2020 Tropical Infectious Disease Forecast

Posted 7 December 2019

What's on the Horizon for Tropical Infectious Disease?

ASTMH Leaders Offer Their Insight

We asked our ASTMH leadership, "What do you think 2020 will bring in terms of tropical infectious disease?" Here's what they said:

 

Joel Breman, MD, DTPH, FASTMH,  President
  My optimism for 2020 is based on recent major scientific advances and policy/funding commitments, such as:
  1. Newly tested and effective vaccines for prevention of, and monoclonal antibodies for treatment of Ebola virus disease.
  2. Increase in U.S. funding for basic research and product development to understand and combat malaria—including private sector commitment.
  3. Global awareness and engagement for: Using mass drug administration to defeat malaria and NTDs; increasing awareness of climate change and planetary health as scientific disciplines; and engaging our Society’s young members of every age.
My concerns are:
  1. Relentless spreading of antimicrobial resistance.
  2. Increasing internally displaced populations, refugee movements and security problems, providing a conducive environment for “tropical infectious” and “chronic” diseases—conditions that we need to address as the world changes.
  3. Clusters of anti-science personalities—those influential few who oppose vaccination and the reality of climate change and its effect on human health.
We need more popular spokespersons for research and health programs as public goods. Look at the eradication of smallpox!

Julie Jacobson, MD, President-Elect  
  2020 will be an interesting year. There will be recalibrations from the 2020 disease targets without the data yet to know how close we got. It will be a year of looking to the SDGs and new disease targets for 2030. There will be a theme of integration within the health system with the WHO push for Universal Health Care (UHC) that will put pressure on disease specific investments.  All of this will be in the context of shifting political situations that could fan and inflame disease transmission and limit the attention to the diseases of those living with limited resources regardless of country of origin. Climate change and outbreaks will change disease susceptibility and access. As we step into 2020, we must be prepared to embrace change and adapt to continue to provide value to science and those we serve.  

 


Chandy C. John, MD, MS, FASTMH, Past President
 
  What I fear 2020 will bring: More measles, flu and other vaccine-preventable disease outbreaks; increasingly clear adverse effects from climate change, due to our lack of work to combat this problem; infectious disease outbreaks in areas of war or natural disaster. 

What I hope 2020 will bring: Increased understanding that vaccines save lives and health, and active efforts to not only combat misinformation about vaccines but communicate their incredible benefit more effectively; militant action by people young and old to force governments to pass laws and acts that combat climate change; and successful peacekeeping efforts that reduce the number of people in war torn areas.
 

Dan Bausch, MD, MPH&TM, FASTMH, Scientific Program  Chair 
 
  Unfortunately, 2020 will be a year of battle—of truth versus untruth in science, health and politics (all inextricably linked); to control outbreaks that continue to emerge on the backs of complex humanitarian emergencies or as a result of denial of the efficacy of vaccines; and to keep our planet from spiraling out of control from global warming. Fortunately, while many resource-rich countries are wavering in these battles, we are seeing emergence of many bright and competent leaders who are building biomedical infrastructure and human resources to combat disease in many low- and middle-income countries. We will continue to see great scientific innovation, with new diagnostic tools, therapeutics and vaccines for some of the world’s most dangerous tropical diseases (think Ebola). However, we can’t be so na├»ve to think that the solutions to a healthy planet are all found in biomedical innovation. Researchers, clinicians and other tropical medicine experts must engage in the greater public battle to get the right tools to the populations in need—the messy but essential battle to ensure health as a human right. The stakes are high, but we can win!

David R. Hill, MD, DTM&H, FASTMH,  Secretary-Treasurer 
 
 
Last year I considered that changing climate, population displacement and continued emergence of disease pathogens would be the greatest risks to global health. Unfortunately, until we seriously tackle man-made pollution, establish equitable policies that protect human life, and provide financial, programmatic and security support for the public health force, these issues will continue to dominate global health. We need to double our efforts on behalf of our global community.
 

Philip Rosenthal, MD, FASTMH, Editor-in-Chief, AJTMH
 
  It will continue to be the best of times and the worst of times for tropical medicine. We race toward the elimination of many tropical infections, from polio to Guinea worm to yaws to various filarial infections. Numbers for many other infectious diseases are improving. All sorts of health metrics show phenomenal gains; more children are surviving to lead long lives. It is the best of times! But, we haven’t actually eliminated a tropical infectious disease since smallpox, and finishing the job for those near the finish line has proven to be very challenging. And, despite gains, HIV infection, TB and malaria remain enormous problems, many children still die unnecessarily of respiratory and diarrheal diseases, measles is increasing, viral epidemics are the norm, and future progress seems in jeopardy due to global instability, a lack of interest in scaling up funding from donors, and, perhaps the biggest elephant in the room, global climate change. It is the worst of times! But, overall, health has objectively improved for most residents of the tropics over the last few decades. Despite enormous obstacles, we can hope that this trajectory of steady improvement continues.
 

