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 2003 the Forum changed its name to the Forum on Microbial Threats.


The global response to the recent severe acute respiratory syndrome (SARS) epidemic has demonstrated strengths and weaknesses in national and international capacities to address infectious disease challenges. The story of the emergence, spread, and control of SARS illustrates the considerable economic, political, and psychological effects—in addition to the impact on public health—of an unanticipated epidemic in a highly connected and interdependent world. At the same time, the rapid response to SARS reflects significant achievements in science, technology, and international collaboration.

The future is likely to bring far greater challenges. Will SARS reemerge, and with greater virulence? Can we contain a more widely disseminated epidemic? Will we have preventive or therapeutic countermeasures? Can the necessary global cooperation and resources for containment be sustained? If not SARS, are we prepared for the next emerging infection? Are our public health and research investments (human, technical, and financial) flexible enough to respond to the ever-changing profile of microbial threats?

These and other questions were explored during a September 30 and October 1 workshop of the Forum on Microbial Threats. The goals of the workshop were to:

  1. Discuss the origin, emergence, and spread of SARS and the ensuing global response to the epidemic.
  2. Evaluate measures employed to contain and control SARS, as well as its clinical management.
  3. Examine evidence of the economic impact of this and future epidemics.
  4. Look at the political repercussions of the international effort to address the threat posed by SARS.
  5. Explore the future of research and technological development related to SARS.
  6. Consider preparations for the next infectious disease outbreak.

The issues pertaining to these goals were addressed through invited presentations and subsequent discussions, which highlighted ongoing programs and actions taken, and also identified the most vital needs in these areas.


This workshop summary was prepared for the Forum membership in the name of the editors, with the assistance of staff and consultants, as a collection of individually authored papers. 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 SARS 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 SARS 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 chapter discusses the core messages that emerged from the speakers’ presentations and the ensuing discussions. Chapters 1 through 5 begin with overviews provided by the editors, followed by papers that reflect the contents of invited speaker presentations. The papers in Chapter 1 describe the emergence and detection of the SARS coronavirus and the global response to the epidemic. The papers in Chapter 2 describe the economic fall-out— known and projected—of the SARS epidemic and analyze political and governmental responses to it. Chapter 3 includes papers on the microbiology, ecology, and natural history of coronaviruses, the genus of viruses to which the SARS agent belongs. The articles in Chapter 4 describe the development of diagnostics, therapeutics, and other technologies to control SARS. Finally, the papers in Chapter 5 examine how SARS might reemerge and how the world could prepare for the next major outbreak of infectious disease.


The Forum on Microbial Threats and IOM wish to express their warmest appreciation to the individuals and organizations who gave valuable time to provide information and advice to the Forum through participation in the workshop (see Appendix A for the workshop agenda and Appendix F for a list of forum, speaker, and staff biographies).

The Forum is indebted to the IOM staff who contributed during the course of the workshop and the production of this workshop summary. On behalf of the Forum, we gratefully acknowledge the efforts led by Stacey Knobler, director of the Forum, and Alison Mack, technical consultant, who dedicated much effort and time to developing this workshop’s agenda, and for their thoughtful and insightful approach and skill in translating the workshop proceedings and discussion into this workshop summary. Particular recognition is given to Katherine Oberholtzer whose tireless research efforts and technical editing were essential to the framing of the workshop and its report. Considerable thanks is expressed to Laura Sivitz for her thoughtful guidance in preparing the report for review and her editing of the report. We also express our gratitude to Karl Galle who contributed greatly to the final editing and organization of the chapter overviews and technical papers. Initial drafts of the report benefited greatly from technical re-views by James Hughes, Michael Osterholm, and David Relman. We would also like to thank the following IOM staff and consultants for their valuable contributions to this activity: Patrick Kelley, Bernadette Pryde Hackley, Marcia Lewis, Amy Giamis, Joe Esparza, Harriet Banda, Dianne Stare, Marjan Najafi, Jennifer Bitticks, Bronwyn Schrecker, Porter Coggeshall, Jennifer Otten, and Sally Stanfield.

Finally, the Forum also thanks sponsors that supported this activity. Financial support for this project was provided by the U.S. Department of Health and Human Services’ National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; U.S. Department of Agriculture; American Society for Microbiology; Burroughs Wellcome Fund; Pfizer; GlaxoSmithKline; and the Merck Company Foundation. The views presented in this workshop summary are those of the editors and workshop participants and are not necessarily those of the funding organizations.

Adel Mahmoud, Chair

Stanley Lemon, Vice-Chair

Forum on Microbial 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.