It Ain’t Over Till It’s Over…but It’s Never Over – Emerging and Reemerging Infectious Diseases

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

Once considered a potentially static field of medicine, the discipline of studying infectious diseases has proven to be dynamic as emerging and reemerging infectious diseases present continuous challenges, Anthony S. Fauci, M.D., writes in a perspective in the New England Journal of Medicine. In the piece, Dr. Fauci, who since 1984 has directed the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, reflects on his career responding to infectious disease threats. Dr. Fauci will step down from his positions as NIAID director, chief of NIAID’s Laboratory of Immunoregulation and chief medical advisor to President Joe Biden in December 2022.

In the perspective, Dr. Fauci notes that the emergence of HIV/AIDS in 1981 led to a sharp increase in interest in infectious diseases among people entering the field of medicine.  Since then, infectious disease specialists have faced numerous medical challenges, including the 2009 H1N1 influenza pandemic, Ebola, Zika, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and COVID-19, he writes.

Dr. Anthony Fauci, director NIAID, in his office in 1984.

Although COVID-19 was “the loudest wake-up call in more than a century to our vulnerability to outbreaks of emerging infectious diseases,” Dr. Fauci notes that one success of the response was the rapid development, testing and distribution of COVID-19 vaccines thanks to years of research and investment in new and highly adaptable vaccine platforms and structural biology tools to design vaccine immunogens. These technological advances, among others, will greatly benefit the field of infectious diseases, he writes. He concludes by stressing the importance of improving capabilities to respond to established infectious diseases like malaria and tuberculosis while also responding to emerging threats.

“In the 1960s and 1970s, most physicians were aware of the possibility of pandemics, in light of the familiar precedent of the historic influenza pandemic of 1918, as well as the more recent influenza pandemics of 1957 and 1968. However, the emergence of a truly new infectious disease that could dramatically affect society was still a purely hypothetical concept.

That all changed in the summer of 1981 with the recognition of the first cases of what would become known as AIDS. The global impact of this disease is staggering: since the start of the pandemic, more than 84 million people have been infected with HIV, the virus that causes AIDS, of whom 40 million have died. In 2021 alone, 650,000 people died from AIDS-related conditions, and 1.5 million were newly infected. Today, more than 38 million people are living with HIV.”  This quote is found in Dr. Fauci’s perspective, appropriately dated December 1, 2022 – World AIDS Day.

Dr. Fauci concludes his perspective with these remarks:

“If anyone had any doubt about the dynamic nature of infectious diseases and, by extension, the discipline of infectious diseases, our experience over the four decades since the recognition of AIDS should have completely dispelled such skepticism. Today, there is no reason to believe that the threat of emerging infections will diminish, since their underlying causes are present and most likely increasing. The emergence of new infections and the reemergence of old ones are largely the result of human interactions with and encroachment on nature. As human societies expand in a progressively interconnected world and the human–animal interface is perturbed, opportunities are created, often aided by climate changes, for unstable infectious agents to emerge, jump species, and in some cases adapt to spread among humans.

An inevitable conclusion of my reflections on the evolution of the field of infectious diseases is that the pundits of years ago were incorrect and that the discipline is certainly not static; it is truly dynamic. In addition to the obvious need to continue to improve on our capabilities for dealing with established infectious diseases such as malaria and tuberculosis, among others, it is now clear that emerging infectious diseases are truly a perpetual challenge. As one of my favorite pundits, Yogi Berra, once said, “It ain’t over till it’s over.” Clearly, we can now extend that axiom: when it comes to emerging infectious diseases, it’s never over. As infectious-disease specialists, we must be perpetually prepared and able to respond to the perpetual challenge.”

I encourage you to share and read his perspective. I personally am very grateful for Dr. Fauci’s interest, perseverance and work with infectious diseases.  Thank you so much for all your work Dr. Fauci – we owe you so much!