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The Forum on Microbial Threats held a workshop on "Ending the War Metaphor: The Future Agenda for Unraveling the Host-Microbe Relationship" in March 2005. A summary of this workshop has been published.
Background and Context:
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. Yet the general public does not appear to share this perception, especially in the shadow of equally scary but less likely risks such as a bioterrorist attack with aerosolized smallpox.
The Challenges of Resistance: Re-Examining the "War" Metaphor
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 multi-drug 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.
Ecology and Dynamics of the Host-Microbe Interaction: A Path Forward
With such evidence of a dwindling armamentarium to wage our "wars" against infectious diseases, it has been suggested that a paradigm shift in how we address the threats posed by pathogens is warranted. 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 will be structured to explore the existing knowledge and unanswered questions indicated by (but not limited to) the following topics:
- an understanding of the outcomes of the relationships between the host and its prokaryotic, eukaryotic, and viral flora and fauna;
- the micro- and macro-environment beyond disease;
- whether there are beneficial relationships between microorganisms and their hosts in the context of postnatal development, immune modulation, digestion that could lead to improved approaches for disease prevention and intervention;
- what discovery, research, and therapeutic insights could be gained from a more holistic and integrated examination of host, microbe, vector, and reservoir biology?
- does the unpredictable nature of emerging or genetically-modified disease pathogens argue for strategies than enable a host response as the countermeasure?
- what effect will the development and widespread use of prebiotics and probiotics therapy have on health maintenance and disease mitigation?
The methods and measures of a response for industry, federal regulation, domestic and international public health, federal and academic research, and the private healthcare sector will also be considered.
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