enced by three sets of variables: (1) the relationship between increasing antimicrobial resistance and the success of research to develop new antibiotics and vaccines; (2) the trajectory of developing and transitional economies, especially concerning the basic quality of life of the poorest groups among the population; and (3) the degree of success of global and national efforts to create public health infrastructure with effective systems of surveillance and response. The interplay among these variables will determine the overall outlook regarding the impact of infectious diseases.

In this context, it is clear that the response to emerging infectious diseases at a global level requires an investment in the capacity of developing countries to address these diseases as they arise. Such investments should take the form of financial and technical assistance, operational research, enhanced surveillance, and efforts to share both knowledge and best public health practices across national boundaries. For example, the World Health Organization (WHO) has developed a program for ensuring global health security by strengthening country capacity in microbiology and epidemiology to improve national preparedness (see Box 4-1). Financial and technical assistance to international agencies, governments, and nongovernmental organizations has already proven to be an effective means of addressing global disease threats. The Centers for Disease Control and Prevention (CDC) continues to support reference laboratories and provide technical assistance for disease outbreaks. Likewise, the National Institutes of Health (NIH) has expanded the number of international research and treatment centers. Financial and technical support has also come from private foundations and other U.S. agencies and organizations, and has been particularly effective in supporting efforts to combat HIV, tuberculosis, malaria, and polio.

The United States should seek to enhance the global capacity for response to infectious disease threats, focusing in particular on threats in the developing world. Efforts to improve the global capacity to address microbial threats should be coordinated with key international agencies such as the World Health Organization (WHO) and based in the appropriate U.S. federal agencies (e.g., the Centers for Disease Control and Prevention [CDC], the Department of Defense [DOD], the National Institutes of Health [NIH], the Agency for International Development [USAID], the Department of Agriculture [USDA]), with active communication and coordination among these agencies and in collaboration with private organizations and foundations. Investments should take the form of financial and technical assistance, operational research, enhanced surveillance, and efforts to share both knowledge and best public health practices across national boundaries.



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