Roots, Not Parachutes: Research Collaborations Combat Outbreaks
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Recent infectious disease epidemics illustrate how health systems failures anywhere can create disease vulnerabilities everywhere. We must therefore prioritize investments in health care infrastructure in outbreak-prone regions of the world. We describe how ‘rooted’ research collaborations can establish capacity for pathogen surveillance and facilitate rapid outbreak responses.
International research collaborations are essential in combating major public health emergencies. Failure to collaborate can delay critical findings, hamper outbreak response, and erode trust between institutions and nations. In this commentary, we expand on recent discussions on the lack of openness during public health emergencies and perceived exploitation of disease-stricken countries by 'parachute researchers' (Heymann et al., 2016). We draw on our experience establishing the Viral Hemorrhagic Fever Consortium and the African Center of Excellence for Genomics of Infectious Disease in West Africa and show how ‘rooted’ collaborations can assist during public health emergencies. Recognizing that many successful infectious disease research collaborations exist, we highlight their critical and often unheralded role in mitigating and preventing infectious disease outbreaks.
Infectious disease outbreaks continue to pose challenges to global health and security, prompting reactive countermeasures. Recently, severe outbreaks of Ebola and Zika virus were designated by the World Health Organization as ‘Public Health Emergencies of International Concern’. Other emerging viral pathogens have warranted similar attention, including virus outbreaks from Lassa, Chikungunya, avian influenza, Nipah, SARS, and MERS. Additionally, endemic human pathogens, such as dengue and West Nile virus, have expanded to new regions due to changing demographics and increased urbanization.
Due in part to underinvestment in health care infrastructure and scientific research, Africa harbors a disproportionate infectious disease burden and vulnerability to acute outbreaks. Though more than a billion people call Africa home, the continent produces only 5% of the world’s gross domestic product (UNESCO, 2015). Total investments in African research and development (R&D) rose more than 50% between 2007 and 2013, but still comprise less than 1.5% of the world’s total R&D expenditure (Marsh, 2016). This increase in investment, however, translated into an immediate expansion of scientific output, with a rise in publications of 60% from 2007 to 2013, compared to less than 15% in Europe over the same period (Marsh, 2016).
Health care and disease surveillance disparities can exacerbate local outbreaks into global infectious threats. The large imbalance between health care capacity in Africa and most western nations means that serious infectious disease outbreaks in Africa should be shared concerns in the U.S., Europe and elsewhere. Controlling pathogens that lack effective vaccines and therapeutics make early detection, isolation, and contact tracing critical. However, even when effective vaccines are available - such as in the recent outbreaks of yellow fever in Africa and measles in the U.S. - breakdown of health care infrastructure and/or low vaccination rates allow preventable infectious diseases to spread. Combined with an ever expanding human population and an increase in the ease of travel, infectious disease outbreaks can therefore no longer be considered local threats, but rather represent international emergencies. With these factors in mind, we expect interactions with severe pathogens to increase, with unpredictable consequences to human health.
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