2017-03-18 13:05:02
Global Health: Trump Plan Eliminates a Global Sentinel Against Disease, Experts Warn

Nobody in the United States has ever died from an intercontinental missile strike. Over the past 50 years, hundreds of billions of dollars have been spent on silos, submarines, bombers and satellites to ensure that does not happen.

During the same period, about 1.3 million Americans have died from intercontinental virus strikes. The toll includes one American dead of Ebola, 2,000 dead of West Nile virus, 700,000 dead of AIDS, and 1.2 million dead of flu — a virus that returns from abroad each winter.

The federal budget to stop these threats is infinitely smaller than the Pentagon’s, and the Trump administration’s proposed cuts to the National Institutes of Health, and particularly its plan to eliminate the Fogarty International Center at the N.I.H., would, global health experts say, make America vulnerable again.

The Fogarty center, based in Bethesda, Md., was one of the few specific trims in President Trump’s “skinny budget.” It is an odd target: Eliminating it would save only $69 million. The administration did not explain why it was picked, leaving scientists to surmise that it was because the center’s grants pay American doctors to train foreign ones. Mr. Trump has a well-known “America First” bent.

But most of those trainees focus on diseases that circle the globe, researchers point out, including flu, mosquito-borne viruses, vaccine-preventable diseases and bioterrorism agents.

The idea of eliminating the center “is just atrocious,” said Dr. Daniel G. Bausch, a Tulane University virologist and the scientific program director at the American Society of Tropical Medicine and Hygiene. “It would have a severe impact not just on global health but on American health.”

“Even if you don’t care about your neighbors, if you see a fire across the street, your best bet to protect your house is not to just stand in your yard with a bucket of water,” he added. “It’s to help put it out.”

New viral threats are constant. Pathogens like SARS, MERS, dengue and H7N9 avian flu have already probed America’s defenses: Cases have reached these shores in people or in birds, but have not yet killed anyone.

The Zika virus, which is lethal to unborn babies, is still probing our limits; it is expected to return to this country this summer. Still in the wings are a host of other threats: The Nipah virus and Lassa fever, for example, are considered so dangerous that the Bill and Melinda Gates Foundation and other donors recently announced a $500 million fund to jump-start the development of vaccines against them.

Rift Valley fever, Japanese encephalitis, Crimean-Congo hemorrhagic fever and many others lie in wait, and they are less remote than most Americans realize. Crimean-Congo fever, despite its exotic hybrid Russian-African name, circulates even in Spain. It killed someone there last year.

The early-warning system that protects America against viruses resembles the one that protects it against missiles. A network of laboratories around the world, known as World Health Organization reference labs, collects samples from disease outbreaks in local humans, animals and even insects.

Researchers share the genetic sequences, track dangerous mutations, and ship virus samples on to more sophisticated labs that can turn them into vaccines.

Only a tiny number of these sentinel laboratories are in American hands. The Navy runs two in Egypt and Cambodia, for example. And the Centers for Disease Control and Prevention in Atlanta, of course, is one of the apex labs in the W.H.O. reference system, like the top labs in Paris, Moscow and Beijing.

But the system’s furthest-flung sentries — the ones most likely to make first contact with a new viral foe — are those in the world’s poorest countries. These labs are often the descendants of British, French, Dutch or Belgian facilities founded during the colonial era or those started by the Soviets.

Vital as they are to global health, they are usually underfunded and underequipped, and their personnel undertrained. The Fogarty center helps remedy that.

Dr. Bausch has a $50,000 Fogarty grant to plan what could turn into a $2 million to $3 million investment in Sierra Leone, one of the three West African countries where Ebola killed 11,000 people in 2014.

“That would buy lab equipment, train people to run it and to do contact-tracing during an outbreak,” Dr. Bausch said. “The ability to do that is not a given in West Africa. If it had been, we wouldn’t have had that massive Ebola outbreak.”

The skills and equipment donated for one disease often help stop another. For example, early last year, Brazilian ultrasound specialists who had been trained under a Fogarty grant to spot brain abnormalities in Chagas disease victims were among the first to detect early signs of brain deformity in fetuses with Zika.

And Ebola was stopped in Nigeria in 2014 because emergency operations centers and case-detection teams that had been created to find polio victims were drafted to track Ebola cases instead.

Grants by the Pentagon let foreign militaries train with American forces, building alliances. The same is true of Fogarty grants.

When he worked in Pakistan, Bangladesh and Mongolia, said Dr. Sten H. Vermund, an AIDS expert who is now dean of the Yale School of Public Health, “I was able to offer Fogarty-supported training to my overseas partners, and they became the leading lights in H.I.V. when the epidemic hit.”

“Cutting the tiny Fogarty budget is penny-wise and pound-foolish,” he added. “In the old days, we’d float in, get our samples, and leave. We were accused, correctly, of scientific exploitation. Nowadays, you don’t do research abroad if you don’t offer the host country something.”

Once tropical diseases emerge, “they know no borders,” said Dr. Chris Beyrer, president of the International AIDS Society. “America is not hived off from the rest of the planet, and it’s incredibly important to our biosecurity to have surveillance capability — which means partners in other countries. That’s what Fogarty does.”