardized time points within post-vaccination period (0-50 days up to 12 months). In comparison, Phase III drug trials typically take one to three years. Enrollment of participants and the vaccination periods are also typically shorter than many other kinds of studies.

Rapid progress in the generation of new technologies and laboratory testing platforms is also helping speed vaccine trials. In addition, the development of molecular approaches to quickly identify and characterize viruses and bacteria has opened the doors to major scientific breakthroughs that are contributing to the quick emergence of new vaccines.

Vaccines are known to be more cost effective in terms of development compared to disease treatments (one dose of a vaccine is typically a fraction of the cost of a drug treatment for the same disease), and the up-front expenditure for vaccine development is entirely offset by the costs averted through disease prevention. For every dollar spent on childhood vaccinations, our country saves over $10. And the CDC estimates the vaccination of children born between 1994 and 2018 has saved the United States nearly $406 billion in direct medical costs and $1.88 trillion in total society costs.

The old adage “an ounce of prevention is worth a pound of cure” has never been more meaningful than during this current pandemic. Vaccines offer prevention and prevention is priceless. Increased awareness of the true value of vaccination and disease prevention is of great importance in today’s world.

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