When he opened the box, André Berro was wearing surgical gloves, mask, and eye protection—routine protocol for a CDC quarantine public health officer, but this was not a routine package. A U.S. Customs scan of the airmail package that arrived at the San Francisco airport from the Philippines showed an outline of what looked like several human skulls.
Or non-human skulls. When Berro lifted the lid, he found himself staring into the empty sockets of a skull with huge horns connected to each temple with leather straps. He found other skulls strapped together with plant-based ropes in triangular and other shapes. One skull, attached to a spine of unknown species, was wrapped with ropes which had animal teeth inserted. Many of the skulls were decorated with feathers or cloth. Some still had remnants of decaying flesh.
Had the package reached its U.S. destination, any of these objects could have been the source of a disease outbreak. The objects apparently came from different remote regions of the South Pacific. The human remains could have carried bloodborne pathogens; the leather and animal skins could have carried anthrax; the feathers could have come from birds infected with deadly influenza; the cloth might have been burial shrouds from people who died of hemorrhagic fever.
All of these alarming materials were confiscated by CDC before they could do any harm. But Berro’s grim discovery was the exception, not the rule. Real health threats usually look innocuous. They arrive every day, along with millions of people and millions of tons of cargo that enter the U.S. from all parts of the globe. Berro’s San Francisco station is one of 20 CDC Quarantine Stations that monitor U.S. ports of entry by air, land, and sea.
This is one line of defense. The front line is wherever diseases break out. With the globalization of travel and trade of foods and drugs, dangerous pathogens that arise anywhere in the world are just a plane ride away. U.S. national health security depends on global health security, because a threat anywhere is a threat everywhere.
That is why this morning, the Centers for Disease Control, working in partnership with the Department of Defense, announced that we will be committing $40 million to 10 additional countries to continue this kind of initial rapid response and increase progress toward global health security.
These threats come from three directions. Emerging diseases don’t just happen in the movies. Every day the CDC starts a new investigation; on average we turn up one new disease-causing organism every year. In 2011 we found three. As I write, the second wave of the deadly H7N9 avian flu is hitting China. We’ve been lucky that this strain hasn’t, yet, learned to pass easily from person to person. New diseases are inevitable, but new epidemics aren’t.
Drug-resistant infections are the second and perhaps most pernicious threat we face. Already the nightmare bacteria called CRE (carbapenem-resistant enterobacteriaceae), resistant to most or all antibiotics, have gone from a single patient in one state in the U.S. to at least 47 states and thousands of patients. Extensively drug-resistant tuberculosis bacteria are another example of why the end of the antibiotic era is already close for some infections. When I was in charge of tuberculosis control in New York City in the early 1990s, I cared for a man with extensively drug-resistant tuberculosis. It took two years, surgery, extended periods of intravenous antibiotics, and more than $100,000 to cure him. A few years later, I helped his village in India set up a treatment program that would have prevented his resistant infection for less than $10.
A third threat is the intentional creation and intentional or accidental dissemination of genetically altered infectious agents. We’ve already seen anthrax deployed in domestic terrorism. An inevitable but unfortunate downside to recent scientific advancements is that there now exist both high-tech and low-tech ways to create more virulent, drug-resistant, potentially vaccine-evading, highly contagious organisms. And the costs of creating such agents are dropping fast.
No single country can achieve global health security by itself. Ensuring national health security means working with international partners.
CDC partners with nations all over the world to detect and respond to disease outbreaks and natural disasters. Holding the front line are more than 1,600 CDC staff in more than 60 countries, leveraging their expertise by working with ministries of health to train new public health experts in fields ranging from community health to laboratory science.
These people, working in their own countries, hold the front line against global health threats. We need more of them, and need more tools and training to offer them. We’ve made excellent progress over the past few years, with support from the U.S. Congress, and now countries around the world conduct hundreds of investigations a year.
Thus today’s announcement for a major push for global health security (GHS). And next year the president will propose adding $45 million to the CDC budget to further expand the initiative, working toward a five-year goal of making sure that at least 30 countries not currently protected with some 4 billion citizens, can improve their capacity to prevent, detect, and effectively respond to disease threats. We are confident that with international partners, every country in the world can improve its own health security, and thereby the world’s. The vision is for host nations to establish their own laboratory networks, emergency operations centers, and prevention capabilities to create a new, globally interconnected line of defense.