Ending the War Metaphor: The Changing Agenda for Unraveling the Host-Microbe Relationship - Workshop Summary

307 Pages·2006·6.91 MB·English

by  Forum on Microbial Threats

ENDING THE
WAR METAPHOR
The Changing Agenda for Unraveling
the Host-Microbe Relationship
Workshop Summary
Forum on Microbial Threats
Board on Global Health
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy of
Sciences, the National Academy of Engineering, and the Institute of Medicine.
This project was supported by the American Society for Microbiology; Burroughs Wellcome Fund;
Defense Threat Reduction Agency; GlaxoSmithKline; Infectious Disease Society of America;
Lawrence Livermore National Laboratory; Merck; Pfizer; Sanofi Pasteur; U.S. Department of Health
and Human Services’ National Institutes of Health/National Institute for Allergies and Infectious
Disease and Centers for Disease Control and Prevention; U.S. Department of Defense/Global Emerg-
ing Infections Surveillance/Walter Reed Army Institute of Research; U.S. Department of Homeland
Security; U.S. Department of State; and U.S. Department of Veterans Affairs. The views presented in
this report are those of the editors and attributed authors and are not necessarily those of the funding
agencies.
This report is based on the proceedings of a workshop that was sponsored by the Forum on Microbial
Threats. It is prepared in the form of a workshop summary by and in the name of the editors, with the
assistance of staff and consultants, as an individually authored document. Sections of the workshop
summary not specifically attributed to an individual reflect the views of the editors and not those of
the Forum on Microbial Threats. The content of those sections is based on the presentations and the
discussions that took place during the workshop.
Library of Congress Cataloging-in-Publication Data
Ending the war metaphor : the changing agenda for unraveling the host-
microbe relationship : workshop summary / Forum on Microbial
Threats, Board on Global Health.
p. ; cm.
Includes bibliographical references.
ISBN 0-309-09601-4 (pbk.)
1. Host-parasite relationships—Congresses. 2. Communicable diseases
—Transmission—Congresses. 3. Microbiology—Congresses.
I. Institute of Medicine (U.S.). Forum on Microbial Threats.
[DNLM: 1. Host-Parasite Relations—Congresses. 2. Communicable
Diseases, Emerging—microbiology—Congresses. 3. Communicable
Diseases, Emerging—prevention & control—Congresses. 4. Drug
Resistance, Microbial—Congresses. QX 45 E56 2006]
RB153.E53 2006
616.9′041—dc22
2006012949
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Copyright 2006 by the National Academy of Sciences. All rights reserved.
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emies and the Institute of Medicine. Dr.Ralph J. Cicerone and Dr.Wm. A. Wulf are chair
and vice chair, respectively, of the National Research Council.
www.national-academies.org
FORUM ON MICROBIAL THREATS
Stanley M. Lemon (Chair), School of Medicine, University of Texas Medical
Branch, Galveston
P. Frederick Sparling (Vice-chair), University of North Carolina, Chapel Hill
Margaret A. Hamburg (Vice-chair), Nuclear Threat Initiative/Global Health
& Security Initiative, Washington, D.C.
David Acheson, Center for Food Safety and Applied Nutrition, Food and Drug
Administration, Rockville, Maryland
Ruth Berkelman, Emory University, Center for Public Health Preparedness
and Research, Rollins School of Public Health, Atlanta, Georgia
Roger Breeze, Centaur Science Group, Washington, D.C.
Steven J. Brickner, Pfizer Global Research and Development, Pfizer Inc.,
Groton, Connecticut
Joseph Bryan, Office of Medical Services, Department of State, Washington,
D.C.
Nancy Carter-Foster, Program for Emerging Infections and HIV/AIDS, U.S.
Department of State, Washington, D.C.
Mark Feinberg, Merck Vaccine Division, Merck & Co., West Point,
Pennsylvania
J. Patrick Fitch, Lawrence Livermore National Laboratory, Livermore,
California
S. Elizabeth George, Biological and Chemical Countermeasures Program,
Department of Homeland Security, Washington, D.C.
Jesse L. Goodman, Center for Biologics Evaluation and Research, Food and
Drug Administration, Rockville, Maryland
Eduardo Gotuzzo, Instituto de Medicina Tropical–Alexander von Humbolt,
Universidad Peruana Cayetano Heredia, Lima, Peru
Jo Handelsman, College of Agricultural and Life Sciences, University of
Wisconsin, Madison
Carole A. Heilman, Division of Microbiology and Infectious Diseases,
National Institute of Allergy and Infectious Diseases, National Institutes of
Health, Bethesda, Maryland
David L. Heymann, Polio Eradication, World Health Organization, Geneva,
Switzerland
Phil Hosbach, New Products and Immunization Policy, Sanofi Pasteur,
Swiftwater, Pennsylvania
James M. Hughes, Global Infectious Diseases Program, Emory University,
Atlanta, Georgia
Stephen Johnston, University of Texas Southwestern Medical Center, Dallas
Gerald T. Keusch, Boston University School of Medicine and Boston
University School of Public Health, Massachusetts
Lonnie King, College of Veterinary Medicine, Michigan State University, East
Lansing
