TEDMED Great Challenges: Public Health’s Work on Infectious Diseases

Oct 9, 2014, 4:11 PM

Infectious diseases—and the treatment of infectious diseases—has been a common theme in the news recently, with almost 4,000 people now dead from an Ebola outbreak in West Africa. It was only yesterday that Thomas Eric Duncan, the first person to be diagnosed with Ebola in the United States, died in a Dallas, Texas, hospital.

Earlier this week, some of the leading experts in infectious disease came together in the Google Hangout “TEDMED Great Challenges: Track, Treat, Prevent—A Better Battle Against Communicable Diseases.” They discussed the risk of communication, treatment, drug resistance, disease tracking innovation and related ethical issues. The event was moderated by Helen Branswell of the Canadian Press.

The panelists—across the board—agreed that the recent Ebola resurgence has served to highlight the importance of public health. Not just what it brings to the table during such emergencies, but the need for it to focus even more on prevention efforts and ensuring public health is fully funded and supported.

“Public health funding is one of those things people only really notice when something goes wrong,” said Dara Lieberman, a Senior Government Relations Manager at Trust for America's Health.

Amy L. Fairchild, PhD, MPH, Professor of Sociomedical Sciences at the Columbia University Mailman School of Public Health, believes that “in many ways, we’ve really lost our way in public health.”

“There was a period at the end of the 19th/beginning of the 20th century in which the field made these enormous strides in combatting infectious diseases and combatting communicable disease,” Fairchild said. “And then, with the rise of chronic diseases, we began to forget some of those...lessons learned about the need to focus on broad, sweeping environmental changes.”

Public health became focused on individual risk behaviors, she said, such as diet, exercise and smoking. The result was many in the field took their eyes off of the fundamental causes of disease.

“It’s not that those things aren’t important,” Fairchild said. “But the things that we’re going to be able to do as individuals are going to be far less consequential than what we can do from a more systematic perspective in public health.”

Ramanan Laxminarayan, a Research Scholar at the Princeton Environmental Institute at Princeton University, said the outbreak of something as serious as Ebola also serves to stress the importance of continuing to implement proven public health strategies, such as vaccinations for preventable disease. 

“Even if disease burden is low, we need to keep the pressure on because it is that pressure that actually keeps infectious disease low,” said Laxminarayan. “If we stop vaccinating the world against measles today, for instance, it is very easy for measles to come back in a relatively susceptible population which is lacking immunity—and an explosive disease like that could kill millions.”

However, when it comes to diseases such as measles—which is one of many infectious diseases that have been declared eliminated in the United States—it can be difficult to communicate the need to continue receiving vaccinations.

“Prevention is going to be challenging because the consequences of prevention are not always obvious or apparent to folks who’ve never even seen that disease in their lifetimes,” said Laxminarayan.

Also, a considerable part of the role of public health professionals when responding to an infectious disease outbreak is managing the public’s reaction and understanding. Lieberman said that includes balancing the needs of those affected with the need to contain a situation.

“I think public health in general takes privacy and individual rights very seriously. At the same time, you just need to balance that with the practical need to protect the public from an infectious disease and from a highly dangerous disease,” said Lieberman. “So you can imagine if public health never knew who the individual was in Dallas, Texas. If that was just a privately treated person and public health didn’t get involved, then they wouldn’t have been able to investigate where he has been and who he’d had contact with. And it could have become a much wider spread outbreak (sic), so there is a need to weigh those two issues.”

When it comes to panic during an outbreak, Fairchild believes that it’s important to understand that panic can also bring about positive reactions.

“Panic is the language of action. When you hear panic in the air, you hear people talking about the need to take action,” said Fairchild. “And so it’s either a prompt to do something more—to beef up the infrastructure in West Africa, to beef up the response in the United States—or it’s a critique. It’s a critique we aren’t doing enough.”

One tactic that has been proven to be a boon for public health efforts has been the online tracking of people’s interest in, and concern over, different health issues. According to Christian Stefansen, a researcher at Google, today when a person is feeling “under the weather” their first action taken is often to log online, where they search for information about their symptoms. In 2008, Google launched Google Flu Trends, which continually looks at what people are searching for online and builds health model than can help public health experts get out in front of an issue.

This commentary originally appeared on the RWJF New Public Health blog.