Disease outbreaks are becoming increasingly common, and their impact is far-reaching. From measles in the United States to Cyclosporiasis in America and Ebola in Africa, these outbreaks expose the cracks in our global public health system. While these incidents may seem unrelated, they share a common thread: they reveal vulnerabilities in our public health infrastructure that have 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.
The Case of Measles
The resurgence of measles in the United States is a stark reminder of the importance of vaccination. 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, thanks 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 becomes 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 by misinformation and lack of trust in vaccines, has allowed for measles to make a comeback in America.
The Case of Cyclosporiasis
America's 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 epidemiological investigations, and coordination among state and federal health agencies. While multiple factors have contributed 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. The Department of Health and Human Services laid off hundreds of CDC employees last year, 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.
The Case of 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 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 decreased personnel, equipment, and laboratory tests.
Public Health Lessons
Measles, Cyclosporiasis, and Ebola are all spreading at unprecedented levels. The lessons connected these outbreaks are 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. We must take action now to strengthen our public health infrastructure and ensure that we are prepared for the next outbreak.
