LAUSR

In the past 5 years, the world has been challenged by a series of high-profile epidemics, among them an unprecedented and devastating outbreak of Ebola in West Africa and the rapid spread of Zika virus throughout the Americas and discovery of the virus’s potential to cause serious birth defects, fetal deaths, and adverse neurological disorders. We have also seen a hospital-associated outbreak of MERS in South Korea, a deadly plague outbreak in Madagascar, and a difficult-to-contain, vector-driven outbreak of Lassa fever in Nigeria. This year, we have seen the return of Ebola—first in an outbreak in the Equateur province of the Democratic Republic of Congo (DRC) and then, weeks after containment, a second, unrelated epidemic in North Kivu, DRC. The sequence and impact of these events suggest that we may well be in an age when the prevailing human, animal, and environmental conditions favor the continued emergence and spread of deadly pathogens. As a result, continued vigilance and preparedness is necessary. The potential for infectious disease outbreaks to cause significant levels of death and disease, and to destabilize economies and governments, is a central reason that countries including the United States work to improve global health security capacities at home and abroad. Pandemics and epidemics can pose a significant economic and political threat to governments. Just a few cases of Ebola in the United States had big political repercussions and some loss of confidence in the ability of the country to prevent spread. Outbreaks can also have serious economic consequences: disruptions in workforces that are sickened or afraid to work, trade and travel upheaval, and high levels of uncertainty. The World Bank reports the Ebola epidemic in West Africa is estimated to have cost the 3 affected countries $2.2 billion in lost GDP in 2015. It further estimates that even a moderate pandemic can cause millions of deaths and decrease global gross domestic product by 0.7% to 1%. These tolls can be avoided if disease outbreaks are contained before they become epidemics. During the Ebola epidemic in West Africa, the importation of the disease into populous, internationally connected Lagos, Nigeria, raised alarms about the potential for transmission of the virus to accelerate and, potentially, to spread throughout the continent. But what ultimately unfolded was much different. Thanks to public health capacities that had been developed with investments from preexisting programs, such as the Field Epidemiology Training Program, PEPFAR, and polio eradication, as well as experience in tracking down contacts, the virus was contained in Nigeria within weeks, with fewer than 2 dozen cases. Similar successes were achieved when an outbreak of Marburg occurred last year in Uganda. Armed with well-trained staff, a world-class virology laboratory, and practiced protocols for transporting and testing specimens, Uganda detected the outbreak quickly and contained the spread of a deadly hemorrhagic fever within weeks. In both of these examples, a well-prepared public health system snapped into place to quickly contain the outbreaks before the disease spread across borders. These examples show us that containment is possible if countries