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. The goal of the Forum is to provide structured opportunities for representatives from academia, industry, professional and interest groups, and government1 to examine and discuss scientific and policy issues that are of shared interest and that are specifically related to research and prevention, detection, and management of infectious diseases. In accomplishing this task, the Forum provides the opportunity to foster the exchange of information and ideas, identify areas in need of greater attention, clarify policy issues by enhancing knowledge and identifying points of agreement, and inform decision makers about science and policy issues. The Forum seeks to illuminate issues rather than resolve them directly; hence, it does not provide advice or recommendations on any specific policy initiative pending before any agency or organization. Its strengths are the diversity of its membership and the contributions of individual members expressed throughout the activities of the Forum. In September of 2003 the Forum changed its name to the Forum on Microbial Threats.

About the Workshop

We live in a time of unprecedented human movement and interaction. As transborder mobility of humans, animals, food, and feed products increases, so does the threat of the spread of infectious disease. While new global markets have created economic opportunities and growth, the benefits have not been equally distributed, and the risks—especially the health risks—of our increasingly interconnected and fast-paced world continue to grow. Although the burden is greatest for the developing world, infectious diseases are a growing threat to all nations.

The resurgence of malaria is a dramatic example of the effects of globalization on disease trends. Twenty years ago, more than 80 percent of the world’s population lived in malaria-free or controlled areas. But today, malaria is the most prevalent vectorborne disease, with more than 40 percent of the world’s population living in endemic areas. Furthermore, with increased air travel and human movement, imported malaria is on the rise in Europe and North America. The AIDS pandemic and the global spread of the annual influenza virus further illustrate how vulnerable even industrialized nations are to unexpected outbreaks and the spread of infectious disease in today’s globalized society.

However, the same globalizing forces that create such rampant opportunity for pathogens also can provide mechanisms for innovative, global efforts to control infectious diseases. A new network of international public health partners is emerging. Multinational partnerships are contributing to the increased availability of drugs and vaccines, the development of health care infrastructures in developing countries, and better public health education programs worldwide. The global proliferation of technology and information has the potential to improve the identification, surveillance, containment, and treatment of disease in both developed and developing countries. Growing international cooperation may lead to more robust and transparent reporting regarding disease outbreaks and control efforts. Distance learning, training, and research exchange programs are creating improved access for scientific and medical professionals.

On April 16 and 17, 2002, the Forum on Emerging Infections held a working group discussion on the influence of globalization on the emergence and control of infectious diseases. Through invited presentations and participant discussion, the workshop explored the impact of increasingly integrated trade, economic development, human movement, and cultural exchange on patterns of disease emergence; identified opportunities for countering the effects of globalization on infectious diseases; examined the scientific evidence supporting current and potential global strategies; and considered newly available response methods and tools available for use by private industry, public health agencies, regulatory agencies, policy makers, and academic researchers. During the last session of the workshop, Forum members, panel discussants, and the audience commented on issues and next steps that they consider priority areas for action.

Organization of Workshop Summary

This workshop summary was prepared for the Forum membership in the name of the editors, with the assistance of staff and consultants. The sections of this summary that are not specifically attributed to an individual reflect the views of the editors exclusively—they do not reflect the views of the Institute of Medicine (IOM) or of the organizations that sponsor the Forum on Microbial Threats. The contents of the unattributed sections are based on the presentations and discussions that took place during the workshop.

The globalization workshop functioned as a venue for dialogue among representatives from many sectors about their beliefs on subjects that may merit further attention. The reader should be aware that the material presented here reflects the views and opinions of those participating in the workshop and not the deliberations of a formally constituted IOM study committee. Moreover, these proceedings summarize only what participants stated in the workshop and are not intended to be an exhaustive exploration of the subject matter.

This summary is organized as a topic-by-topic description of the presentations and discussions from the workshop. The purpose is to present lessons from relevant experience, delineate a range of pivotal issues and their respective problems, and put forth some potential responses as described by the workshop participants. The Summary and Assessment discusses the core messages that emerged from the working group discussions. Chapter 1 summarizes the presentations and discussions related to the increasing cross-border and cross-continental movements of people, products, pathogens, and power, and how these affect the emergence and spread of infectious diseases. Chapter 2 provides a summary of the presentations and discussions that revolved around the changing global landscape and how this could exacerbate the emergence and global spread of infectious diseases. Chapter 3 focuses on the opportunities and obstacles surrounding the global application of knowledge, tools, and technology that result from increasing globalization. Chapter 4 summarizes the means by which sovereign states and nations must adopt a global public health mind-set and develop a new organizational framework to maximize the opportunities and overcome the challenges created by globalization and build the necessary capacity to respond effectively to emerging infectious disease threats.



Representatives of federal agencies serve in an ex officio capacity. An ex officio member of a group is one who is a member automatically by virtue of holding a particular office or membership in another body.