The cover of the May 2013 edition of Emerging Infectious Diseases offered an appropriate analogy to reflect on the advances in infectious disease medicine over the last 30 years and to put in perspective those accomplishments against current and future challenges. The artwork portrayed Titian’s masterpiece of Sisyphus toiling with the never-ending burden of pushing the stone up the hill as punishment for cheating death. Polyxeni Potter provided an accompanying editorial comparing Sisyphus’ endless journey to public health efforts to understand and battle against emerging and reemerging infectious diseases. Ms. Potter draws on the final chapter of The Myth of Sisyphus by Albert Camus that in public health one must imagine Sisyphus happy as the struggle itself is enough to fill one’s heart .1 Potter concludes, “…and in public health, where monumental effort sometimes brings incremental improvement, success is still measured by tying up Death.” 2
The last 30 years have seen a number of significant advances in the understanding, prevention, and treatment of infectious diseases. Unfortunately, the world of infectious diseases is far from static, and new threats emerge or old threats evolve faster than available countermeasures. Describing the many significant advances in infectious disease medicine (as well as the numerous new threats) would occupy volumes. Moreover, several journals exist for the specific purpose of describing advances in infectious diseases. However, it is worthwhile to describe a few key advances as well as to discuss the lessons learned over the last 30 years and to put in perspective some of the challenges and opportunities available for federal practitioners.
First, a short disclaimer. I am not an infectious disease researcher or clinician. I have an enviable position of supporting the infectious disease clinical research enterprise through helping researchers navigate through the regulatory matrix with the least burden possible. As such, I have the opportunity to work with clinical researchers who are surrogates for Sisyphus with every hypothesis geared toward answering questions that advance our understanding of respective infectious diseases resulting in the need to continue their struggles to answer the subsequent questions generated by their findings. I have the good fortune of currently working with many highly skilled and truly dedicated clinicians and researchers in the National Institute of Allergy and Infectious Diseases (NIAID) and had the opportunity of gaining experience with a similar group in the DoD while serving in the U.S. Army Medical Research and Materiel Command. It is from the work of these many experts that I have gained some appreciation for the advances and challenges of infectious disease medicine.
Advances in public health programs took the U.S. death rate from 797 per 100,000 in 1900 to a low of 39 per 100,000 in 1982. Improvements in sanitation, water, standard of living, vaccination, and the development of antibiotics had much to do with the tremendous reduction seen during that 8 decade run. Since the early 1980s, the emergence of the human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS), the development of resistance to antibiotics, and the emergence of new threats have conspired to limit the opportunity for additional reductions. Moreover, while the situation in the U.S. is somewhat stable, the situation abroad is far different. Geo-political realities and the multimodal nature of international transportation compel all of us to recognize that infectious disease threats across the globe impact all of us in this increasingly interconnected world.