In March, Puerto Rico declared a public health emergency over an alarming outbreak of dengue fever. Local officials have confirmed more than 500 cases of the potentially fatal mosquito-borne virus as of mid-April, a record that far surpasses previous years' annual totals.
Puerto Rico is not the only part of our nation affected by dengue; 35 states have reported cases so far this year.
Though once seen as a disease that only afflicted people in developing countries, dengue — and diseases like it — now poses an imminent danger to American public health. We need leadership from Washington to develop a comprehensive plan to track, fight and prevent these diseases.
The dengue outbreak in Puerto Rico is not a "one-off" problem. Far from it. This disease is endemic in 100 countries, causing up to 400 million infections a year and about 40,000 deaths. Dengue fever is one of about 20 "neglected tropical diseases." Every neglected tropical disease places overseas American military forces, workers and travelers at risk.
And increasingly, these diseases threaten Americans within the continental United States. Dengue, yellow fever, Chagas and Zika have expanded beyond their historical tropical origins with the spread of the Aedes mosquito and other carriers. Florida, Texas and other temperate — but not tropical — Southern states were previously too cold for these mosquitos to thrive. But as average temperatures keep rising due to global heating, that has changed. In recent years, multiple states have reported locally acquired cases of malaria and Zika.
While not currently on the World Health Organization’s official list of neglected tropical diseases, there is a push to accord Valley Fever that designation. Valley fever is another global infectious threat — this one a fungal infection – that is gaining a stronghold in the U.S. With symptoms ranging from mild to pneumonia-like and carrying the risk of long-term lung damage, Valley Fever is endemic in parts of South America and in Southwestern states like California and Arizona. More recently, cases have emerged in Illinois and other Midwestern states. These trendlines are unlikely to reverse on their own.
As neglected diseases like these continue to wreak havoc globally and increasingly threaten the health and lives of Americans, our nation is without a plan to fight back.
That is not the fault of any one administration or Congress. Neglected tropical diseases are aptly named; they have been overlooked, underfunded and under-researched for decades.
In fiscal 2020, the U.S. government devoted $103 million in funding for these diseases — just $3 million more than Congress appropriated six years earlier, in fiscal 2014 — effectively a cut in funding after inflation. And to date, no administration has produced a plan for tracking, treating and preventing these diseases.
We need that plan. We need coordinated action across federal, state and local governments and the public and private sectors to fill dangerous gaps in surveillance, clinical protocols and neglected tropical disease countermeasures.
Our nation has the research and public health capacity to reverse the upward trajectory and reduce the staggering toll of neglected tropical diseases. In fact, just this month, the World Health Organization prequalified a new dengue vaccine — only the second to receive prequalification. This is a welcome and important development. Currently the vaccine is only recommended for children and is not yet approved for use in the U.S. The need for new Dengue diagnostics and interventions is significant and further progress against other neglected tropical diseases is imperative; the work of scientists in both the public and private sectors is far from over.
Similarly, our elected leaders have their work cut out for them. They need to formulate and set in motion an action plan that leverages those capacities to get the job done.
Hopefully, future generations will look back on the Dengue outbreak in Puerto Rico as the catalyst for an enduringly significant societal accomplishment, not a danger signal we missed or dismissed.
