Peter Sands, M.P.A., Carmen Mundaca-Shah, M.D., Dr.P.H., and Victor J. Dzau, M.D.
January 13, 2016DOI: 10.1056/NEJMsr1600236
Pandemics and epidemics have ravaged human societies throughout history. The plague, cholera, and smallpox killed tens of millions of people and destroyed civilizations. In the past 100 years, the “Spanish Flu” of 1918–1919 and HIV–AIDS caused the deaths of nearly 100 million people.
Advances in medicine have transformed our defenses against the threat of infectious disease. Better hygiene, antibiotics, diagnostics, and vaccines have given us far more effective tools for preventing and responding to outbreaks. Yet the severe acute respiratory syndrome (SARS), the Middle East respiratory syndrome (MERS), and the recent West African Ebola outbreak show that we cannot be complacent (Figure 1Figure 1
Major Emerging and Reemerging Infectious-Disease Outbreaks, Epidemics, and Pandemics, 2002 through 2015.).
Infectious-disease outbreaks that turn into epidemics and potential pandemics can cause massive loss of life and huge economic disruption.
Indeed, Ebola demonstrated how ill-prepared we are for such infectious-disease crises. There were failures at almost every level. Identifying the outbreak in the community and raising alerts took too long. Local health systems were quickly overwhelmed. Response teams did not adequately engage communities and deepened distrust in health authorities. The international response was slow, cumbersome, and poorly coordinated. Rapid diagnostics, protective equipment, effective therapeutics, and a vaccine were lacking. Ultimately, the crisis was contained, thanks to the courage and commitment of medical staff and communities on the ground and a massive deployment of international resources. Yet the cost in human lives and economic and social disruption was far greater than it should have been.