David Heymann, MD, serves as assistant director-general of the World Health Organization’s Health Security and Environment Cluster and as representative of the director-general for polio eradication. In his many years on the global health front, Heymann has also served as executive director of WHO’s Communicable Disease Cluster and led research activities for WHO’s Global Program on AIDS. Prior to his work with WHO, Heymann worked as a medical epidemiologist in sub-Saharan Africa for the Centers for Disease Control and Prevention.

Heymann was editor of the recently released 19th edition of APHA’s "Control of Communicable Diseases Manual." The manual has served as a health resource staple for 90 years.

The other component of health security helps to decrease our collective vulnerability, both at the national and at the global level, to acute public health events such as epidemics, pandemics or diseases associated with chemical or other contamination. This is often referred to as public health security. A lesson that we have learned about our public health security is that communicable diseases have a way of surprising us. The severe acute respiratory syndrome epidemic in 2003 is a clear example of this. So both at the national and at the international level, we have to keep strengthening our ability to detect and respond quickly to infectious disease threats. Robust national surveillance and response systems have to be the foundation on which a system of global surveillance and response is built. And it is vital that surveillance information is shared between nations on a basis of trust. This is how we can build common and shared public health security that will benefit people across the world.

It is especially important for industrialized countries like the United States to help countries that have limited resources build capacity to detect and respond to infectious disease threats. A major challenge we face is finding the resources, both within poorer countries and globally, to build this capacity, and to help countries communicate information to each other quickly and transparently in the interests of best ensuring our public health security.

There are at least two compelling arguments linking health security to economic security. One is direct and immediate and the other more long term and indirect.

To take the more immediate argument first, we know that even at the best of economic times, an infectious disease epidemic that spreads globally can have a significant impact on the global economy. The impact SARS had on global economic growth is a case in point. At a time like this, when the global economy is in trouble, a disease outbreak with potential regional or global spread could tip economies from recession into depression. We need to keep in mind that the risk of an influenza pandemic, or in fact any other disease outbreak, remains unchanged whether an economy is in recession or not.

A more long-term argument is that while investment in global health security and surveillance always makes sense, it can make special sense during an economic downturn. National and global surveillance is impeded by a lack of technology, including an absence of simple-to-use diagnostic and screening tests and predictive methodologies. As part of stimulus packages, initiatives to fund research and development in these areas would likewise help global health security as well as the economy.

While I have stuck to a tried and tested structure that has been developed over the years since Haven Emerson, MD, edited the first edition in 1916, most chapters have had parallel updates by experts at CDC and WHO to ensure their continued global relevance. New disease variants have been added, and in some cases, chapters have been comprehensively reworked. The chapter on influenza, for example, includes separate sections on seasonal influenza and human influenza of animal and avian origin.

We have also added chapters concerned with public health security in a globalized world. It has been mine and the editorial board’s wishes to see that this manual remains as relevant and useful to public health professionals around the world as previous editions have been.

The international community cannot achieve the aim of a healthier and safer world without the leadership and support of the United States and other industrialized countries. The capacity within the United States to assess, detect and respond to infectious disease threats, as well as other threats to global health security, is difficult to match elsewhere in the world. The United States has always placed these resources at the disposal of the global community, and I have no reason to believe that the new administration will not continue to do this.

At WHO, we hope for continued support from the new administration in our efforts to build better global health security through the provision of technical experts to our various advisory groups and technical activities, and financial input to priority areas of work such as polio eradication, AIDS, TB and malaria control, neglected tropical diseases and pandemic preparedness. Provided within a multilateral framework, this support will ensure better public health security for all countries. Above all, clear leadership in global health from the United States, especially at a time of global financial crisis, is an essential example if the world is to protect itself against threats to health security during these uncertain times.

Rather than search for missed opportunities, it seems more important to look at the new opportunities we have to strengthen our global public health security and better respond to infectious diseases threats that cause illness, death and often, negative economic impact. The revised International Health Regulations, which came into force on June 15, 2007, provide the international community a mechanism with which to ensure common public health security against infectious diseases threats and other threats such as chemical and nuclear accidents. These revised (regulations) are stronger than the previous International Health Regulations in several significant ways and will improve the capacity of countries to detect, assess, notify and respond to public health threats. The revised regulations require countries to establish certain minimum core public health capacities and set out criteria that oblige countries to notify WHO of events that might constitute public health threats of international concern. Through the (regulations), countries with less developed health systems will find a way to both protect themselves through developing their core public health capacities and to promote global public health security.

The long term goal of the (regulations) is for all countries to develop the capacity to detect and contain infectious disease outbreaks when and where they occur. But it will take time for the capacity to develop across the world. So for now, the (regulations) also provide a safety net of international reporting and response and a requirement for all countries to share information about infectious disease outbreaks that have the potential to spread internationally.

What we urgently need now is continuing international cooperation to help developing countries build their core public health capacities, and a commitment by all countries to use these regulations as a means of ensuring global public health security. If we do not succeed, then there will indeed be a missed opportunity to curb infectious diseases in the years ahead.

There are reasons to be optimistic that polio can be eradicated. It is useful to recall what the Global Polio Eradication Initiative has achieved since its creation in 1988: The incidence of polio has decreased by more than 99 percent, from approximately 1,000 children paralyzed each day in 125 countries during 1988, to just over 1,600 children paralyzed during the entire year of 2008 in four countries that have not interrupted the transmission of indigenous poliovirus and other, polio-free countries, to which they have exported the poliovirus in international travelers.

The four countries that continue to have indigenous wild poliovirus transmission are India, Nigeria, Pakistan and Afghanistan. In real terms, progress in polio eradication means that 5 million people are walking today who would otherwise have been paralyzed, and more than 250,000 polio deaths have been prevented.

But clearly, we face challenges in eradicating polio in each of the four remaining countries. The challenges differ from one to the other, ranging from security challenges in Pakistan and Afghanistan, to highly efficient virus transmission and compromised oral polio vaccine efficacy in northern India. New vaccines have been licensed to address some of these issues and increases have been made in the speed with which polio diagnosis is now made.

In February 2007, the polio eradication initiative and its four core partners — Rotary International, CDC, UNICEF and WHO — launched an intensified polio eradication effort. Among the successes since then has been the interruption of indigenous type 1 polio transmission in Uttar Pradesh in India, though it has now become reinfected from a neighboring state. New, innovative approaches in Nigeria, Pakistan and Afghanistan have shown that some of the remaining obstacles can be overcome with intensive work and commitment at the national and sub-national levels.

Added to this, is the continuing international support for polio eradication efforts, most recently demonstrated by the commitment of $630 million by Rotary International, the Bill and Melinda Gates Foundation, the United Kingdom and Germany.

We all have a role to play in attaining a polio-free world, and the intensified eradication effort has shown that everything is in place to achieve success and consign polio to the history books. What is needed is for country-specific strategies to be fully and completely implemented with the full engagement of national and local leaders, and with continued financial and technical support from the international community.