2019 Tropical Infectious Disease Forecast

Posted 31 December 2018

What's on the Horizon for Tropical Infectious Disease?

ASTMH Leaders Offer Their Insight

We asked our ASTMH leadership, "What do you think 2019 will bring in terms of tropical infectious diseases?" Here's what they said:

 

Chandy C. John, MD, MS, FASTMH, President
 
Here’s what I hope 2019 will bring in terms of tropical infectious diseases:
1) Serious measures by the US, China, India and other countries to dramatically decrease human-generated climate change
2) More countries certified malaria-free (no local malaria transmission)
3) A reduction of malaria cases and deaths in the countries with the highest malaria burden after two years of stagnation in these goals

Climate change  is probably the single most important issue facing us as a planet. It affects most tropical infectious diseases, particularly those that are spread by mosquitoes like malaria and dengue. And it affects health and living in many other ways. I hope we’ll get back on track with ways to combat this pernicious problem.

 

Joel Breman, MD, DTPH, FASTMH,  President-Elect 
Early in 2019 the political, economic and military situation in countries X, Y and Z have destabilized further. Reports of massive outbreaks of diarrheal disease are being reported from X; fever, chills and anemia in Y; and hemorrhagic fever in Z.  The WHO is understaffed and unable to respond to these epidemics, which are now moving toward the capitals.  A call goes out from Geneva to tropical disease experts to join international-national control and research teams in each of these countries.  As the first wave of volunteers leave for the field the UN and WHO receive a red alert from a large Asian country reporting clusters of severe acute respiratory disease in several large cities with the highest death rates in young adults.  USAID asks the ASTMH to collaborate in the investigations and initiation of rapid control measures in all countries.

 

Dan Bausch, MD, MPH&TM, FASTMH,  Scientific Program Chair 
 
Of course, epidemics—very clear to me as I write from the Congo as part of the response to the ongoing Ebola outbreak. That this outbreak will continue well into 2019 is an unfortunate given. Other viruses are also lurking, so we'll collectively have to be able to respond to more than one outbreak at a time. I especially worry about yellow fever and Rift Valley fever. The other thing that I think we'll see is acceleration of the effects of global warming. While these may manifest primarily as extreme weather events, I believe that these events will ultimately shepherd in a host of less obvious threats, both infectious and non-infectious, that we are just beginning to understand.

David R. Hill, MD, DTM&H, FASTMH,  Secretary-Treasurer 
 
It is difficult to say which pathogen(s) will rear its head this coming year, but we can be sure that one or more of them are waiting to fill the niche created when heat, drought, flooding, natural disaster, forced population migration or lapse in control measures occurs. We have made great strides in disease control, but current data documents that for many of them, such as malaria and tuberculosis, progress has stalled. Although we say this each year, we need to forcefully address the warming of our planet, reenergize our efforts at disease control, and develop a humane policy for displaced persons. As the AIDS activist organization Act Up said in the 1980s, "Silence is death"; we cannot be silent on these issues.
 

Philip Rosenthal, MD, FASTMH, Editor-in-Chief, AJTMH
 
For many tropical diseases we see a glass half-full. We have seen dramatic improvements, but advances in malaria appear to have stalled, TB is bedeviled by multidrug resistance, and HIV remains a huge problem; there are exciting opportunities for new treatments, but we do not appear to be much closer to highly effective vaccines for any of these pathogens. The West Africa Ebola outbreak of 2013-16 is gone, but new outbreaks in the Democratic Republic of Congo are very concerning, with control complicated by political instability. We remain near eradication for some tropical infections, yet polio persists in small numbers and eradication of Guinea worm is challenged by zoonotic infections and apparent new foci of human infection. Funding for international disease control and research is flat, and political currents are hard to predict. Moving forward, we must celebrate advances, but keep sight on the great challenges ahead, including the need for increased international investment and continued research to work toward the control and elimination of our great infectious disease killers.

 

Nicole Achee, PhD,
Board Member

 

Advancements toward malaria elimination, vector-borne disease prevention and control, in general, will continue to be challenged by mobile populations, either self-motivated or from forced migration.

 

Koya C. Allen, PhD, MS, MSPH, Board Membe
In the coming year I expect to see increased focus on the nexus between global health and security. It's no secret that infectious diseases are significant transboundary threats for both natural and intentional movement of pathogens that risk impacting populations globally. From the current Ebola outbreak in DRC and the conflicts in Yemen and Syria, to the ongoing need for capacity building and health systems strengthening in the most vulnerable countries for disease emergence, I think the conversation of "What can we do?" will be addressed more frequently and more transparently.

 

Abdoulaye Djimde, PharmD, PhD, Board Member 
 
The African continent is better known for infectious diseases – new ones, old ones, emerging ones, re-emerging ones and everything in between.  However, Africa is also suffering from an "epidemic" of non - communicable diseases (NCD) including hypertension, diabetes, cancer, sickle cell anemia and obesity, just to name a few. These NCDs once considered "diseases of the rich" or "diseases of the West" are on the rise even in rural Africa. Although lifestyle changes in Africa would account for part of this rise, one cannot help but wonder whether the co-occurrence of the many infectious and parasitic diseases are not worsening the situation. In 2019 and beyond we ought to pay more attention to co-morbidities between infectious diseases and NCDs in Africa.

