This is an archived USAID document retained on this web site as a matter of public record.
Administrator J. Brian Atwood
USAID Conference on infectious Disease
Washington, D.C., December 17, 1997
U.S. Agency for International Development
I want to thank you all for coming -- many of
you from thousands of miles away -- to what I
believe is a very important discussion. Thirty
years ago, we often used to hear, "If you're not
part of the solution, you're part of the problem."
While the circumstances have changed a bit since
the sixties, everyone in this room is here because
you can be part of the solution and because you
are making unique contributions to combatting the
scourge of infectious diseases.
Certainly we are offered almost daily
reminders of the depth of the problems we face.
While the leading experts on disease outbreaks are
gathered for this conference, a new and deadly
avian flu appeared in Hong Kong. This
underscores the fact that we can't predict when
these issues will arise, but we can confidently
predict that they will arise. Safety can only come
through preparedness. This highlights the
importance of your advice in shaping our strategy.
When we look at the numbers affected by
infectious diseases in the developing world, and
when we consider the suffering and the immense
social costs spurred by disease, we know that more
has to be done -- and soon. On World AIDS Day,
I had the dubious pleasure of releasing the findings
of a USAID study on AIDS that found that more
than 40 million children -- in just the 23
developing nations we looked at -- will likely have
lost one or both their parents by 2010.
Most of these deaths will be the result of the
AIDS epidemic and complicating illnesses. The
human and social costs of these numbers are
absolutely staggering. But what is even more
troubling: this is but one disease of many, and the
burdens of any given disease will be exacerbated
by all the others.
Pestilence has been with us since the four
horsemen of the Apocalypse. For as long as we
have existed as a species, our closest companions
from cradle to grave have been microbes. Some
of the most compelling moments of human history
turn on our battle against disease. It is small
wonder that Typhoid Mary, the Black Death and
Scarlet Fever have worked their way into the
collective consciousness.
In our age old battle against disease,
complacency has always been the greatest threat.
As microbes evolve right along beside us, they
patiently bide their time, ready to strike down vast
numbers when our ability, or willingness, to
respond as a society has wavered.
In its seminal 1992 report, the Institute of
Medicine issued a wake-up call to the American
people about the re-emerging risk of infectious
disease. As the report described in detail, the
developing world provides an all too fertile
breeding ground disease. The Institute of
Medicine highlighted the following dynamics
driving this new era in disease:
-- The combination of rapid population growth
and equally rapid urbanization are creating
more and more areas dense with the critical
human mass capable of triggering and
sustaining epidemics;
-- Changing patterns of economics and land use
are leading to increasing encroachment on rain
forest "hot zones" around the world and
exposure to new and variant microbes;
-- Booming international travel and commerce
now mean any organism on earth is now less
than one day away from our own cities;
-- The ability of these same microorganisms to
evolve and adapt to the drugs we have
developed to fight them over the last half
century;
-- And, of course, the breakdown of public
health measures needed to fight diseases at
their source in the developing world -- the
kind of trench warfare that had been so very
effective in reducing this threat until the last
decade.
Fortunately, this report did not fall on deaf
ears. Recognizing that the new threats to national
security after the end of the Cold War went well
beyond traditional military issues, the Clinton
Administration tasked its Committee on
International Science, Engineering and Technology
to study this problem and come up with concrete
recommendations. The resulting Presidential
Decision Directive on Emerging Infectious
Diseases, issued in 1996, has served as the basis
for my agency's development of a draft plan,
which you have been discussing -- and improving -- for the past two days.
Our efforts to combat infectious disease are
very much a team effort. Congress deserves
praise for its role in this expanded initiative.
Senator Leahy, who we were fortunate to have
help open this conference, well understands the
growing importance of non-traditional threats to
our national security, and it was his vision and
leadership that saw to it that there would be
resources to back up the words. Similarly,
Congressman Sonny Callahan, long a supporter of
child survival programs, led the House in
increasing USAID's budget in order to address this
critical issue. This $50 million for this fiscal year
will give us all some critically needed tools in our
common cause.
I want to note that it was largely because of
the efforts of these two Congressional leaders that
USAID's appropriated budget this year reversed its
precipitous decline. I congratulate them on their
foresight and prudence on behalf of the American
people.
Let me turn to the critical work that you have
all been carrying out over the past two days. An
expanded budget has little value without a
thoughtful and meaningful plan based on solid
technical analysis and an understanding of the real
world. The draft of my agency's Infectious
Disease Strategy, which has served as the basis for
these discussions was never envisioned to be the
end point, but rather the starting point for
discussions with you, our partners in this effort.
