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Institute of Medicine (US) Forum on Microbial Threats. Ending the War Metaphor: The Changing Agenda for Unraveling the Host-Microbe Relationship: Workshop Summary. Washington (DC): National Academies Press (US); 2006.

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Ending the War Metaphor: The Changing Agenda for Unraveling the Host-Microbe Relationship: Workshop Summary.

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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. It was established by the Institute of Medicine (IOM) to provide structured opportunities for leaders from government, academia, and industry to meet and examine issues of shared concern regarding research, prevention, detection, and management of emerging or reemerging infectious diseases. In pursuing this task, the Forum provides a venue 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; for this reason, it does not provide advice or recommendations on any specific policy initiative pending before any agency or organization. Rather, its strengths are embodied in the diversity of its membership and the contributions of individual members expressed throughout the activities of the Forum. In September 2003, the Forum changed its name to the Forum on Microbial Threats.

About the Workshop

In the mid-1970s, the U.S. Surgeon General claimed that infectious diseases had been conquered through the development and use of antibiotics and vaccines and that therefore it was time to shift the U.S. government’s attention and resources to the “War on Cancer.” The ensuing years have brought us Legionnaire’s disease, toxic shock syndrome, an awareness of Lyme disease, outbreaks of hantavirus throughout the southwestern United States, SARS, and of course, HIV. The discovery that infection with Helicobacter pylori is associated with peptic ulcer and gastric cancer has led to an increasing search for the infectious nature of other “noninfectious” diseases such as atherosclerosis.

Infectious diseases remain the leading causes of death and morbidity on our planet. For these reasons, the IOM’s Forum on Microbial Threats hosted a public workshop: “Ending the War Metaphor: The Future Agenda for Unraveling the Host-Microbe Relationship.” Through invited presentations and discussion, this workshop aimed to inform the Forum, the public, and policymakers of the dynamic host-microbe-environment relationships and to explore the issues that must be resolved to better prepare and protect the global community from infectious disease threats.

Resistance in microbes—bacterial, viral, or protozoan—to therapeutics is not surprising or new. It is, however, an increasing challenge as drug resistance accumulates and accelerates, even as the drugs for combating infections are reduced in power and number. Today some strains of bacterial and viral infections are treatable with only a single drug, some no longer have effective treatments. The disease burden from multidrug-resistant strains of tuberculosis, malaria, hepatitis, and HIV is growing in both developed and developing countries.

The challenges of resistance are compounded by growing concerns about the possible use of biological weapons leading to large-scale disease outbreak or exposure. The ability to respond effectively to such exposures could be significantly compromised by the introduction of drug-resistant pathogens. The use of prophylactic drugs or therapies on large populations may also contribute to the development of drug resistance and thus increase both the immediate and longer-term challenges of treating infectious diseases.

With such evidence of a dwindling armamentarium to wage our wars against infectious diseases, it has been suggested that a paradigm shift is warranted in how we address the threats posed by pathogens. In an attempt for the Forum to understand how such a new lens might be devised through which the challenges of disease should be viewed, the presentations and discussions of the workshop were structured to explore the existing knowledge and unanswered questions indicated by (but not limited to) the following topics:

  • host-pathogen interactions: defining the concepts of pathogenicity, virulence, colonization, commensalism, and symbiosis;
  • the ecology of host-microbe interactions;
  • understanding the dynamic relationships of host-microbe interactions;
  • novel approaches for mitigating or minimizing the development of antimicrobial resistance; and
  • challenges and opportunities for developing a new paradigm to replace the “war metaphor” of the host-microbial relationship.

The issues pertaining to these topical areas were addressed through invited presentations and subsequent discussions that highlighted the complexity and incompleteness of our appreciation of the dynamic interplay between a host and its associated microbial flora and fauna, and identified areas for research collaborations within and between the clinical medicine, veterinary medicine, and plant pathology communities.

Copyright © 2006, National Academy of Sciences.
Bookshelf ID: NBK57061
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