As the legion of Democratic presidential candidates face off this week, they will be addressing an audience that ranks health as a leading concern. A Kaiser Family Foundation poll of Democrats and independents leaning towards Democrats published earlier this month found that health care tops the issues they want to hear about.
Infectious diseases might get lost in the shuffle over access to health care, high drug prices, and health disparities, but they shouldn’t.
As a country, we are facing the resurgence of measles, the longest flu season in a decade, infectious diseases linked to the opioid epidemic, the growing challenge of antibiotic-resistant infections, and emerging public health threats such as the Zika virus. Living in a world drawn closer by trade and travel heightens the problems posed by infectious diseases. These issues should be on the minds of all voters and presidential candidates.
The debates are being held in Miami. The city and its surrounding region highlight many of the health challenges facing Americans today. As an infectious diseases specialist practicing in the city, I see many patients who have preventable infectious diseases and/or infections with limited treatment options complicated by delays in accessing care or limits placed on their treatment options.
Miami is a city enriched by a diverse population, which adds opportunities for the spread of disease and an urgency to addressing public threats confronting all Americans. It is home to retirement communities with aging populations vulnerable to infections. It is also an international travel hub where through tourism, business, and immigration people continually arrive from places lacking adequate resources to prevent, detect, and respond to infectious outbreaks.
Across America, similar elements have led to a resurgence of measles imported from elsewhere and fueled domestically by misinformation. In Miami, like other cities and towns across the country, infections are growing resistant to many first and second-line antibiotics and continue to spread while treatment options run out. An estimated 2 million Americans develop antibiotic-resistant infections each year and, according to the most recent estimates, they kill up to 162,000 people in the U.S. alone. It’s an issue the candidates should be prepared to discuss and offer ways to prevent the spread of infections, protect the antibiotics we have through appropriate usage, and provide incentives for the development of desperately needed new antibiotics.
Miami’s climate and location facilitate local outbreaks of emerging global diseases. Florida was one of just two states to see local transmission of Zika in 2016. The outbreak was another reminder of the importance of continued and robust support for the research and development of new and rapid diagnostic technology as well as the need for a trained infectious diseases workforce. All presidential candidates should have plans to protect Americans with investments in the tools and experts needed to detect and respond to new public health threats.
Miami-Dade County, along with Broward and Palm Beach counties, are among the U.S. “geographic hotspots” — counties that accounted for more than 50% of HIV diagnoses in recent years. These counties have been targeted by the Trump administration’s initiative to end HIV transmission in the next 10 years. The initiative has every chance of success, but will depend on eliminating barriers to primary care health services and will require policies supporting the inclusion of populations vulnerable to infectious diseases, including foreign-born individuals, people with substance use disorders, and those with chronic health conditions. Candidates should be prepared to discuss plans to improve access to, and awareness of health care services.
Sustained U.S. leadership of global health security efforts will be essential to optimizing the value of our domestic public health and biomedical research investments. Locally transmitted outbreaks of malaria, dengue, and Zika viruses in South Florida have demonstrated that infectious diseases do not stop at national borders, and neither should our investments. Continued leadership in the global responses to HIV, tuberculosis and to emerging infectious diseases will optimize the value of our domestic health dollars.
I see the importance of robust responses to the infectious disease and health care challenges that Americans face every day among the patients I serve in Miami. My hope is that the candidates will, too.
Ann T. MacIntyre, D.O., is an infectious diseases specialist in Miami and a board member of the Infectious Diseases Society of America.