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George Korch, United States Army Medical Research Institute for Infectious
Diseases, Ft. Detrick, Maryland
Joshua Lederberg, The Rockefeller University, New York
Joseph Malone, Department of Defense Global Emerging Infections System,
Walter Reed Army Institute of Research, Silver Spring, Maryland
Lynn Marks, Medicine Development Center, GlaxoSmithKline, Collegeville,
Pennsylvania
Stephen S. Morse, Center for Public Health Preparedness, Columbia
University, New York
Michael T. Osterholm, Center for Infectious Disease Research and Policy,
School of Public Health, University of Minnesota, Minneapolis
George Poste, Arizona BioDesign Institute, Arizona State University, Tempe
David A. Relman, Stanford University, Palo Alto, California
Gary A. Roselle, Central Office, Veterans Health Administration, Department
of Veterans Affairs, Washington, D.C.
Anne Schuchat, National Center for Infectious Diseases, Centers for Disease
Control and Prevention, Atlanta, Georgia
Janet Shoemaker, Office of Public Affairs, American Society for
Microbiology, Washington, D.C.
Brian Staskawicz, Department of Plant and Microbial Biology, University of
California, Berkeley
Terence Taylor, International Institute for Strategic Studies, Washington, D.C.
Liaisons
Enriqueta Bond, Burroughs Wellcome Fund, Research Triangle Park, North
Carolina
Nancy Carter-Foster, Program for Emerging Infections and HIV/AIDS, U.S.
Department of State, Washington, D.C.
Edward McSweegan, National Institute of Allergy and Infectious Diseases,
National Institutes of Health, Bethesda, Maryland
Staff
Eileen Choffnes, Forum Director
Stacey Knobler, Former Forum Director*
Elizabeth Kitchens, Research Associate**
Kim Lundberg, Research Associate
Allison Mack, Science Writer
Muhammad Salaam, Project Assistant
Kate Skoczdopole, Research Associate
*Until December 2004
**Until March 2005
vi
Reviewers
This report has been reviewed in draft form by individuals chosen for their
diverse perspectives and technical expertise, in accordance with procedures ap-
proved by the National Research Council’s Report Review Committee. The pur-
pose of this independent review is to provide candid and critical comments that
will assist the institution in making its published report as sound as possible and
to ensure that the report meets institutional standards for objectivity, evidence,
and responsiveness to the study charge. The review comments and draft manu-
script remain confidential to protect the integrity of the deliberative process. We
wish to thank the following individuals for their review of this report:
John Bailar, University of Chicago, Illinois
Ruth Berkelman, Center for Public Health Preparedness and Research,
Rollings School of Public Health, Emory University, Atlanta, Georgia
Lora Hooper, Center for Immunology, University of Texas Southwestern
Medical Center, Dallas
Stephen S. Morse, Center for Public Health Preparedness, School of Public
Health, Columbia University, New York
The review of this report was overseen by Melvin Worth, Scholar-in-
Residence, National Academies, who was responsible for making certain that an
independent examination of this report was carried out in accordance with institu-
tional procedures and that all review comments were carefully considered. Re-
sponsibility for the final content of this report rests entirely with the authoring
committee and the institution.
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Preface
The Forum on Emerging Infections was created in 1996 in response to a
request from the Centers for Disease Control and Prevention and the National
Institutes of Health. It was established by the Institute of Medicine (IOM) to
provide structured opportunities for leaders from government, academia, and in-
dustry to meet and examine issues of shared concern regarding research, preven-
tion, detection, and management of emerging or reemerging infectious diseases.
In pursuing this task, the Forum provides a venue to foster the exchange of infor-
mation and ideas, identify areas in need of greater attention, clarify policy issues
by enhancing knowledge and identifying points of agreement, and inform deci-
sion makers about science and policy issues. The Forum seeks to illuminate is-
sues rather than resolve them directly; for this reason, it does not provide advice
or recommendations on any specific policy initiative pending before any agency
or organization. Rather, its strengths are embodied in the diversity of its member-
ship and the contributions of individual members expressed throughout the ac-
tivities of the Forum. In September 2003, the Forum changed its name to the
Forum on Microbial Threats.
ABOUT THE WORKSHOP
In the mid-1970s, the U.S. Surgeon General claimed that infectious diseases
had been conquered through the development and use of antibiotics and vaccines
and that therefore it was time to shift the U.S. government’s attention and re-
sources to the “War on Cancer.” The ensuing years have brought us Legionnaire’s
disease, toxic shock syndrome, an awareness of Lyme disease, outbreaks of
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