On the plus side, the full-court press applied to the emergence of HIV/AIDS resulted in the reversal of a universally fatal outcome to that of a chronic, albeit a serious, illness that is manageable with medication. The development of highly active antiretroviral therapy (HAART) that is relatively convenient to take has made living with AIDS a reality for millions. Additionally, the President’s Emergency Plan for AIDS Relief has made headway in addressing the availability of medication on a global basis. Moreover, several prevention strategies focused on educating the public as well as making condoms and circumcision available have stemmed the tide in HIV acquisition.
Also, the spike in hepatitis C infections resulted in a substantial response from the research community. The growth of available effective treatments has expanded substantially, resulting in the capacity to clear the virus in many patients. Vaccines to prevent hepatitis B, hepatitis A, Haemophilus influenzae type b, human papillomavirus, Lyme disease, rotavirus, and a nasal influenza vaccine have all been introduced in the last 30 years. Basic science advances in the genomic and proteomic underpinnings of bacterial and viral processes as well as host susceptibility have opened the door for applied sciences to move the field further ahead in the next generation.
Regardless, the uphill struggle continues. As pointed out by NIAID Director Anthony Fauci, “If history is our guide, we can assume that the battle between the intellect and will of the human species and the extraordinary adaptability of microbes will be never-ending.” 3 Challenges such as methicillin resistant Staphlococcus aureus, multidrug and cross-drug resistant tuberculosis, emerging infections such as the novel Middle East respiratory syndrome coronavirus, bird-tohuman influenza transmission in China, sporadic outbreaks of chikungunya, Marburg, and Ebola viruses as well as the always present threat of malaria and dengue fever throughout most of Africa, parts of Asia, and South America continue to overwhelm health care systems and perplex practitioners and researchers. Added to this burden are those diseases resulting from inadequate sanitary conditions leading to cholera and bacterial diarrhea. Moreover, while AIDS treatment allows patients to live nearly normal lives, the long-term effects of prolonged therapy with HAART, such as the increased incidence of atherosclerosis, continue to push the research community to discover a cure as well as an effective vaccine. And for diseases for which childhood immunizations are effective, poorly informed information campaigns have inappropriately scared away parents from making appropriate vaccination decisions for their children.
Practitioners and researchers in the federal sector are in the forefront of the struggle. The unique capabilities of the various agencies when used through a coordinated and collaborative effort, especially when working with nongovernmental organizations such as the Gates Foundation and willing industry partners, can be a formidable force. Whether it be the infectious disease physician consulting on cases in the health care setting, the researcher at the bench or in the field, or the public health information specialist developing messages to advocate for appropriate adherence to vaccination schedules, we all have a place in pushing the stone forward—and perhaps imagining ourselves as happy doing it.