In 1961, President Kennedy said, “We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.
When President Obama announced cancer moonshot at the beginning of this year, I applauded from my couch and felt proud of the one billion dollar initiative to eliminate cancer. I must also admit wondering at the same time how long it would be before it’s the turn of Infectious Diseases. Infection, unlike cancer, does not respect geographic boundaries. Infection, unlike cancer, preferentially hurts those belonging to poor socioeconomic status. So, an ID moonshot would have to be an international initiative, similar to the climate change initiative but on a much bigger scale, and it will cost much more than a billion dollars. Because of how much it would cost, the poorer countries would need help, to put it mildly.
The best way to frame the Infectious Diseases crisis is probably how the Commission on a Global Health Risk Framework for the Future framed it, as a ‘Neglected Dimension of Global Security’. This commission was initiated in the spring of 2015 to address epidemic infectious diseases and they presented their report recently. They made four categories of recommendations – investing in pandemic preparedness by several international bodies including G7, G20, UN, WHO, World Bank, IMF, and the World Health Assembly, strengthening public health in member countries, strengthening global and regional system for outbreak preparedness and response, and accelerating research and development. Implementing these recommendations would cost $4.5 billion per year. Cost of potential pandemics is estimated to be $60 billion per year. The commission says about the needed investments: “We accept that there are huge uncertainties about the scale of the threat from infectious diseases, but the risks of investing too much or too little are asymmetric. If we overinvest, we will spend more on shoring up our defenses against infectious-disease outbreaks than strictly necessary. Yet it is hard to see that as wasted money, since these investments will help us achieve other critical health objectives. For example, strengthening national public health and primary care systems will help us tackle endemic diseases such as tuberculosis and malaria more effectively and detect the emergence of antimicrobial-resistant pathogens more swiftly. On the other hand, if we underinvest, we open the door to potential catastrophe.”
Right, we have always needed the epidemic and emerging infectious diseases to advance the cause of endemic infectious diseases which are mostly diseases of poverty, lack of sanitation and lack of proper public health. Research and development of vaccines and drugs is not as lucrative for acute infections as it is for chronic infections like HIV, Hepatitis B and C, even if they are associated with high morbidity and mortality. Even if effective drugs are available, lack of access to care is a huge issue. Globally, only half the individuals with HIV have access to care. A country like India spends a mere 1% of its GDP on healthcare. I cheered Bill Gates on when he called out the Indian Prime Minister Narendra Modi for this. The United States spends 17% in contrast. Antimicrobial resistance or drug-resistant infections (DRI) will cost the world GDP close to a hundred trillion dollars in the next thirty-five years! Per the report on antimicrobial resistance, these infections will also cause ten million deaths per year in the world by 2050, exceeding cancer, diabetes and other major causes of death.
Closer to home in the US, each year antibiotic resistance sickens two million Americans and claims the lives of at least 23,000. These infections annually result in an additional 8 million hospital days and costs in excess of $20 billion to the U.S. healthcare system. HIV continues to be a major public health burden. Of the 1.2 million individuals living with HIV in the United States, only an estimated 40% are in HIV care and just 30% achieve clinical goals of treatment.
We need an Infectious Diseases moonshot!
Report of the Commission on a Global Health Risk Framework for the Future http://nam.edu/wp-content/uploads/2016/01/Neglected-Dimension-of-Global-Security.pdf
Cancer Moonshot Announcement from the White House https://www.whitehouse.gov/the-press-office/2016/02/01/fact-sheet-investing-national-cancer-moonshot
P.S. The picture shows an exhibit by B Braun at the 17th International Congress on Infectious Diseases meeting held March 3-5, 2016 in Hyderabad, India.