Recession may worsen spread of exotic diseases

Brian Alexander • E-mail

To most Americans, diseases with names like dengue fever, chikungunya, malaria, Chagas and leishmaniasis might sound like something out of a Victorian explorer’s tales of hacking through African jungles. Yet ongoing epidemics of these diseases are killing millions of people around the world. Now, disease experts are increasingly concerned these and other infections may become as familiar in the United States as West Nile or Lyme disease.

Few believe Americans face a killer epidemic from tropical diseases. But scientists who specialize in emerging infectious diseases say such illnesses may become more common here as the economic downturn batters an already weakened public health system, creating environmental conditions conducive to infectious diseases spread by insects or other animals. At the same time, such vector-borne diseases are capable of spreading around the world much more rapidly due to massive south-to-north immigration, rapid transportation, and global trade.

“We truly did become a global village,” said Duane Gubler, Director of the Duke/NUS Graduate School of Medicine Emerging Infectious Disease Program in Singapore. “It has been a sequence of events over a period of 30 years and has come to a head in the last ten years. So we have sounded the alarm.”

Budget cuts over a period of years have left public health at all levels of government underfunded by $20 billion, according to a report published in the U.S. in October by the non-partisan Trust for America’s Health.

Fact file 5 deadly infections Get the facts on five of the world's deadliest diseases, including malaria and dengue fever. msnbc.com

The recession has only piled on the pain, with states and counties being especially hard hit. For example, Washington's King County was forced to cut roughly $19 million out of public health in its 2009 budget.

Funding was surprisingly tiny even before the recession. “When I started at the CDC in the summer of 2001, I was told my branch budget was zero,” said Dr. James Maguire, former chief of the CDC’s parasitic diseases branch and now a Harvard professor. “It was always pretty sparse.” Currently, the budget for the branch is thought to be less than $75,000, not including staff salaries. (The agency was unable to provide a definite amount.) The total for all emerging diseases was $130.3 million for fiscal 2008. By comparison the CDC expects to spend about $103.7 million on anti-tobacco promotions. The 2009 CDC budget for chronic disease prevention, which includes heart disease, diabetes and stroke, is more than $932 million.

A significant amount of the CDC funding for emerging diseases goes to salaries and state and local health departments, explained Dr. Ali Kahn, deputy director of the National Center for Zoonotic, Vector-Borne and Enteric Diseases at the CDC, “There is no doubt we could do a lot more in the U.S. and worldwide with additional funds,” said Kahn.

The recession has weakened the government's ability to develop better treatments, vaccines or prevent an epidemic, experts said.

“States do not have resources to keep people on board and these people are monitoring diseases, the epidemiologists doing shoe leather investigations,” said Jeffrey Levi, executive director of Trust for America’s Health. “You cannot turn them on and off with a switch. If you lose them you’ve lost them forever.”

Once ‘conquered,’ now returning
Diseases such as Chagas and leishmaniasis affect more than 13 million people around the world each year, according to experts. These vulnerabilities in America’s disease defensive shield comes at a time when worldwide changes have boosted the ability of such diseases to spread.  Cities in tropical Asia and Africa, for example, “have gone from 4 million to 15 million people,” Gubler explained. “These are mega cities that have inadequate housing, water and sewer treatment, waste management,” Gubler said. “This creates ideal conditions for transmission of all kinds of infectious diseases.”

Video   Bill Gates bugs out Feb. 5: Hoping to make a point when he appeared at a conference of some of the biggest leaders in the tech industry Thursday, Bill Gates opened up a container full of mosquitoes, saying "There is no reason only poor people should be infected" with malaria. NBC's Brian Williams reports. Nightly News

Climate change is a wild card. Experts aren’t exactly sure what a warming climate will do. Last year, a Virginia Tech study predicted that a 1 degree Celsius temperature rise predicted by the Intergovernmental Panel on Climate Change would bring the bugs that carry Chagas disease into the central U.S. Will insect carriers thrive in the new region?

American health officials thought they had conquered most such diseases after World War II through a combination of mosquito-killing campaigns and public health measures like draining swamps, improved housing, better sewage and waste control. As a result, medical professionals turned their attention to conditions like cancer and diabetes.

“That’s what I call the period of complacency,” Gubler said. “It set in during the 1970s after the war on infectious disease had been declared won.”

But it wasn’t won.

In a June 2008 article in the journal PLOS Neglected Tropical Diseases, Dr. Peter Hotez, chairman of the department of microbiology, immunology and tropical medicine at George Washington University in Washington, D.C. wrote that Americans living in poverty, immigrants and those living in medically underserved regions suffer from a host of such diseases, including Chagas, dengue and leishmaniasis. 

Increasingly, these diseases pose a risk to the rest of the country. For example, in 2007, in the middle of a drought that should have prevented large-scale mosquito breeding, Kern County, Calif. became the national epicenter of West Nile disease, which emerged in Africa and is spread by mosquitoes.

At least 140 confirmed cases, and four deaths, were recorded. At first, public health officials were mystified. They soon realized that because the county was an early victim in the national housing collapse, foreclosed and abandoned homes sat with partially filled swimming pools and spas serving as mosquito love motels.

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