cholera and plague. Additional ecological factors (e.g., deforestation or other forms of land use change) are associated with many emerging vector-borne and zoonotic diseases, such as dengue, malaria, yellow fever, Lassa fever, Lyme disease, and West Nile encephalitis, but remain poorly understood. New grounds for mosquito breeding have developed in waste dumps, threatening vector control efforts that have traditionally focused on vector breeding in swamps and marshes. As previously noted, agricultural practices have been closely linked to the spread of antibiotic resistance, influenza outbreaks, and diseases of food crops and animals. Migration, travel, and commerce have been associated with several microbial threats to health.

Human development and large-scale social phenomena are closely connected to infectious disease threats at a global level. National security and an enlightened self-interest require that countries recognize the direct impact of social, economic, political, and ecological factors, especially in developing countries. In additional to technical and financial support, a research program focused on the global social and ecological factors affecting infectious disease emergence should be established. Only recently have studies been conducted within the traditional biomedical, social epidemiology, and medical anthropology research arenas to begin to address these factors and the interventions necessary to combat them.

Inferences about the etiology of disease are typically drawn through statistical association of natural observations or experiments. Recognizing, however, that the emergence of infectious disease is usually not attributable to any single factor, but the result of complex interactions among numerous and often unknown physical, biological, ecological, and socioeconomic variables, it is clear that multidisciplinary studies, including dynamic analyses of such interactions, are needed.

NIH should develop a comprehensive research agenda for infectious disease prevention and control in collaboration with other federal research institutions and laboratories (e.g., CDC, DOD, the U.S. Department of Energy, the National Science Foundation), academia, and industry. This agenda should be designed to investigate the role of genetic, biological, social, economic, political, ecological, and physical environmental factors in the emergence of infectious diseases in the United States and worldwide. This agenda should also include the development and assessment of public health measures to address microbial threats. A sustained commitment to a robust research agenda must be a high priority if the United States is to dramatically reduce the threat of naturally occurring infectious diseases and intentional uses of biological agents. The research agenda should be flexible to permit rapid assessment of new and emerging threats, and should be rigorously reevaluated



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