Addressing Emerging Microbial Threats in the United States

Public health professionals generally have been complacent regarding the erosion of infectious disease surveillance, prevention, and control programs in the United States over the past two decades.¹⁻⁴As infectious diseases have emerged or reemerged, some crises such as those posed by the emergence of the acquired immunodeficiency syndrome (AIDS) or resurgence of tuberculosis and measles have been addressed selectively. However, the infrastructure to maintain vigilance and to respond to most emergent or reemergent infectious diseases has generally continued to deteriorate. Consequently, for domestic problems ranging from outbreaks of cryptosporidiosis caused by contamination of municipal water supplies⁵to the currently growing crisis of antibiotic resistance,⁶efforts at surveillance, prevention, and control have frequently been delayed or inadequate. Global capacity to detect and respond to emerging diseases has also been compromised as surveillance networks have deteriorated and laboratory capacity for accurate diagnosis has declined in many countries.²,⁷ There