3. The Global Threat of Infectious Diseases Background 20 th Century Re-Emergence of Infectious Diseases - Newly recognized diseases - Known diseases - Geographic spread - Increased epidemic activity 26% of Global Mortality – 2003

4. Fauci, NIAID/NIH 2005 Dengue H5N1AI Chikungunya Dengue

5. The Global Threat of Infectious Diseases Global Public Health Emergencies, 1994-2005 Plague, India/Global, 1994 Influenza, Hong Kong, 1997 Nipah Encephalitis, Malaysia/Regional, 1999 SARS, China/Hong Kong/Global, 2003 Avian Influenza, Southeast Asia/Global, 2004/2006

6. AISA-PACIFIC INSTITUTE OF TROPICAL MEDICINE AND INFECTIOUS DISEASES Global Public Health Emergencies Hawaii in Ideal Position to Develop a Center of Excellence – Geography – Cultural & Economic Ties – Training – East-West Center – Other partners Rationale

7. Basic Science Departments Clinical Departments Dean John A. Burns School of Medicine Pacific Center for Emerging Infectious Diseases Research Asia-Pacific Institute of Tropical Medicine and Infectious Diseases Asia-Pacific Institute of Tropical Medicine and Infectious Diseases Organizational Structure Asia-Pacific Center for Translational Research Asia-Pacific Center for Infectious Disease Ecology Research Asia-Pacific Center for Biosecurity and Conflict Research Pacific Center for AIDS Research Asia-Pacific Center for Public Health and Population Research

8. Mission To develop a global center of excellence in Hawaii for emerging and re-emerging infectious diseases Emphasis will be placed on infectious diseases of the Asia-Pacific Region, and on developing trans-disciplinary research and development programs that will result in new diagnostics, drugs, vaccines and other treatment and prevention modalities. Asia-Pacific Institute of Tropical Medicine and Infectious Diseases

9. ASIA-PACIFIC INSTITUTE OF TROPICAL MEDICINE AND INFECTIOUS DISEASES Develop a balanced trans-disciplinary research and training program that focuses on basic, field and translational research. Develop a laboratory reference and research center Develop local and international partnerships. To build laboratory and epidemiologic capacity, and research collaborations in selected countries of Asia where diseases with epidemic potential commonly occur. Develop a graduate program that will attract highly motivated, research-oriented doctoral candidates. Goals

10. ASIA-PACIFIC INSTITUTE OF TROPICAL MEDICINE AND INFECTIOUS DISEASES Disease Priorities Zoonotic viruses Influenza Dengue/dengue hemorrhagic fever West Nile fever HIV/AIDS Malaria Leptospirosis

11. Asia-Pacific Institute of Tropical Medicine and Infectious Diseases Laboratory Capacity –Biocontainment (BSL-2, BSL-3, ABSL-3) –Basic research –Diagnostics –Pathogenesis Epidemiology Bioinformatics Pathogens –Emerging infectious diseases –Viruses, parasites, bacteria, zoonoses Scientific Capability

12. Asia-Pacific Institute of Tropical Medicine and Infectious Diseases Progress Partnerships/Collaboration

13. Hawaii ’ s PRETREAT Alliance Preventing, Responding, and Treating Emerging Asia-Pacific Disease Threats Hawaii’s Global Solution for Emerging Infectious Disease Threats

14. Hawaii Biotech Vaccines and drugs Product Development FDA approvals DOD Surveillance Emergency response Clinical Research Clinical trials MHPCC NIH PacRBL PSWRCE COBRE RCMI? CDC? International surveillance response UH/JABSOM/ APITMID Center of excellence Basic & applied research Pathogen discovery Surveillance Epidemiology Asian field sites Training Hawaii Pacific Health Queen’s Hospital Clinical Research Clinical trials Treatment PRETREAT Participants and Their Capabilities Hawaii DOH Surveillance Emergency response East West Center Demography Geography Climate Change

15. PRETREAT Components Prevention and treatment –Early warning surveillance –Diagnostics –Drug and vaccine research –Preclinical development, GLP animal testing –GMP manufacturing –Clinical research –FDA approved products

16. PRETREAT Components Asian field sites –Research, clinical & vaccine trials Pathogen discovery –Surveillance, field epidemiology, “pathogens of tomorrow” Biocontainment laboratories –Fixed, mobile Basic research Training Asia-Pacific Institute of Tropical Medicine and Infectious Diseases

17. International Partnerships WHO Viet Nam Thailand Singapore Indonesia Others

18. Asia-Pacific Institute of Tropical Medicine and Infectious Diseases Progress - Funding State of Hawaii University of Hawaii NIH DOD

19. Microbial Threats to Health Case in Point: SARS

20. Global SARS Cases (Probable) WHO 26 September 2003 CountryCasesDeathsCase fatality Canada2514315.3%15.3% China53273496.5%6.5% Hong Kong175529916.9%16.9% Singapore2383315.5%15.5% Taiwan3463712.5% Thailand9222%22% U.S.7500% Vietnam6357.9% Other8156.2% Total80987749.6%

21. Dengue Hemorrhagic Fever Social Impact

22. DEN-1 DEN-2 Global Distribution of Dengue Virus Serotypes, 1970

23. Global Distribution of Dengue Virus Serotypes, 2006 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-3 DEN-4

24. Dengue/dengue hemorrhagic fever, average annual number of cases reported to WHO, 1955-2005 Number of Cases

26. Source: WHO Humans & Birds Birds Humans Wave III: Dec 04 - Present

27. Source: WHO Humans & Birds Birds Humans Wave III: Dec 04 - Present

28. New York City

29. Aedes aegypti

30. Aedes aegypti Distribution in the Americas

31. POTENTIAL GLOBAL SPREAD OF URBAN YELLOW FEVER

32. West Nile Virus in the Western Hemisphere

33. Epidemic West Nile Virus in the United States, 1999-2005 * Reported as of 1/13/2006

34. Epidemic/Epizootic West Nile Virus 1937 1950-75 1994 - 2005

35. Factors Responsible for Increased Epidemic Infectious Diseases Complacency, Lack of Political Will Policy Changes Changes in Public Health Demographic Changes - Population growth - Urbanization - Agricultural/Land Use Practices - Animal Husbandry Modern Transportation - Increased Movement of People, Animals, Commodities Changing Life Styles/Behavior Microbial Adaptation Technology Intent to Harm Climate Change?

37. Zoonotic Diseases: Hitching a Ride? Modern Transportation

39. Asia-Pacific Institute of Tropical Medicine and Infectious Diseases Hawaii and the US mainland are highly vulnerable to the importation of exotic pathogens, and at high risk for epidemic disease. Demographic and cultural factors, along with economic growth and globalization will insure that the Asian region will be important in producing future epidemic disease. A center of excellence for research on emerging infectious diseases of Asia and the Pacific in Hawaii will be highly beneficial to the global efforts to detect, respond and control epidemic disease.

40. Pacific Regional Biosafety Laboratory at Kaka’ako