The progress of H5N1 avian influenza reminds us that new pathogens remain a stubborn threat. Although a full-blown pandemic does not appear to be imminent, the virus’s ability to infect a wide range of species, from migratory birds to dairy cows, means it may evolve into a strain that more easily spreads to and among humans. There is an increasing possibility that
This risk highlights the urgent need for strong surveillance of emerging disease threats. Such tools are not just central to public health infrastructure; It can also ensure public health security and prevent serious disruptions to health services.
The Centers for Disease Control and Prevention must keep its focus squarely on this core mission. The new emphasis on chronic disease priorities advocated by the incoming Trump administration should not diminish this national security imperative.
There is a path to achieving this dual mandate, where basic public health protections strengthen national security protections. Funding for some of the surveillance initiatives established after the COVID-19 pandemic fosters partnerships with front-line health care providers and embeds health threat tracking into health systems. But that funding is set to expire, and the investment could be completely scrapped in response to widespread political backlash against public health measures.
Expanding these surveillance programs is critical to our national security front.
of Risks we face from new biological threats Nothing is more serious than this. Rogue nations maintain deadly biological weapons programs, and the know-how and equipment for converting microbes into terrorists continues to expand. Since the new coronavirus infection, in many countries Speeding up the construction of a high-security biological research laboratory They argue that the ability to study dangerous pathogens, often in poorly governed areas, would strengthen public health infrastructure. This frenzied expansion means more countries are embarking on high-risk experiments, each with the potential to become a flashpoint for a catastrophic laboratory leak.
The scope of the danger was recently highlighted by 38 scientists working in nine countries, who warned in a special paper Published in Science magazine About the potential of “mirror bacteria” – synthetic organisms whose molecular structures can be reverse-engineered to neutralize the current arsenal of anti-infective drugs. Not so long ago, such synthetic engineering was outside the scope of our science. Now, these new and potentially deadly pathogens could be created in the lab within a decade.
The best bulwark against these risks is a robust domestic system to detect such threats before they become established in the population. COVID-19 has shown that disease surveillance is important. The U.S. was unable to detect the virus when it first took hold, and was unable to map where and how widely it spread in some cities, accelerating the pandemic’s impact. Even as the coronavirus pandemic was in full swing, the country was wondering which specific regions were bearing the brunt of the infection, facing new variants, and which regions were relatively untapped. There was a lack of infrastructure to determine whether the situation was still intact. This has prevented the United States from implementing a better targeted response to reduce infections while limiting the burden on the public.
Since the coronavirus outbreak, the United States has expanded its routine surveillance tools. However, many of these programs are still under construction and require supporting investments, and some funding for existing efforts will need to be renewed starting in 2025 for the programs to continue.
Partnerships between the CDC and health care delivery systems are expanding and are now scrutinizing patients’ symptoms and diagnoses in the emergency department to detect unusual patterns of illness, or signs of a developing outbreak. By relying on de-identified electronic health records with standards for data sharing and privacy protection, surveillance platforms and their algorithms can spot subtle signals of emerging threats in near real time. this National Syndrome Surveillance Program Expanded after Covid-19, we now collect secure data feeds from over 6,500 healthcare facilities, covering approximately 80% of emergency rooms.
Another key benefit of this public-private partnership is the daily data stream from the five commercial laboratories, which perform approximately 80% of all blood tests in the United States, allowing the CDC to identify more than 200 infectious diseases of concern. You will be able to monitor for signs of new outbreaks. CDC has also developed extensive systems to: monitor wastewater It will be possible to track pathogens within wastewater facilities and measure their prevalence across the country.
This approach provides a more comprehensive view of the spread of infectious diseases and acts as a local tripwire for early warning to track seasonal outbreaks or identify emerging threats like avian influenza. I will. These capabilities also provide the foundation to enable increased transparency and informed local decisions by healthcare organizations, providers, and consumers to reduce community risk and improve national responses. strengthen.
Maintaining these modernized public and private defenses against natural and intentional threats requires sustained funding from Congress. Some of these efforts were launched with a one-time funding boost after the pandemic and could disappear if support is not renewed. For example, wastewater monitoring was funded by remaining COVID-19 supplemental funds in fiscal year 2024, but these efforts have no appropriation and will not be funded under the continuing resolution. The Center for Forecasting and Outbreak Analysis (CFA), which uses data analytics to predict and prepare for potential infectious disease outbreaks, was funded through a joint appropriation line that includes funding for CDC’s data platform. However, continuing CFA in 2025 will require approximately $55 million in dedicated funding.
CDC’s core mission is to control infectious diseases and support state and local responses, a mission that strengthens national security. While the political winds are currently driving a shift toward investing in health and wellness, we cannot allow one of our priorities to come at the expense of the CDC. Core responsibility to reduce the threat of infection.
These same systems that enable the monitoring and containment of infectious disease threats also help communities track and respond to non-communicable risks. Emergency room data is already being used in some communities to detect and mitigate new synthetic opioids that are causing a surge in overdoses, and data from innovative pediatric practices is It can provide timely data on regional trends in childhood nutritional disparities and obesity.
These and related efforts are critical pillars of national security and the foundation of an effective, prevention-oriented health system. The scope of risk is expanding as new viruses become more prevalent and the tools to manipulate dangerous new strains become easier and more widespread. Being able to quickly detect and halt the initial introduction of pathogens into a country is a critical wire against these growing dangers.
Dr. Scott Gottlieb is a senior research fellow at the American Enterprise Institute and former commissioner of the FDA. He is a partner at New Enterprise Associates and a director of Pfizer and Illumina. Dr. Mark B. McClellan is director of the Duke Margolis Institute for Health Policy Research, former FDA commissioner, and administrator of the Centers for Medicare and Medicaid Services. He is a member of the boards of Alignment Healthcare, Cigna, and Johnson and Johnson.
