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We are a country lurching from crisis to crisis’
While it has been duly noted that many hospitals lack the surge capacity and training to deal with an Ebola patient, the public health system is also ill prepared for emerging infectious disease outbreaks and pandemics, an expert in the field warns.
"The next few cases of Ebola or another infectious threat will show that we underfund public health at great peril to our country," says Walter Tsou, MD, MPH, a professor of health policy at the Center for Public Health Initiatives at the University of Pennsylvania in Philadelphia. "We are a country lurching from crisis to crisis without making the planned and dedicated investment in scientific research and public health preparedness."
Indeed there is every expectation among epidemiologists and researchers that emerging infections and potential pandemic pathogens will continue to arise, as the speed of global travel and continued encroachment of humans on animal habitats yield novel zoonotic agents like SARS and MERS coronavirus.
"People forget that there are very few things that could close down a city the size of Toronto or for that matter a superpower like China, but in fact in 2003, SARS did precisely that," Tsou says. "SARS closed down air travel to much of Asia and devastated its economy."
China was able to end the crisis by changing its hospital emergency department policies, allowing anyone with respiratory symptoms — regardless of ability to pay — to come in for medical evaluation and treatment, Tsou tells Hospital Infection Control & Prevention.
"After SARS, China’s CDC’ found their budget was doubled and they built an entire new campus and moved from their cramped space in downtown Beijing," he says. "In Taiwan, their CDC’ budget was tripled. Asia learned not to mess with public health."
The Ebola threat in the U.S has been stopped at least temporarily by the labor intensive efforts of public health staff and clinicians, but how much easier might the response have been if there was a safe available vaccine for Ebola? One would almost certainly be available by now if researchers and governments had acted when Ebola first appeared in the Congo in 1976 near the eponymous river that bears its name.
"There was no way for pharmaceutical companies to profit and our NIH budget has been cut, it has not been a priority for researchers — as if the lives of Africans did not matter," Tsou says. "Now we are trying to paddle up a stream desperately looking for a treatment or vaccine without the type of basic research and safety trials that should have been in place decades ago."
Other largely unknown diseases like Marburg, Chikungunya, Dengue and other unwelcome viruses could become part of the American lexicon soon without a dedicated effort to confront them now and put in place the research needed to address their prevention, Tsou warned.
"All of this requires money and planning — something in short supply for a largely ideologically driven, crisis directed government," he says.