Recent disease outbreaks across the globe may appear unrelated—a resurgence of measles in the United States, a persistent foodborne Cyclospora outbreak and Ebola spreading in parts of Africa. However, they share a common thread—each exposes vulnerability in a global public health infrastructure that has become increasingly fragile.
Public health rarely gets the attention it deserves when systems are working efficiently. Strong vaccine uptake prevents epidemics and disease surveillance detects outbreaks before they spread. When these systems fall apart, outbreaks can become uncontrollable, more expensive and much more difficult to control. Here’s how measles, Cyclosporiasis and Ebola are revealing cracks in our public health infrastructure.
Measles
The United States has reported the most cases of measles in a single year in over three decades, with five months still left on the calendar year. According to John’s Hopkins University’s U.S. measles tracker, 2,295 cases have been reported, with 93% occurring in those unvaccinated or whose vaccination status is unknown.
Measles was declared eliminated in the U.S. in 2000 largely due to the highly effective measles, mumps and rubella vaccine that offers 97% protection against measles when two doses are given. However, declining vaccination rates fueled by vaccine hesitancy have created pockets of susceptible individuals where the virus can spread quickly. In order for the general population to be protected against measles, vaccination rates need to be 95%. This allows for herd immunity, the protection conferred upon a population when a certain percentage of the population become immune either from prior infection or vaccination. Currently, at least 39 states have school vaccination rates under 95% for measles. Vaccine hesitancy, caused in part from misinformation and lack of trust in vaccines, has allowed for measles to make a comeback in America.
Cyclosporiasis
America’s current struggle with Cyclosporiasis illustrates a different, but equally important weakness. Cyclospora is a small parasite that causes a food-borne illness, often from contaminated produce. Identifying the contaminated food source often requires sophisticated laboratory techniques, detailed epidemiologic investigations and coordination among state and federal health agencies.
Although multiple factors have been contributing to the large number of cases in the U.S.—including the long incubation period that makes testing food difficult since infected individuals can have symptoms up to two weeks after eating contaminated food—the lack of investment in public health infrastructure has also played a role. As an example, last year, the Department of Health and Human Services laid of hundreds of CDC employees, some of whom were involved in the detection of disease outbreaks like Cyclosporiasis. The CDC also downsized a lab that specifically monitored certain infectious diseases like Cyclosporiasis. When these systems are under-resourced, investigations become more difficult, delaying interventions that protect the public.
Ebola
The Ebola outbreak in Africa highlights another critical lesson: global funding matters. International assistance has historically played a major role in supporting outbreak surveillance, laboratory capacity, healthcare worker training and emergency response in countries facing limited resources.
The current outbreak in the Democratic Republic of Congo is the fastest growing Ebola outbreak on record with over 1,000 deaths already and more than 2,500 confirmed cases. In mid-July, the World Health Organization said its joint $518 million plan to fight Ebola with the Africa CDC faced a funding shortfall of over $400 million. In addition, global funding cuts through the U.S. Agency for International Development have raised concerns about the ability to rapidly detect and respond to Ebola with respect to decreased personnel, equipment and laboratory tests.
The precise impact of any individual funding reduction is difficult to quantify because the Ebola outbreak and its spread has been influenced by many factors, including political turmoil, armed conflict and mistrust in healthcare workers. However, funding for surveillance and response capacity remains widely recognized as a cornerstone for effective outbreak control.
Public Health Lessons
Measles, Cyclosporiasis and Ebola are all spreading at unprecedented levels. The lessons connected these outbreaks is clear. Public health cannot operate as a reactionary system that receives attention only during emergencies. It requires sustained public trust, clear and transparent communication, investment in surveillance systems and robust global funding and partnerships to address infectious disease threats. The outcome of future disease threats will be determined long before the threat occurs.