 

David H. Hamer,
MD, FASTMH, Board Member 

 
We may see more outbreaks in 2019 resulting from an unfortunate confluence of political and economic instability, and spread through internally or externally displaced populations. Civil war and unstable political systems lead to destabilization of public health programs, including surveillance of routine and emerging infectious diseases and routine health activities such as immunizations. The long-term instability in the eastern Democratic Republic of the Congo has presented major challenges to the control of the Ebola outbreak there. In 2019, there is a risk of spillover into neighboring countries, especially Uganda. Similarly and elsewhere in Africa, political and economic instability in South Sudan set the stage for potential outbreaks of emerging infectious diseases in this region of the continent. A very different situation has arisen in Venezuela, where near complete breakdown of public health systems has resulted in a massive resurgence of malaria and measles, with trans-border movement of migrants threatening to introduce the latter disease into neighboring countries.

 

Julie Jacobson, MD, Board Member 

 
With 2020 fast approaching, 2019 will be a year of opportunity and challenge. Many disease targets were set for 2020 and now programs will be focused on measuring progress and framing success, as well as setting new targets beyond 2020. Many global health programs will be coming up for refinancing and are not meeting ambitious targets for funding. Investments in tropical medicine will increasingly be put in the context of Universal Health Care. The broad SDG goals will provide a framework for creating priorities that are an opportunity for tropical diseases and global health with interventions inclusive of environment and poverty reduction. We will also find increasing competition for more scarce resources and we will need to partner effectively to move and increase impact beyond 2020. Partnership will bring the chance for creativity and increased reach of programs. Overall, I think 2019 will be an exciting year.

 
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Miriam Laufer, MD, MPH, Board Member 

 
One thing we can predict: Something unpredictable will happen in the world of infectious disease. Infectious disease that we typically consider "tropical" and limited to far-off places will be brought closer to home. This might represent progress in our fight against disease, such as by identifying a major breakthrough in the treatment of Ebola or developing a vaccine against an emerging hemorrhagic fever. Or it may be a reminder to those of us in North America and Europe that our world is connected in every possible way and pathogens do not need passports.

 

Anna Uehara, MSc, PhD (Candidate), Board Member 
 
Further outbreaks are inevitable. What I do hope for is further advancement and incorporation of next-generation sequencing (NGS) and related techniques so that pathogen discovery and detection can be expedited. There is much advancement in the technology front and if we can work to combine with the needs of disease detection and public health – especially in the field – we might be one step closer to better management of outbreaks.

Lark Coffey, PhD,  ACAV Chair 
In 2019, arboviruses will continue to threaten human and animal health. Arbovirus outbreaks causing widespread morbidity and disability have been increasing since the 1970s. Notably, chikungunya, dengue, yellow fever and Zika viruses have all cause global epidemics. Tick-borne viruses including African swine fever and Powassan viruses are also increasing in geographic range and incidence. Arbovirus emergence has led to augmented global public health infrastructure and renewed research efforts. Even so, we still lack specific diagnostics and licensed vaccines for most arboviruses. Recent yellow fever outbreaks that resulted from vaccine shortages highlight challenges to preventing arboviral disease even when an effective vaccine exists. Vector control approaches are key to reducing arbovirus vector populations, especially in combination with other intervention approaches. Fortunately, our global community of arbovirologists, medical entomologists and public health professionals are together working toward new and improved approaches to combat arboviral disease.

 

Julie Pavlin, MD, PhD,  MPH, ACGH President
 
We need to be discussing multiple ways to positively impact health in overcrowded and under-resourced cities in order to decrease disparities and be able to reach our goal of a world free of tropical infectious disease. As I write this, I'm looking out of my hotel window in Kigali, Rwanda. I'm here to meet with local stakeholders regarding an evaluation of a public health program. One of many that take place all over the world, some with great impact and others with little to none, despite best intentions and efforts. And underlying all of these efforts are social and political issues that can undermine a program and set a community back in an instant. These issues are amplified in cities, and with increasing urban migration, we have both the opportunity to reach people and improve their health, and also see a deterioration of access to basic needs such as clean water, food security, and safe and reliable shelter. 

 

Michael Ferdig, MD, PhD, MPH, ACMCIP Chair
 
In 2019, science and evidence-based decision-making will make a comeback against the prevailing skepticism of recent years. And ASTMH is uniquely situated to lead this charge. Why? There is no faking it – we are unique as a Society in feeling compelled to face these challenges through two key components: teamwork and open science. Teamwork links lab data to fieldwork and, when guided by clinically relevant questions, leads to quick translation into innovative control strategies and treatments. Integrating lab, field and clinic can be driven by a strong move toward open science, a step within easy reach for our research community. By working closely with researchers in endemic regions, sharing data and samples in real-time, and distributing the analysis (e.g., via community-based challenges), we can much more quickly reach our common goal: the discovery of facts that can be aimed straight at the heart of tropical diseases.

 

Karen A. Goraleski,
Executive Director

 
January 2019 will see the 116th Congress step into their roles. The research community, individually and collectively, will recognize this unique opportunity to help inform Members of Congress of the multi-faceted impact of research: life-saving, job creator, innovator, and diplomatic envoy. In spite of continued pressure from the White House for flat or even minimal increases at NIH, CDC, USAID and the infectious disease efforts at DoD, Congress – as a result of efforts from the research and advocacy communities – will again recognize the ROI of a strong U.S. investment in the scientific enterprise.