National responsibilities, cooperative possibilities

Governments and scientific communities in the developed world devote considerable attention and study to the emergence and re-emergence of pathogens. But in resource-constrained countries, this is often not the case. Africa is a region especially prone to outbreaks of the diseases naturally transmitted between vertebrate animals and humans (zoonotic diseases); these include Ebola, Rift Valley Fever, and plague. All countries in the region are at risk from these diseases, and cross-border outbreaks are frequent. But African nations are often characterized by a failure or inability to effectively address the emergence of new diseases or the re-emergence of endemic ones.

Several reasons for this stand out. Africa's systems for disease surveillance are weak and laboratory support is poor, making it difficult to produce data needed for assessing disease burdens and responding with appropriate priorities. When good information is unavailable, the emergence of new pathogens is often met with denial—until a disease outbreak reaches epidemic proportions. Once an epidemic is under way, an affected country is invaded by international health agencies, but they operate in panic and crisis-response mode, and their efforts amount to too little, too late. Pathogen outbreaks ultimately become opportunities for foreign researchers and health agencies to fine-tune their skills, leaving scientists in resource-poor countries permanently dependent on outsiders—reduced to mere sample collectors, unable to control the next pathogen outbreak on their own.

How can these challenges be overcome? The first step involves focusing on local processes of pathogen emergence. Pathogens emerge under widely varying environmental, demographic, and socioeconomic circumstances. A pathogen's ability to emerge or re-emerge depends on factors including genetic changes or adaptation in the pathogen itself; environmental conditions associated with climate, economic development, and land use patterns; and issues related to pathogens' human hosts, including demographics, international trade patterns, misuse of antibiotics, people's occupational exposure, the neglect of public health services, and bioterrorism. These factors and conditions interact differently in different parts of the world—therefore, the first step toward preventing and controlling outbreaks of emerging and re-emerging diseases is to gain a thorough understanding of local processes of pathogen emergence. Once such an understanding is gained, governments, institutions, and professionals—especially in the developing world—must commit themselves to clearly defined, proactive roles in the fight against emerging and re-emerging diseases.

At the national level, in particular, it is essential that each country take "ownership" of systems for disease surveillance, prevention, and control; this allows country-specific response measures to be formulated. Taking ownership of these systems entails making a genuine political commitment to them, and requires that adequate resources, financial and human, be provided for disease surveillance and for laboratory support systems. It is crucial that nations maintain systems capable of detecting, identifying, and containing pathogens that have epidemic potential before they spread too widely.

For governments, taking a proactive role in combating disease also entails implementing appropriate emergency response plans; coordinating collaborative interactions between human and veterinary health surveillance systems; building and sustaining the disease-fighting capacity of local health personnel by providing them training, opportunities to update their skills, and an empowering work environment; and establishing a multidisciplinary approach to disease control, one that allows individuals from diverse fields to bring their expertise to bear on the control of emerging or re-emerging diseases. (Engagement from the private sector, for example, ought to be forthcoming because disease outbreaks threaten everyone's economic security.)

Making the world safer from emerging and re-emerging pathogens also requires a great deal of global collaboration. Nations should collaboratively implement policies, for example, that control pathogens' ability to spread via modern transportation systems. They should participate in regional surveillance and response activities. They should share real-time surveillance information in order to detect zoonotic diseases in animal populations before they appear in human populations. Meanwhile, researchers all over the world should collaborate to strengthen surveillance of human populations that are at high risk of contracting zoonotic diseases. Science-based nongovernmental organizations, because of their wide geographic reach and their field expertise, should be engaged as partners to help provide comprehensive surveillance and response capabilities. Meanwhile, innovative mechanisms could be established that would ensure adequate funding for sustain­able global disease surveillance systems. The struggle against emerging and re-emerging disease is a complex and difficult challenge that requires full-scale effort at both the national and international levels.