Your presence here and your active dialogue
shows that it has served that purpose admirably.
Your intense efforts over the past two days, which
my Senior Health Advisor, Dr. Nils Daulaire, has
kept me abreast of, has done a great deal to clarify
the path that we should take in incorporating an
infectious disease strategy into the core of our
development strategy. And just as important, it
has identified many of the steps that we must take
together, among all of our various institutions with
their individual capacities, in order to have the
greatest possible impact on infectious diseases
worldwide.
With these new insights, we are prepared to
work with you to address the issue of microbes
that are increasingly resistant to drug treatment;
to expand common efforts to control tuberculosis;
to fight the expansion of malaria around the globe;
and to help set in place a system of disease
surveillance that builds the lasting capacities of the
countries themselves.
Together we will se to it that outbreaks like the
one in Hong Kong today do not go unrecognized.
Fortunately, Hong Kong already has a first rate
surveillance system. USAID's new infectious
disease will help extend surveillance systems -- our
critical tripwire in combatting disease --
throughout the developing world.
USAID staff will begin tomorrow reviewing
your recommendations, incorporating your advice,
and working with you to enlarge the partnership
you have helped establish.
I know that you are all keenly interested in the
budget that will come out of this process over the
next few months -- this has been far from an
academic exercise, and $50 million has a
wonderful way to concentrate the mind. But I
would be careful in reminding you that we cannot
save the world with $50 million. We will not be
able to fully fund every deserving program or
research initiative. But this money will make a
real difference, and we are committed to using it
to maximize its effect.
Your solid judgement and expertise has led
you to focus first on what it is we all need to do,
where critical gaps exist in programs and how we
need to address those gaps. This is the best basis
for deciding how resources can be wisely and well
spent, and is consistent with the charge we were
given by Senator Leahy at the opening of this
meeting.
We all know the story of the group of blind
men describing an elephant from their own point
of view. I would certainly not suggest that we are
gathered here as a group of visually impaired.
However, we all bring to this discussion the
strength of our specific perspectives. Represented
among you are a broad variety of personal and
institutional missions, and each of us would
probably describe our particular elephant
somewhat differently.
At USAID, our mission of course is, and will
continue to be, sustainable development. We view
all our programs and funds through the lens of
what they will do to strengthen societies' ability to
address their own problems over the long term.
Our job is to build America's partners of
tomorrow, not to preserve dependency on our
largesse, or our expertise. Triage can only be
effective in the short term.
We must build the capacity of societies to deal
with these issues over the long term, with their
own resources and with their own expertise. This
is at times a different vantage point from those of
you whose mission is to deal with disease, often
one particular disease, and whose first priority is
to get the job done as quickly and efficiently as
possible. I believe the discussion that has
unfolded over the past two days has brought these
two vantage points together, so that we are all
much closer to being able to envision that elephant
as it really is: not just an issue of microbes, but
one of human societies. Not just of cure, but of
fundamental prevention.
As we move over the next months from a
strategy to a definite plan, we intend to build on
the collaboration that has been established here. I
have asked our Office of Health and Nutrition,
together with our Policy Bureau and regional
geographic bureaus, to continue their consultations
with you as the plan for this year's budget is
developed. And I have asked Dr. Daulaire to
make sure that the process continues to be open
and collegial, and to assure that the end product
will both fight disease and promote sustainable
development.
Let me end with a clear understanding of what
all of us have to offer. We at USAID believe that
our development expertise provides a critical
element to this common effort, but so too does the
disease control expertise of the Centers for Disease
Control and Prevention, the research expertise of
the National Institutes of Health, the global
technical expertise of the World Health
Organization, and the unique contributions of the
other institutions we have invited here. Each of us
has resources, both human and financial, that we
can mobilize for this important goal. This is an
effort far greater than the $50 million that the
Congress has put on the table, and one that will
need to be carried on for many years.
The eternal enemies of human health will
never rest in their continued efforts to find the
chinks in our common armor. We are fortunate to
have the opportunity to strengthen that armor
through our joint efforts. Your work here has
done a great deal toward this end. I look forward
to working closely with all of you and thank you
for your insight and dedication.
Thank you.
This is an archived USAID document retained on this web site as a matter of public record.
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Last Updated on: July 18, 2001
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