Abdoulaye Djimde, PharmD, PhD, Board Member 
 
  In 2020, I expect increased challenges with emerging and re-emerging infectious diseases in the tropics. Already there are growing concerns in some parts of West Africa about yellow fever, Lassa, dengue and other previously unheard-of or controlled viruses in this part of Africa. Although part of these new findings may be due to increased diagnostic capacity in local laboratories, this scary news will have to be addressed by the already fragile health systems. This calls for increased transnational and international cooperation and scientific collaboration in order to avert these novel or newly discovered local health threats that could have global reach

Hanna Ehrlich, PhD (Candidate), Board Member
  Sadly, more measles and more malaria. We’ve made amazing progress in reducing infectious diseases, and we have so many of the tools we need to fight them, but we aren’t seeing the gains we expect anymore. To get there, we as a scientific community need to advocate harder for structural changes in research and global inequality while focusing our scientific efforts on local problems with insight from local stakeholders. We're just beginning to learn how malaria persists in the dry season in the Sahel, or why certain communities in middle- and high-income countries are resisting vaccines. Climate change and rising nationalism exacerbate these issues and create many more existential threats for tropical disease control, data sharing and our planet’s health. Luckily, ASTMH will be there to tackle many of these themes in 2020!

 
Desiree-Lebeaud-headshot.png
A. Desiree LaBeaud, MD, MS, Board Member
 

 
  As we welcome 2020, a year that has a sci-fi ring to it and seemed so far away when I was little, I sense oncoming decades of opportunity and commitment to improve our world and planetary health. Momentum is building to make substantial changes to save our planet from the impacts of climate change, a consistent driver for many tropical diseases. In order for us to look toward the future, we must face our prior mistakes and be bold enough to face the possibility of making new ones as we work together to heal and sustain our planet for our descendants and their grandchildren. We now have the scientific capability to predict the harm done by climate change and the applied humanity to prevent those impacts. As we strive to understand the best ways to prevent ongoing ecological losses and increasing disease burdens, partnerships will be essential to accomplish this difficult planetary health work – and that is where ASTMH comes in! Not only do we have the scientific prowess to address these complex global issues, we also engender the deeply committed, compassionate and thriving networks necessary to get the job done! In 2020, we can commit ourselves to act boldly and intentionally to thwart the harms brought about by climate change and provide better health for vulnerable populations in the world as well as the entirety of our planet’s interconnected web of life. Each one of us can make changes to improve the lives of others and I feel that 2020 has just the right sci-fi credibility to propel many of us to make deliberate choices for a better future.

 

Jetsumon Sattabongkot Prachumsri, PhD, Board Member
  Vector-borne diseases will remain in the top rank of infectious disease in 2020. Although malaria has declined in many regions, febrile illness caused by other vector-borne disease has increased in many areas. More cases of dengue, chikungunya and rickettsial diseases were found in 2019 in Thailand and bordering countries. Reliable diagnosis, including the point of care that can be used at limited infrastructure public health clinics, will be essential for proper treatment and disease surveillance.   There is an urgent need for vector biologists and social scientists in the endemic countries to increase our understanding and chance for better control/eliminating the diseases. Accurate information on what/where vectors are, host-seeking behavior and population risk factors  for disease transmission are required to improve the design of new products to control the vector and stop transmission. Proper community engagement will raise awareness of the diseases and increase self-protection and collaboration on the diseases’ elimination.

 

Jonathan K. Stiles, PhD, Board Member
 
  For 2020, barring any catastrophic disease outbreak, I am looking forward to seeing developments of new drug targets, vaccine candidates as well as preventive strategies against some of the deadliest infectious diseases including Ebola, Zika, drug-resistant TB and malaria.  We will see increasing involvement of low- and middle-income (LMIC) nations, especially in Africa, in the fight against these diseases through sustainable biomedical workforce capacity strengthening and implementation of viable disease control/elimination strategies. I hope to see research products generated through such past and present capacity building efforts taken off library shelves and out of databases and applied translationally in the field. However, I am also aware that these positive changes will be negatively impacted in some cases by national and international conflict, climate change and dwindling basic/translational research support to academic/research institutions and NGOs. An African proverb, “He who knows no other wisdom praises his own,” illustrates how little is accomplished in the absence of “true collaboration.” In the coming years, the time, effort and cost associated with attaining a goal of global health equity could be reduced significantly by harnessing the collective wisdom (diversity) of all through productive collaborations based on mutual trust.

 

Katherine Taylor, PhD, Board Member

 
  Over the last 15 years, great progress was made in reducing the most deadly and debilitating infectious diseases, primarily through the development and successful integration of technologies (e.g., drugs, vaccines and improved diagnostics). ASTMH members have made enormous contributions to these advances. Achieving the Sustainable Development Goals, in particular, Universal Health Care, will, however, require a whole systems approach rather than the disease-by-disease tactics of the past. The health equity gap, driven by poverty, now more than ever is amplified by environmental factors (pushed by both climate change and environmental degradation), war and mass migrations. In the face of this ever increasing complexity, systems change and global cooperation will be needed to improve and sustain the lives of the world’s most poor and vulnerable. While ASTMH members will continue to play a role in the development, assessment and implementation of lifesaving new technologies, they will become increasingly involved as thought leaders in the whole system's changes that are needed to move toward health equity and justice.

 

Karen A. Goraleski,
CEO

 
  The year 2020 is a United States Presidential election year. This will bring distractions to Congress and the public that will obscure the message of the benefits that research brings to Americans and to those around the world. As the March for Science continues around the world, the research community will actively help inform their decision-makers and everyday citizens of the multi-faceted impacts of research: life-saving, job creating, innovating and diplomatic. In spite of continued pressure from the White House for selective funding increases across NIH, CDC, USAID and the infectious disease efforts at DoD, Congress – buttressed by outreach from the research and advocacy communities – will again recognize the ROI of a strong U.S. investment in the scientific enterprise.
    
     
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