The magazine of the UW School of Public Health

From the Dean

The Northwest Is Rising to the Challenges of Emerging Diseases

Dean Pat Wahl The range of challenges resulting from globalization, including emerging and re-emerging infectious diseases, came home to me in rural Washington. After I became Dean of this School, I spent a couple of years making the rounds of the 34 local health jurisdictions in our state. During those visits I was surprised to observe how many health departments, rural as well as urban, were dealing with HIV/AIDS, hepatitis C, widespread drug use, and a growing number of cases of antibiotic-resistant TB and other reemerging diseases, as well as a range of problems related to multi-ethnic communities.

Since then, we've seen West Nile virus spread west across the country, SARS arrive from across the Pacific, and BSE (mad cow disease) make its way south from Canada. And lest we think we are only importers of infectious diseases, consider that most of the HIV/AIDS victims in Japan contracted their disease from infected American blood products.

It seems such a short time ago that we thought our miracle drugs had essentially conquered infectious diseases. Today we know better. Glancing through the Seattle Post-Intelligencer recently, I saw stories on the world's drug-resistant TB hotspots, now found on four continents; Utah bracing for the West Nile virus season; the USDA proposing new standards for BSE testing; and how an outbreak of avian flu could lead to a chicken shortage in British Columbia. Far from being conquered, in fact, infectious diseases are the leading cause of death worldwide.

There are many reasons for this surge in infectious diseases, some of which are discussed in these pages. While new infections, including HIV/AIDS, West Nile virus, and SARS, continue to emerge, some old foes, such as TB and malaria, have become resistant to traditional therapies and are making a remarkable comeback. Changes in land use can cause microbes to thrive. International travel and global commerce are often the mechanisms for the spread of disease, and with its many ports of entry to the Pacific Rim, the Northwest is vulnerable on both counts. Every year, unprecedented numbers of travelers enter our region, the most trade-dependent in the nation. Because our food safety system is being overwhelmed, insects and contaminated products make their way easily across our borders. We have much to learn about the interplay between globalization and emerging infectious diseases.

Fortunately, we also have resources. Researchers worldwide, including many in this School, are working in such areas as drug resistance, the genetic diversity of viruses, avenues of transmission, and the social and economic causes for the emergence or reemergence of infectious diseases. The Bill & Melinda Gates Foundation and other groups are expending extraordinary amounts of money and energy to reduce global health inequities, promote vaccine development, and prevent disease transmission. And the dedicated public health w orkforce I encountered on my tour around this state—and that exists throughout the Northwest—is committed to responding to challenges as they emerge. This issue of Northwest Public Health offers an excellent overview of some of those efforts.

Patricia Wahl, Dean
School of Public Health and Community Medicine