The last 30 years have seen newly emerging and re-emerging infectious diseases, starting with the international spread of HIV/AIDS, the emergence of Ebola and other hemorrhagic fevers, SARS, MERS, novel influenza viruses, Zika, and, most recently, the global spread of COVID-19. As the leading cause of death worldwide, is well known that infectious diseases are a major public health issue. The reality is that infectious diseases not only impact public health, but also have significant, but less understood, consequences for national security, commerce, infrastructure, education, and other essential elements of society. To better understand these consequences, in 2018 SGNL was commissioned by the Council of State and Territorial Epidemiologists, through funding provided by CDC, to conduct a thorough analysis of impacts of past instances when diseases spread to, and throughout, regions of the United States.
In looking at the past, we assessed the decisions that were made in response to imported infectious diseases, measured the success of specific strategies in terms of their respective outcomes, and documented our findings to help officials anticipate the range of non public health consequences in the event of an infectious disease arriving in the United States.
SGNL began by conducting a review of literature pertaining to imported infectious diseases and the impacts of these threats. The review ended in the selection of seven specific occurrences across seven different jurisdictions in the United States. Those selected were:
caused by introduction of a pathogen from outside the United States (i.e., imported),
associated with a declared public health emergency of international concern from the World Health Organization
associated with CDC Bio-Terrorism Agents, and/or
associated with pathogens that are well controlled or eradicated in the United States.
The next step was to select key informants from the affected jurisdictions and to interview them on how the respective pathogen or threat affected communities, to include financial burdens, job loss, business struggles, resource disruptions, and mental health issues.
From these interviews the number of cases studies were further narrowed to five final pathogens and jurisdictions. These included: Dengue in Yuma County, Arizona in 2014, Ebola in Texas in 2014, Measles in Orange County, California (Disneyland) in 2014-15, Zika in Florida in 2016, and Multi-Drug Resistant Imported Gonorrhea in Hawaii in 2016.
After conducting interviews with case study stakeholders, we compiled and analyzed the data, and produced five case study reports and a scientific summary report with our findings and recommendations for improved response to future global health security threats to protect U.S. communities. The case study reports and scientific summary report was provided to CSTE and CDC and is not available publicly.
We answered three main questions in relation to global health security threats in America. The first of which asks, what is the impact on public health systems and the communities they serve? The bottom line is that outbreaks can burden and put an overall higher stress on the public health agencies. Personnel and resources are already spread very thin and response to urgent situations is difficult.
The second question was, what are the barriers and enabling factors encountered that could be modified to prevent or mitigate future outbreaks? Educating the population on the risks associated with the possibility of imported infectious disease can be effective in the slowing of spread. With cutting of funds for preparedness plans, however, it is increasingly difficult to be ready for an occurrence, along with distrust among the community for the government.
The final question was, what are the roles of all levels of government in global health security? Communication and collaboration are common among the different levels of government but processes are often slowed down by bureaucracy, regulations, and policies. During a severe infectious disease outbreak, response time can be shortened if the all levels of government can agree to share information in a more informal and flexible manner.