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Building local capacity to fight epidemics

Containing global virus outbreaks starts at home.

The arduous and painful lessons learned from the ongoing Ebola outbreak and other recent epidemics like SARS, MERS, Chikungunya, influenza and of course HIV/AIDS, demonstrate how vulnerable the global community is to viral infections and how rapidly a virus outbreak in one part of the world can quickly shut down operations and harm people in distant countries.

Most of the recent calls to action to combat global viruses emphasize increasing health care system capacity to detect pathogens in all countries and establishing a reserve group of experts who can travel to hotspots of infections. While these efforts are important, the Global Virus Network (GVN), a Baltimore-based non-profit organization, believes that the most effective way to combat a global epidemic is to start at the local level with support and training for medical virologists in every country.

In our testimony to the Senate Appropriations Committee on the U.S. government response to Ebola, we called on all partners to support training of local medical virologists — who could work in trusting relationships with colleagues worldwide — as an essential component of the global safety net against pandemics. Local challenges must be met with cultural sensitivity and local expertise, or we run the risk of losing the trust of people who are needed to ensure that prevention activities are put in place. It is a culture of science, well implemented and adequately funded, in every nation that holds the most hope against viral pandemics.

A prime example of the positive impact of developing and maintaining a cadre of highly skilled virologists in resource-poor nations is the containment of Ebola in Nigeria last year — a miraculous feat in Africa's most populous country. Among those credited for stemming the spread of Ebola were Nigerian doctor Abdulsalam Nasidi, who had received specialized training in virology at the Institute of Human Virology (IHV) at the University of Maryland School of Medicine, and John Vertefeuille, a CDC epidemiologist, also affiliated with IHV, who had lived in Nigeria for four years and worked with Nigerian officials on the global campaign to eradicate polio. The Nigerian response to the Ebola epidemic depended on an infrastructure built through a 10-year investment from the U.S. President's Emergency Plan for AIDS Relief and NIH that included development of local Nigerian expertise.

When Ebola breached the Nigerian border through air travel from a neighboring hotspot, Drs. Nasidi and Vertefeuille and their team engaged rapidly to trace 895 contacts of 19 laboratory-confirmed cases stemming from the one initial case. This involved 18,500 face-to-face interviews, allowing for a local response which avoided the chaos of an uncontrolled outbreak as seen in neighboring countries that did not have this infrastructure. The key to this response was a trained epidemiology and laboratory team already in place that was able to contain individual cases and that prevented what could have become a national tragedy.

GVN, which represents more than 25 countries and comprises foremost experts in every class of virus-causing disease in humans, believes that training for virologists in every country will lay a solid foundation for developing global systems and processes, such as those outlined by Bill Gates in his recent editorial in the New England Journal of Medicine and World Bank president Jim Kim in a New York Times op-ed.

With the current momentum to do more to facilitate the detection and response to viral infections, we encourage national and global public policy makers, business leaders and academic leaders to increase support for the training of the next generation of medical virologists as part of comprehensive pandemic preparedness plans. Senior leaders in virology should redouble efforts to inspire the next generation to pursue and flourish in medical virology careers. And government and private sector leaders should step up investments in training of tomorrow's virologists as a critical element of pandemic preparedness plans. Acting together, and with urgency, we can safeguard our future against pandemics by supporting a cadre of well-trained medical virologists globally. Without such a force of viral disease experts, we are all at risk.

Dr. Robert C. Gallo is co-founder and scientific director of GVN and director of the Institute of Human Virology at the University of Maryland School of Medicine, a GVN Center of Excellence. N. Scott Fine is chairman of the board of GVN. Dr. Diane E. Griffin is University Distinguished Service Professor, W. Harry Feinstone Department of Molecular Microbiology and Immunology, and director of GVN Center of Excellence at Johns Hopkins Bloomberg School of Public Health. Sharon H. Hrynkow is president of GVN.

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