'There Will Be Epidemics': 2018 Tropical Infectious Disease Forecast

Posted 14 December 2017

What's on the Horizon for Tropical Infectious Disease?

ASTMH Leaders Offer Their Insight

We asked our ASTMH leadership, "What do you think 2018 will bring in terms of tropical infectious diseases?" Here's what they said:


Regina Rabinovich, MD, President
I predict we will see both the good and bad this year. There will be epidemics...somewhere....because we face these every year. Perhaps not as impressive as Ebola, but just as real. Unfortunately, other diseases which have a huge impact, like tuberculosis, will continue to kill about 1.8M - read that “million” - people per year, without much notice. But on the positive side we can looking forward to seeing the results of trials on presumptive treatment of children with azithromycin, and the launch of the phase IV RTS,S trials. And if I could have one wish for the year, it would be to see the aggressive launch of advanced development of interventions for vector borne diseases  (i.e., targeting the vector) because we really need them.


Chandy C. John, MD, FASTMH, President-Elect
I hope 2018 will bring good news in areas of slow but steady progress like polio and guinea worm eradication. I hope 2018 will also bring renewed (and successful) efforts to reduce malaria transmission and incidence, given the disappointing 2017 World Malaria Report, which showed a slowing of progress in that area. I think we will have increasing awareness of the potential effects of climate change on tropical infectious diseases, and I hope that work across countries, organizations and corporations will continue to combat climate change. I am a perpetual optimist, but it would be foolish not to consider that 2018 could bring along a new infection like Zika virus or new problems with old infections like Ebola. Let’s hope not, but if one does come along, I hope the lessons from Ebola, Zika and other infections will help to make us more prepared to deal with the new infection.


Patricia F. Walker, MD, DTM&H, FASTMH, Past President
In my area of specialty (refugee and migrant health), 2018 will be a very active year. Europe continues to respond to the migrant crisis, with varying success. Migration Medicine will be the focus of a conference in Rome in October 2018, co-sponsored by the International Society of Travel Medicine and ASTMH. The Fogarty International Center is looking at issues related to conducting research during humanitarian crises. The world will need to remain vigilant to international human rights issues as new and continued crises occur, such as the Rohingya of Myanmar. In the United States, we must continue to advocate for evidence-based migration policies that are good for individuals, and good for the country. We must continue with the message that “global is local “ in healthcare.  Now more than ever, we need transnational research, academic teaching and other scientific exchange to solve the world’s pressing humanitarian and health crises.

Philip Rosenthal, MD, FASTMH, Editor-in-Chief, AJTMH
For 2018, I predict a change in the recent conversation about malaria. After some years of optimism and steady improvement, the 2017 World Malaria Report was sobering. Estimated cases of malaria increased and deaths were stable. These estimates were described as “conservative,” and the word on the street is that the real numbers are worse than the reported estimates. We will continue to optimistically encourage a push to eradication, but we also must acknowledge that we are stalled in key regions, and without new ideas we may backslide. This has happened before. But, the malaria situation is not as grim as in decades past. Great progress has been made, and some countries are achieving elimination. But, we need to do better. I predict that 2018 will see a reanalysis of goals and strategies. Numerous powerful tools are available, but we need to better utilize these tools to regain our momentum and get back on track toward worldwide control and elimination of malaria.


Nicole Achee, PhD,
Regarding arthropod-borne infections, I expect 2018 will bring stories showcasing global, multidisciplinary collaborations in reducing burden, such as the continued success of visceral leishmaniasis elimination goals in Bangladesh.  This will be balanced with highlights of the fundamental need for continued emergency preparedness and response, both domestically and internationally, such as was demonstrated by the 2017 Yellow Fever outbreak in Brazil. I am confident that our Society members are sure to be contributing to these efforts.


David H. Hamer, MD, FASTMH, Councilor 
During 2018, we will see continued advances in the control of some tropical diseases with continued reduction in the global burden of malaria and nearly final Guinea worm eradication with a limited number of cases in just one country—Chad. In contrast, given continued climate change-associated extreme weather conditions, we will face the threat of an outbreak caused by a relatively novel, mosquito-borne flavivirus or alphavirus. Will 2018 be the year that Mayaro virus raises its profile or will there be a movement of Kyasunur forest virus out of India to other countries with competent ticks? There may be more outbreaks of chikungunya and even, potentially, Zika virus in summer months in areas of Western Europe and the southeast USA that are endemic for Aedes aegypti. Improvements in surveillance and effective public health response will be critically important for control and prevention of these potential future outbreaks.


Laura Kramer, PhD,
FASTMH, Councilor
In 2018, newly emerging/ re-emerging viruses may pose a threat of a widespread outbreak if we become complacent and develop a lax attitude towards public health preparedness. Rampant disturbance of the environment and climate change are exposing humans to previously sequestered pathogens. With the current frequency and speed of travel, infected individuals, invasive mosquitoes and pathogens move rapidly. One lesson we can take away from recent mosquito-borne virus outbreaks is that we have not been able to predict virus emergence in time to prevent an explosion into outbreaks. No preemptive activity took place in the western hemisphere even as West Nile, chikungunya and Zika virus activity was increasing significantly in Europe and Asia, respectively.  This highlights the critical need for global awareness. A strong public health infrastructure must be maintained, trained staff must be supported, research must be backed to be prepared to meet the next challenge even in the absence of any current local outbreak. Finally, enhanced surveillance, rapid communication and secure funding, among other needs, are critical to public health intervention of current and future threats.

Desiree LaBeaud, MD,
ACAV Chair
More arboviral outbreaks for sure! With our changing planet and our inability to keep up with the world’s most deadly animal, the mosquito, I’m sure we will see more and more outbreaks of mosquito-borne diseases. It is our task to work together across international boundaries to defeat these dangerous threats by conducting rigorous studies that lead to evidence-based strategies and policies for prevention and control.  In addition, because arboviruses, like all neglected tropical diseases, affect the impoverished more severely, we must continue to strive for the alleviation of poverty in all its forms to truly see our collective work come to fruition.

Karen A. Goraleski,
Executive Director
If past behavior is a predictor of future behavior, we can expect another round of White House budget slashing to the CDC, NIH and the infectious disease efforts at DoD. Along this same line of thinking, we should see strong pushback from the science community, stakeholders, supporters and our Members of Congress. However, we can’t be complacent and think someone else will fight the battle for us. Each one of us needs to be an advocate. We all have a stake in this.