After Malaria Is Controlled, What's Next?†

Walker, David H.

Just before I graduated from medical school, the war on infectious diseases was declared to be over and indeed, won. In 1992, more than two decades later, a period during which scores of newly discovered disease agents were identified, the concept of emerging infections was promulgated by a very prominent publication from the Institute of Medicine. 11 society's members have played important roles in the discovery of many novel, previously unknown pathogens, such as the agents of several viral hemorrhagic fevers. 12, 13 However, this success has not been a strategic initiative, but rather, it has been more like firemen responding to the call of a house fire. I am certain that emerging infectious diseases will always continue to appear. We should be more proactive programmatically in pursuing research programs for competitive peerreviewed funding for investigation of unusual undiagnosed syndromes and earlier discovery of the infectious agents. Indeed, we could probe more deeply into nature itself. Who would have predicted that bats would be a reservoir of agents such as the filoviruses Ebola and Marburg, the coronaviruses of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), and a new genus containing Nipah and Hendra viruses? [14] [15] [16] Human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) was once an unrecognized tropical syndrome with a small geographic footprint in Africa and a low incidence. It spread around the world before we identified its etiologic agent, even more years passed until successful treatment was developed, and we are still pursuing an effective vaccine. One can only dream of the potential effect of earlier identification of HIV, recognition of the nature of the threat, and possibly, even the early control of HIV-AIDS before it became a pandemic. Are we missing the opportunity now to counter future infectious plagues before they spread?