Vice Chancellor for RESEARCHOffice of the

Global Health is America’s Health and National Security

Samuel L. Stanley, Jr., M.D.

Paul Rogers Global Health Ambassador

Research!America

Vice Chancellor for RESEARCHOffice of the

Infectious diseases know no borders

• The flat, hot and crowded world.– Jet travel removes the temporal and

geographic barriers – Increased population density– Environmental changes may promote

increased vector range and disease transmission

Vice Chancellor for RESEARCHOffice of the

Infectious diseases know no borders

• Our actions, and the inherent properties of our microbial enemies, guarantee new disease threats.– Expansion and encroachment lead to

exposures to previously unrecognized microbes– Microbes are evolution in motion—constantly

changing their genetic makeup through mutation to expand their host range, and resist therapies.

Vice Chancellor for RESEARCHOffice of the

Under Siege--Biosecurity

• International public health infrastructure.

• Incentives to produce new vaccines and therapeutics for existing and emerging diseases.

• Support for basic and applied research on these biological threats.

Vice Chancellor for RESEARCHOffice of the

Infectious diseases know no borders

• .

Wisconsin, Illinois, Indiana, Kansas, Missouri, and Ohio with cases. 72 suspected, 37 confirmed.

Vice Chancellor for RESEARCHOffice of the

US Research Responds

• Why did we see such low morbidity and mortality with the monkeypox outbreak? – Virus was from W. Africa—lacks two key

genes found in the more virulent Central African strain—clues to how we fight off these viruses.

– Help us understand and prepare for any future poxvirus outbreaks.

Vice Chancellor for RESEARCHOffice of the

SARS

• More than 8000 cases and 774 deaths

• Epidemic began in November 2002, exploded internationally in March 2003.

• Widespread concern and significant economic impact.

Vice Chancellor for RESEARCHOffice of the

SARS—US Research Responds• In just three months:

– Virus identified.

– Virus completely sequenced.

– Natural host probably identified.

– Diagnostic tests based on viral sequence developed.

– Koch’s postulates fulfilled for SARS-CoV– isolated virus successfully infected monkeys with development of SARS-like illness and identification of virus in pathological specimens.

– Understanding the disease led to some preventive measures and no further significant outbreaks reported.

Vice Chancellor for RESEARCHOffice of the

New Threats

• Chikungunya—mutation in virus caused massive outbreak in Reunion—260,000 cases and 37 cases in the U.S.

• 4 deaths in S. Africa from unknown virus—now identified as arenavirus.

• Methicillin resistant staphyloccus aureus in the United States and the world, requires expensive and more toxic antibiotics.

Vice Chancellor for RESEARCHOffice of the

Global Research Needs for Biosecurity

• Worldwide research into rapid recognition and identification of new disease threats

• Collaboration on new diagnostics—large scale sequencing to identify new pathogens—work between U.S. researchers and those in other countries.

• Epitomized by SARS effort, but U.S. must help lead the way.

Vice Chancellor for RESEARCHOffice of the

Global Research Needs for Biosecurity

• Continue to support research into broad spectrum interventions—therapeutics that target whole classes of viruses or bacteria.

• Vaccines or drugs that boost the immune system to provide response against multiple biologic threats—notion of controlling infection until specific measures are available.

Vice Chancellor for RESEARCHOffice of the

Global Research Needs for Biosecurity

• Support research on diseases that could spread to U.S. but are not present currently. – Marburg, Ebola, Dengue, Chikungunya.

• Support research on diseases that are unlikely to threaten the U.S. but destabilize developing countries.– Malaria, cholera,

Vice Chancellor for RESEARCHOffice of the

Global Research Needs for Biosecurity

• Support research on diseases that threaten all people worldwide– Influenza, HIV, tuberculosis, drug resistant

bacteria and viruses.

Vice Chancellor for RESEARCHOffice of the

Final Thoughts

• Near misses: SARS, monkeypox

• Ongoing hits:– HIV (present since ?1900)—did not have the

infrastructure to recognize the disease or identify the agent before it was too late.

– MRSA—driving increased mortality and cost in our health system

– Drug resistant TB—extensively drug resistant TB

Vice Chancellor for RESEARCHOffice of the

Final Thoughts

• What is next? – While it does not guarantee success, shame on us if

we do not make every effort to be prepared for the next major threat.

• Preparation means– Global collaborative research on basic mechanisms of

infectious diseases and countermeasures– Support for a worldwide public health infrastructure– Incentives to develop the next generation of vaccines

and therapeutics.

Vice Chancellor for RESEARCHOffice of the

Final Thoughts

• Who does this (federal agencies) ?– NIH– CDC– PMI (USAID, HHS, CDC, State, White House)– Others (DOD, DHS)

• How should it be done?– Experts identifying major target themes– Peer reviewed proposals

Vice Chancellor for RESEARCHOffice of the

Thanks

• Paul Rogers—inspiration for how each of us can make a difference in global health.

• NIH—the backbone of biomedical research and a key to the discoveries that will address these threats.

• You