The "Achilles Heel" of Global Efforts to Combat Infectious Diseases

TotheEditor—In the 1 February 2006 issue of Clinical Infectious Diseases, a timely article by Petti et al. [1] on the need for increased investment in laboratory services in Africa was accompanied by an excellent editorial commentary by Bates and Maitland, who called for “laboratories and their advocates ... to be given a much louder voice on the international health care stage” [2, p. 384]. Many have become concerned that laboratory services are the “Achilles heel” in global efforts to combat HIV infection, tuberculosis, and malaria and the antimicrobial resistance that accompanies them. On 9–10 May 2005, the American Society of Microbiology (ASM) held a meeting of experts from the United States and other countries to engage in a thoughtful discussion about laboratory infrastructure needs in underresourced countries to support infectious disease prevention and control programs. The meeting focused on (1) the need to increase the awareness of the importance of laboratories to the success of public health programs in underresourced countries and (2) ways to build on existing or planned programs that require a good laboratory system for a program's success. The ASM report [3] describes several opportunities to enhance laboratory services in developing countries, with 2 opportunities of particular note: (1) improvement in the understanding of and knowledge about countries developing, implementing, and evaluating the President's Emergency Plan for AIDS Relief program and the Global AIDS Program to address the critical need for adequate laboratory systems to support the goals of these programs, both for diagnosis of HIV infection and for clinical management of patients; and (2) encouragement of polio laboratories, where feasible, to address laboratory needs of the highest priority in these countries. Polio laboratories are already assisting in limited areas with prevention and control of several other viral diseases of high priority. The report also recommends a global coordinated focus for advocacy and support of laboratories vital to global public health programs (e.g., a Secretariat). More recently, the ASM responded to a request by the Centers for Disease Control and Prevention to assist with the President's Emergency Plan for AIDS Relief program. Under a 4-year cooperative agreement, the ASM's “Building the Capacity of Microbiological Laboratories for HIV/AIDS and Opportunistic Infections Program” will address 2 key aspects in the building of clinical microbiological laboratory capacity: (1) strengthening laboratory organizational and technical infrastructure, especially as it relates to clinical microbiology for HIV prevention, care, and treatment programs; and (2) assuring the quality of laboratory testing. Working through ASM members who have been chosen on the basis of their technical and cultural expertise and experience from among the societies' clinical laboratory microbiologists and immunologists worldwide, the ASM will support laboratories with direct, hands-on guidance in laboratory management and procedures. The Association of Public Health Laboratories, American Society for Clinical Pathology, and Clinical Laboratory Sciences International are also instrumental in assisting with this need as partners of the Centers for Disease Control and Prevention. At the same time that we address HIV/AIDS, the urgency of strengthening laboratory services for all major infectious diseases is increasing. Rapid increases in the prevalence of multidrug-resistant tuberculosis are not being well monitored, cases of bacterial disease are assumed to be malaria, and antimicrobials continue to be inappropriately distributed [1]. The unseen laboratory is the underpinning for the major treatment and prevention programs for infectious diseases, and further impetus is needed to ensure that programs designed to strengthen the world's health do not neglect this critical resource. Potential conflicts of interest. All authors: no conflicts.