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  • January 2020
  • 5 minutes

Today's Challenges in Infectious Disease

  • Michael T. Osterholm
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Infectious Diseases
In Brief
Infectious diseases continue to be a topic of great concern for medical professionals, researchers, public health officials, and insurers. RGA interviews Michael T. Osterholm, Ph.D., MPH, a global expert in infectious disease epidemiology, regarding current and evolving trends and risks in this area. 

Dr. Osterholm founded and leads the Center for Infectious Disease Research and Policy (CIDRAP), which is part of the University of Minnesota’s Department Office of the Vice President for Research. Under his aegis, CIDRAP, which was founded in 2001, consults with corporations and other organizations and governments, providing information and research and teaching preparedness for outbreaks and related crises. (RGA is an executive member of the CIDRAP Leadership Forum.).

With regard to infectious diseases, what keeps you up at night?

Right now, several things. The near-future risk of a pandemic, especially for influenza, tops the list, but I am also concerned about the worldwide resurgence of polio, measles, and sexually transmitted infections. How vector-borne diseases are spreading in developing countries where urbanization is ramping up faster than infrastructure is also a worry, as well as newer diseases such as acute flaccid myelitis, which public health officials are still trying to figure out. Increased worldwide travel and migration are also making the spread of disease faster and more efficient.

Speaking of influenza, what do you think are the chances for successful development of a universal flu vaccine? How long do you think it might take?

Fortunately, this is one area where a lot of major investment and interesting research is taking place. I am optimistic we will have an influenza vaccine that will be highly protective against many strains of influenza virus and will protect for many years. However, this type of vaccine won't be available for at least another five to seven years.

Australia’s 2019 flu season was described by some as a particularly bad one. Can that provide any information about what the Northern Hemisphere might expect?

First, you simply can’t predict the coming influenza season from the one just past. Even though Australia’s flu season was a severe one, with increased morbidity, there have been seasons in the past where what happened during one season in one hemisphere was not followed by a similar trend in the other.

That being said, it has become clear that most influenza vaccinations, especially in the U.S., are given far too early. Flu is rarely seen in the general population before December, and flu vaccine efficacy generally begins to significantly reduce in four to six months. As U.S. vaccination programs tend to coincide with the beginning of the school year (late August/early September), this mismatch needs attention.

Can you tell us more about acute flaccid myelitis (AFM)?

As far as we know, it is most probably caused by an enterovirus, but scientists don’t yet know how the virus causes the disease or why it has a bi-yearly surge pattern. Research is progressing, but one of the challenges is the relatively small number of cases makes it hard to study. (Editor’s Note: AFM is a rare disease that affects spinal cord gray matter. It mostly affects young children with symptoms that include weakness of the limbs, loss of muscle tone, and decreased or absent reflexes.)

In 2014, the report "Review on Antimicrobial Resistance" stated that by 2050, 10 million deaths a year may be attributable to antimicrobial resistance (AMR). What are your thoughts?

I agree with this assessment – and this is yet another thing that keeps me up at night. By 2050, if things don’t change, we will likely see 10 million deaths annually from infectious diseases that can’t be treated – more than the projected mortality for cancer and diabetes combined. Look at Candida auris: it wasn’t even on the radar two years ago, and now it has many strains with high levels of drug resistance. It’s a real challenge in hospital settings.

What needs to change? AMR needs to be a real priority. Right now, the U.S. spends about $1 billion a year on AMR, but given the current issues, the need is really for more. My hope is that governments will make the effort now to prioritize the need to combat AMR.

Are there best practices insurance companies should follow when managing pandemic risk, especially for influenza?

Awareness of the potential impact and managing expectations are probably the two most important things. Predicting an influenza pandemic’s severity is very difficult, as they generally come in several waves – at least two in the first year – and the second wave can be far worse than the first. Then there is making sure preparations are in place to ensure a company’s business activities can continue: will there be people who can come to work, to turn on the lights, respond to emails and phone calls, and maintain processes?

Is there a Disease X – an unknown future disease – that insurance companies need to be concerned about? If so, how can they prepare?

A disease we’re keeping an eye on is Chronic Wasting Disease (CWD). Much like Mad Cow Disease, it is animal-borne. Currently, it affects only cervids (deer, elk, moose), but the prion that causes it is mutating quickly. Although human transmission has not been documented yet, as with Mad Cow, it could just be a matter of time, as hunters are eating animals that test positive for infection, and there has been resistance among some U.S. hunters to have their killed cervid tested for CWD before consumption. Epidemiologists are watching CWD closely, tracking both human and animal exposure, and are working toward more reliable tests.

What value does CIDRAP add for its consulting clients such as RGA? How does it enhance information-gathering and business outcomes and benefit both society and bottom lines?

Companies need authoritative, up-to-date knowledge of infectious diseases. Scientists and public health experts are making steady progress, but many diseases are still flourishing. For insurance companies, the threat is from more than just well- known conditions such as influenza: morbidity and mortality from measles and polio is again on the rise, new infectious diseases are emerging, and the rapidly developing pace of AMR is a constant worry. Companies need to plan for their own futures, and to align their plans with local and national infrastructures.

What we provide is in-depth, up-to-the-minute knowledge – we have a news team that collects timely, accurate knowledge and disseminates it daily – and the experience and expertise to help companies know what can pop up in a crisis and orchestrate well-coordinated response plans.

What is your fear for the future? What is your hope?

Probably we should say “fears.” What has become clear to me over the years is that public health is really an issue of national security. Pharmaceutical supply chains are one concern, as they can be compromised by natural disasters, wars (trade or military), and epidemics. Another is the growing distrust of science, which in epidemiology is translating into resistance to vaccination. The forces driving this resistance are powerful and well-funded, and in terms of disease are resulting in outbreaks of diseases thought to have been eradicated.

Public health is also not a static issue. It is constantly evolving, and the epidemiology piece is a worldwide challenge. Meeting it will take resources. My hope is that the focus of the medical profession and of governments on these issues will improve, so that the world can meet today’s challenges and the challenges to come.

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Meet the Authors & Experts

Michael T. Osterholm
Michael T. Osterholm
Director Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, Department Office of the Vice President for Research

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