Anywhere is Everywhere

Infectious diseases do not respect international borders.

OK—I have tried to not have these posts be political. I focus on the science, as best it is known, and filter it through my 30+ years of experience caring individually for patients, and working at Infection Prevention in healthcare systems.

Recently, a new (or rather, returning) US Administration has chosen to disengage from activities that will have direct impact on the health of my patients, my community and our country.

On his first day in office, our President gave notice to the World Health Organization (WHO) that the United States would be withdrawing from that body. This started a one year countdown for cutting off funding. The US has been the largest funding source for the WHO, at over $1.2 billion, but is not the only source. The WHO will go on, but hobbled. While the WHO is not a perfect institution, it has been essential for collecting, evaluating, and communicating data about emerging infections around the globe. A weakened WHO is a less effective WHO.

What could be worse than defunding a global infectious disease intelligence gathering organization? How about not communicating about infectious disease threats. Recently, the US Administration instructed the US Centers for Disease Control and Prevention (CDC), to disengage from any activities with the WHO. No communications. No information sharing. When a pathogen is one or two flights away from anywhere in the world, this is a dangerous game. Moreover, humans are not the only carriers of highly pathogenic viruses—so are migratory birds. It’s one thing to cut off your nose to spite your face—we have cut off our eyes and our ears as well.

To add to the tragedy of not communicating with the rest of the globe, the US is now not communicating within our borders. CDC communications have been reduced or curtailed. Funding for assembling expert panels and new and ongoing research has been put on hold. This is anticipated to be a ten day pause, but disruption can have immediate effects on budgets and schedules.

What does all this mean to our health? Without the situational awareness provided from trusted sources at CDC (and WHO), it will be hard for your doctors to provide care and direct diagnostic and therapeutic techniques for you and your contacts. It will mean blunted response to emerging infections both common, such as influenza, and rare, such as Mpox and Marburg and Ebola.

Another global disease threat undermined by recent policy changes is the President’s Emergency Plan for AIDS Relief (PEPFAR). Started by President George W. Bush in 2003, PEPFAR has over the years distributed $120 billion of AIDS medication and supportive services, and is credited with saving 25 million lives, including 5.5 million children, in Sub-Saharan Africa (doing the math—a cost $4800 per life saved). What does this have to do with the United States? Reducing the global burden of HIV/AIDS also reduces the risk of emergence of further drug resistance in HIV, as well as building infrastructure to respond to other health emergencies—and building good will. Unfortunately, the current Administration has shut down the PEPFAR program—whether this is permanent is unknown.

I would encourage interested readers to contact the White House to express their opinion. Unfortunately, as of this writing, the comment line (1-202-456-1111) is closed and the suggested website is nonfunctional. The whitehouse.gov website lists no phone number or email address for comments—only the physical address of 1600 Pennsylvania Ave, Washington DC, 20500 is listed.

An infection anywhere is a potential infection everywhere. When it comes to communicable diseases, ignorance is not bliss—it’s lethal.