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 government* 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 emerging 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 commitment of individual members expressed throughout the activities of the Forum.

A critical part of the work of the Forum is a series of workshops. The first of these, held in February 1997, addressed the theme of public- and private-sector collaboration (IOM, 1997). The second workshop took place in July 1997 and explored aspects of antimicrobial resistance (IOM, 1998). The third workshop (IOM, 2000a) examined the implications of managed care systems and the ability to address emerging infectious diseases in the age of managed care. The fourth workshop (IOM, 2000b) examined the core capacities of the public and private health sectors in emerging infectious disease surveillance and response. The fifth workshop, held in October 1999, which this document summarizes, examined the international aspects of emerging infections and the forces that drive these diseases to prominence from the global to the local levels. The topic of zoonotic diseases was the focus of the Forum’s sixth workshop, which was held in June 2000. The summary of that workshop is in production. The next workshop sponsored by the Forum will address factors surrounding viral disease eradication.


In recent years, emerging infections have captured increased attention internationally. This comes at a time when other diseases are gaining in importance. In an effort to increase our knowledge and understanding of the current and probable future public health significance of emerging infections internationally, the Institute of Medicine’s Forum on Emerging Infections hosted a 2-day workshop on October 28 and 29, 1999, titled “International Aspects of Emerging Infections.” The goal of the workshop was to collect new information on this topic from public health practitioners, academicians, and policy makers at the global, regional, national, and local levels from various geographical areas. Their presentations focused on the interplay among emerging infections, economics and trade, public health policies, population and demography, strategic planning and resource allocation, and infrastructure and capacity at their positions of practice. Panel discussions then focused on the interaction of these factors with infectious disease surveillance and response, communication and coordination, and research and training needs with recognition of the lessons and mistakes learned in the process and identification of novel approaches and obstacles at each level. Through the presentations and discussions, we hope to gain new insight into

  • the forces that drive the policies of governments and international organizations;
  • the ways in which diseases are prioritized; and
  • the strengths and weaknesses of past and current local, national, and multinational efforts to effectively bring nations and international organizations closer together to mitigate the impacts of emerging infections.

Early-on during the workshop, it was clear that the infrastructure and level of support for surveillance, research, and training on emerging infectious diseases varied widely across geographic regions. For example, in many countries a shrinking number of trained infectious disease specialists was cited. The latter point was accentuated while developing the workshop as some of the foreign scientists invited to make presentations were unavailable owing to exigent schedules and demanding workloads for the qualified few, in addition to difficulty in obtaining government permission to travel and technological obstacles to effective communication. Consequently, although the presentations were rich and wide-ranging, the workshop did not support a comprehensive and balanced treatment of issues across regions.


This report of the Forum-sponsored workshop is prepared in the form of a workshop summary by and in the name of the editors, with the assistance of staff and consultants, as an individually authored document. Sections of the workshop summary not specifically attributed to an individual reflect the views of the editors and not those of the Forum on Emerging Infections or its sponsors. The contents of the unattributed sections are based on the presentations and discussions that took place during the workshop.

The workshop summary is organized as a topic-by-topic description of the presentations and discussions. Its 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. Chapter 1 is an introduction and overview of the international perspective on confronting emerging infections. Chapter 2, Chapter 3, Chapter 4 and Chapter 5 begin with overviews provided by the editors, followed by the edited presentations made by the invited participants. Appendix A is a glossary and list of acronyms useful to the reader. Appendix B presents the workshop agenda. A list of workshop participants is found in Appendix C. Forum members and staff biographies are presented in Appendix D.

Although this workshop summary provides an account of the individual presentations, it also reflects an important aspect of the Forum philosophy. The workshop functions as a dialogue among representatives from different sectors and presents their beliefs on which areas may merit further attention. However, the reader should be aware that the material presented here expresses the views and opinions of those participating in the workshop and not the deliberations of a formally constituted Institute of Medicine study committee. These proceedings summarize only what participants stated in the workshop and are not intended to be an exhaustive exploration of the subject matter.


The Forum on Emerging Infections and the Institute of Medicine (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.

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, I gratefully acknowledge the efforts led by Jonathan Davis, study director for the Forum and coeditor of this report, who dedicated much effort and time to developing this workshop’s agenda and for his thoughtful and insightful approach and skill in translating the workshop proceedings and discussion into this workshop summary. I would also like to thank the following IOM staff for their valuable contributions to this activity: Vivian Nolan assisted with the development of the workshop agenda, Thelma Cox assisted with editing various sections of the workshop summary list and provided comprehensive administrative support and Nicole Amado assisted in developing the glossary and acronyms in Appendix A. Other IOM staff also provided invaluable help: Sue Barron, Clyde Behney, Claudia Carl, Michael Edington, Carlos Gabriel, and Andrew Pope. Kathi Hanna, a consultant and technical writer contributed significantly to writing many sections of the workshop summary. The extensive commentary and suggestions made by the copy editor, Michael Hayes, are gratefully acknowledged.

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 the U.S. Food and Drug Administration; U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; Abbott Laboratories; American Society for Microbiology; Bristol-Myers Squibb Company; Burroughs Wellcome Fund; Eli Lilly & Company; Glaxo Wellcome; F. Hoffmann-La Roche AG; Pfizer; SmithKline Beecham Corporation; and Wyeth-Ayerst Laboratories. The views presented in this workshop summary are those of the editors and workshop participants and are not necessarily those of the funding organizations.

Joshua Lederberg




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.