The Age of Plagues

It wasn't that long ago that medicine declared a victory over infectious disease. Now a raft of new and mutating bugs are at the door, and a declining public health system is in no shape to fight them.

To wit: In Milwaukee, the cryptosporidium outbreak that made 400,000 sick was only spotted when stores found themselves running out of toilet paper and diarrhea meds. In Nevada, an outbreak of e. coli from fast-food hamburgers that eventually killed four children wasn't found until it spread to Washington. The 1989 Lassa patient in Chicago was sick for weeks before doctors even diagnosed him; it was sheer luck that no one else got infected.

Three years ago, Osterholm conducted a study of disease surveillance capacity around the country, finding that government spent $74 million on tracking all infectious diseases in 1992. Of that, $42 million came from the federal government. By contrast, the Pentagon spends some $225 million each year on military bands.

What's more, 95 percent of the federal money was earmarked for just four areas: HIV, tuberculosis, sexually transmitted and vaccine-preventable diseases. All the rest--emerging microbes, food-and waterborne diseases, drug-resistant organisms, everything--received $1.5 million in federal surveillance funding. "That's like trying to run O'Hare International Airport with tin cans and string," Osterholm told a U.S. Senate committee in September. In 12 states and territories, there was not a single person responsible for tracking food-and-waterborne diseases, he added. "You could sink the Titanic in their backyard, and they would never notice."

"There has been a complacency that has developed over last 20, 25 years," says James Hughes, director of the National Center for Infectious Diseases at the Centers for Disease Control. "You happen to be living in an area under purview of a state health department that takes infectious diseases very seriously and has the capacity to identify and respond to many of the problems. But that's somewhat unique."

Hughes's, of course, is the agency that's supposed to pick up where everyone else may fail, deploying superior technology and unrivaled expertise in the worldwide battle against the bugs. But, Hughes admits, "we have had some severe staff shortages, and there's currently some fiscal uncertainty." More plainly put, the CDC is emaciated. Just two years ago, when it was renamed the Centers for Disease Control and Prevention, added responsibilities without added funding resulted in cuts of 518 non-prevention jobs. Current funding, agency officials say, is insufficient even for basic surveillance, not to mention responding to crises.

When plague appeared in India in 1994--a potentially massive global health threat--CDC closed down all of its Lyme disease research to free up some scientists. When leptosporidiosis surfaced in Central America this summer, a retired researcher was sent to investigate it. And when Ebola struck Zaire in May, the CDC sent a team composed of a mid-level Ph.D., a postdoctoral student, and a visiting scientist; on arrival in Kinshasa they found they didn't even have the money to rent bicycles. Samples of Ebola-contaminated blood were shipped to Atlanta via Federal Express. CDC's Biosafety Level 4 lab, one of only two in the country deemed safe enough to tackle "hot" bugs, is deteriorating; the agency finally got the OK for $47 million to construct a new one, but that was whacked by Senate budgeteers this fall.

The story repeats itself wherever you look. The U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), star of Richard Preston's The Hot Zone, expects its budget by 1997 to be cut to two-thirds its 1991 level, and to lose more than 120 of its 600-plus scientists. The World Health Organization's total budget is less than what New York City spends each year for street cleaning. For its emergency viral-outbreak response program, WHO had a robust $25,000 to spend in 1993.

On a more pedestrian level, funds for food and water safety have dwindled steadily through the past decade, partly as a favor to industry and partly to save money. The budget just passed by Congress includes massive new reductions in water and sewage treatment funds. By some estimates, Minnesota alone stands to lose $6.7 million in revolving EPA funds alone. "If [waterborne] bugs were watching C-Span," says one local public health official who doesn't want his name used, "they'd be cheering right now."

In 1992, the CDC announced what it said was a bare-bones prevention strategy to help spot emerging and reemerging infections. The full program would have cost $200 to $500 million a year; of the $125 million the agency actually asked for, Congress approved $7 million. With that money, the CDC has started a much pared-down pilot program involving four state health departments; Minnesota's, with a grant of $350,000, is one of them. Among the projects is what the researchers fondly refer to as "the death study"--the survey of unexplained deaths that turned up Terry and about 100 other healthy Minnesotans between 1 and 49 years old who apparently died of unidentifiable infections.

Minnesota was picked as one of the participants in the study because, compared to most, its epidemiology department is in good shape. Osterholm's team has built a web of connections with public and private researchers around the state, from the Mayo Clinic to the University of Minnesota. (Last month it was announced that the state and the U were collaborating in a new international virology center with a focus on emerging infections.) The group has also been adept at augmenting its $2.4 million budget--of which about one-fifth comes from the state--with research grants and special projects; Osterholm maintains they're the first in the world to use "genetic fingerprinting" tools on a broad disease surveillance scale.

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