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Stephanie James, Ph.D.
Chief, Parasitology and International Programs Branch
Division of Microbiology and Infectious Diseases, NIAID
Dr. James began the discussion by restating the problem: new infectious diseases continue to appear ("emerge") as a result of genetic changes, environmental pressures, and other influences, while known infectious diseases increase in incidence or change in distribution ("re-emerge") when current control measures fail. This was illustrated by a timeline showing a number of pathogens and diseases that have appeared in the last two decades. Dr. James described the sequence of events between identification of a new infectious disease problem and its control, emphasizing the importance of both surveillance and research. She reminded the group that in a Presidential Decision Directive released in June, 1996, NIH was designated to lead Federal government efforts to strengthen research on the development of new tools to detect and control emerging infectious diseases and on the biology and pathology of infectious agents.
Dr. James described the research agenda developed by NIAID in response to this directive, which focuses on three major goals. The first goal is improved prediction and prevention of future threats, which is being addressed by support of fundamental research on the influences underlying disease emergence, as well as support of applied research on improved technology for diagnosis and prediction of outbreaks. The second major goal, development and validation of new or improved control strategies, is being addressed by applied research on drug and vaccine discovery and design, as well as evaluation through preclinical and clinical testing. The third focus of the NIAID research agenda is strengthening the national and international capacity to detect and respond to infectious disease threats, which the Institute is addressing through support of multidisciplinary research projects, focused training programs, and international research.
The implementation of these activities has taken the form of both disease-specific and approach-specific initiatives. Recent examples of the former include NIAID initiatives to expand research on Lyme and other tick-borne diseases, tuberculosis, as well as Hanta and other emerging viral infections. Recent approach-specific initiatives include drug discovery and development programs for HIV and opportunistic infections of AIDS, medically important mycoses, and emerging viral diseases. In addition, NIAID is supporting expanded research on the environmental and microbial factors influencing disease emergency, and on improved detection and prediction of emerging diseases. NIAID is also exploring the use of broader, more flexible, funding mechanisms to meet the challenge of rapid response to new infectious disease problems, and is working closely with other groups, including the CDC, to coordinate activities. The overall intent of the NIAID research agenda is to provide an integrated, proactive, research program that will contribute to national and international preparedness to meet new infectious disease challenges.
Daniel Colley, Ph.D., Director, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention
Dr. Colley presented an overview to Council of some key aspects of what the Centers for Disease Control and Prevention (CDC) does, and a summary of CDC’s plan for dealing with emerging and re-emerging infectious diseases, Addressing Emerging Infectious Disease Threats. He then described the current status of the implementation of this plan, which is formulated around four main goals: Surveillance and Response; Applied Research; Prevention and Control; and, Infrastructure.
To achieve enhanced surveillance and response capabilities (CDC) has begun to strengthen both U.S. and global epidemiologic and laboratory capacity. In the U.S. there are three major new competitively awarded extramural programs: 1) Emerging Infections Programs; 2) Epidemiology and Laboratory Capacity Program; and 3) several Sentinel Networks to detect emerging infections. Several intramural surveillance projects are ongoing, following internal competitions. Globally, CDC has, with NIAID, been a major participant in the CISET deliberations and report, and its implementation. CDC has several staff detailed to the World Health Organization (WHO), specifically in regard to infectious diseases, and now supports 14 WHO Collaborating Centers at CDC, and funds over 15 intramurally-competed global emerging infections studies.
In the area of applied research, CDC has reinitiated its extramural research program by beginning in two areas: prevention and research in regard to anti-microbial resistance and tick-borne diseases. There are also competitive programs in prevention effectiveness, and in blood safety. Emerging infections-related prevention and control programs that have been implemented include: the new journal "Emerging Infectious Diseases"; funding of various conferences; support for health communications in CDC; support to the Institute of Medicine for an Emerging Infectious Disease Forum; and coordination of the multi-partner Working Group on Waterborne Cryptosporidiosis.
In response to the need to rebuilt and expand the infrastructure base needed to address the threat of emerging infections, the CDC has provided the National Center for Infectious Diseases (NCID) with 75 new fulltime employees, 45 of which are supported by emerging infections funds. NCID has established a new Public Health Laboratory Training Fellowship;, through a cooperative agreement with the Association of State and Territorial Public Health Laboratory directors, and now supports intramural laboratories and training infrastructural needs through a series of intramural competitions on emerging infections-related projects.
Dr. Colley then announced a proposed joint venture between NIAID and NCID to augment the epidemiologic base of research on global emerging infections. This initiative is intended to provide epidemiologic expertise and training to NIAID’s ICIDR and TMRC research sites, and is being promulgated in direct response to suggestions in the Research and Training portion of the CISET Report.
This program should capitalize on the existing strengths and investments of NIAID and NCID, and thus provide added value to current programs with the focus on enhancing our global capacity to detect and deter emerging infectious disease threats.
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