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It is the committee's hope that this report will be an important first step in highlighting the growing problem of emerging microbial threats to health and focus attention on ways in which the United States and the global community will attempt to address such threats, now and in the future. The committee strongly believes that the best way to prepare for the future is by developing and implementing preventive strategies that can meet the challenges offered by emerging and reemerging microbes. It is infinitely less costly, in every dimension, to attack an emerging disease at an early stage—and thus prevent its spread—than to rely on treatment to control the disease.

In some instances, the measures that this report proposes will require additional funds. The committee recognizes and has wrestled with the discomforts that such recommendations can bring—for example, the awareness that there are other compelling needs that also justify (and require) increased expenditures. But policymakers and the public alike must realize and understand the potential magnitude of future epidemics in terms of human lives and monetary costs. The 1957 and 1968 influenza pandemics killed 90,000 people in the United States alone. The direct cost of medical care was estimated to be $3.4 billion (more than three times the NIAID budget for fiscal year 1992) and the total economic burden to be $26.8 billion2—almost three times the total NIH budget for fiscal year 1992. A more current example offers a similar lesson. The recent resurgence of TB (from 22,201 cases in 1985 to 26,283 cases in 1991, or 10.4 per 100,000 population), after a steady decline over the past several decades, will be costly. Every dollar spent on TB prevention and control in the United States produces an estimated $3 to $4 in savings; these savings increase dramatically when the cost of treating multidrug-resistant tuberculosis is factored in. We also have a recent example of what results when early prevention and control efforts are lacking. The costs of AIDS/HIV disease—in human lives as well as dollars—have been staggering, and the end is not yet in sight. The objective in the future should be earlier detection of such emerging diseases, coupled with a timely effort to inform the population about how to lower their risk of becoming infected.

Obviously, even with unlimited funds, no guarantees can be offered that an emerging microbe will not spread disease and cause devastation. Instead, this committee cautiously advocates increased funding and proposes some more effective ways for organizations—domestic and international, public and private—as well as individuals—both health professionals and the lay public—to work together and, in some cases, combine their resources. These efforts will help to ensure that we will be better prepared to respond to emerging infectious disease threats of the future.


Figures are in 1992 dollars.

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