Preventative medicine: Research and use of medical countermeasures during an outbreak

Abstract

New viral and bacterial pathogens are continuously emerging; today’s world of increasing interconnectivity and mobility accelerates this shared global risk. As such, emerging infectious diseases will continue to require attentive public health surveillance programs in order to identify these events and allow effective responses and interventions to prevent or slow the spread of these diseases. Research that permits a better understanding of the potential source of infection, and the benefit of public health interventions such as therapeutics, vaccines, and diagnostics are critical components of preparedness. As an example, preparedness of smallpox medical countermeasures enabled a quick response to related monkeypox disease upon its introduction in the U.S. in 2003. In turn, the monkeypox response efforts identified a number of research questions that informed our understanding of monkeypox pathogenesis, and provided an animal model to evaluate smallpox antivirals and next generation vaccines. During the response to the Ebola Zaire virus epidemic in West Africa during 2014–2016, approaches that had been used to contain previous smaller outbreaks in DRC and Uganda proved successful in controlling disease spread and eventually, halted the epidemic. The size of the Ebola epidemic in West Africa provided unique opportunities to understand further how this virus affects the human host, and the persistence of virus in certain areas of the body. Additionally, Ebola medical countermeasures, evaluated later in the response, may have application in ongoing prevention efforts and in diminishing the size of future outbreaks. Evaluation or observational studies carried out during a response are important in that they provide evidence of best practices. This essay, a synopsis of a presentation made in Belgrade in March 2017, will expand on these specific examples of how research can affect the outbreak response, and in turn, how effective evaluation during a response identifies new research questions.