Thank you, Dr. Khabbaz.
It's a pleasure to join everyone,
if only virtually,
for the start of Vector Week 2022.
I understand you will be discussing
some pretty ambitious goals for reducing illness and death ….
and talking about how you will work to address vector-borne diseases
in a whole new way.
This is a very exciting time.
It seems almost a lifetime ago that I was introduced to vector-borne diseases.
I vividly recall my first exposure to a case of ehrlichia
in the mid-90s as an intern in Baltimore.
There was a young woman … a marathon runner, who was encephalopathic
and incapacitated in the ICU with liver function
abnormalities, low platelets, and an unknown diagnosis.
Without a standard laboratory test for ehrlichia at hand,
we went to the research labs in search of a diagnosis, and ultimately got one.
By the time I started my infectious disease training in Boston,
I had seen that one case of ehrlichia and a handful of cases of Lyme …
but I was soon to be introduced to an enormity of Lyme disease
each summer … generally June through September.
As our climate changed, Lyme disease gradually became something
a Boston doctor had to deal with year ‘round,
along with babesia, anaplasma, and tularemia.
Indeed we sometimes say vector-borne diseases
have become the “bread and butter” of infectious disease practice
in Massachusetts and we would not infrequently see
Lyme, anaplasma, and babesia in the same patient.
The impact of climate and weather and health
on vector-borne diseases is tremendous with ticks
and tickborne diseases spreading into new geographic regions.
For example, West Nile virus first appeared in New York in 1999
and in five years, it had marched across to California.
Now West Nile virus is the leading cause
of mosquito-borne illness in the United States.
In 2021, the West Nile virus outbreak in
Maricopa County, Arizona was the largest local outbreak
since the virus was first detected in 1999.
Last summer’s outbreak was responsible for almost twice
the number of West Nile virus neuroinvasive disease cases
than the next largest localized outbreak in the United States.
In 2019, Nebraska state health officials identified
established populations of the blacklegged tick in several counties.
And in 2021, the first cases of locally
acquired Lyme disease were reported there.
Mild winters, fewer days of frost, early springs, and warmer temperatures
are giving mosquitoes and ticks more time to reproduce, to expand their habitats
throughout the United States, and to spread diseases.
The geographic and seasonal distribution of mosquitoes and ticks and the pathogens
they can transmit depend not only on climate, but also on land use,
socioeconomic and cultural factors, pest control, access to health
care, and human responses to disease risk among other factors.
As with all health crises, everyone is not equally at risk.
We have seen that after extreme weather events, socioeconomically disadvantaged
and marginalized populations sustain disproportionate
harm and loss, making this an issue of health equity.
Certain tribal communities in Arizona
are disproportionately impacted by Rocky Mountain spotted fever.
In fact, the three most highly impacted tribal communities in Arizona
have incidence rates of spotted fever rickettsiosis … including Rocky
Mountain spotted fever … 150 times higher than the national average.
More than 500 cases … including 28 deaths …
have been reported between 2003 and 2021.
Since 2018, CDC has
dramatically increased its efforts to support capacity
building for tribal communities
through extramural funds to purchase equipment and train staff
in vector control and animal control and to adapt Rocky Mountain
Spotted Fever prevention activities based on local needs and resources.
Working together with tribal communities, our goal is to reduce
Rocky Mountain spotted fever infections on Arizona tribal lands
to less than 10 per year by 2024.
This work is possible through a strong collaboration
with tribal, state, federal, and non-profit partners,
including CDC Foundation and PetSmart Charities.
Entomologists play an important role in characterizing vector-borne disease
risks within communities and in developing and implementing
prevention programs along with state and local health departments.
However, the field currently lacks diversity
and recently the National Science Foundation found just over two
percent of graduate students in entomology and parasitology are Black
and just under five percent are Latino or Hispanic.
This lack of diversity limits the ability of the field
to address issues of racial and cultural barriers.
Recognizing that entomologists have an important role in addressing
racial and cultural barriers, CDC and the Entomological Society of America
partnered to establish the Public Health Entomology for All fellowship…
a five-year program
to expand the diversity of those working in public health entomology.
Passage of the Kay Hagan Tick Act in December 2019 …
named in honor of Senator Kay Hagan who passed away in October 2019
from complications of the tickborne Powassan virus … was a major milestone
in supporting research and program activities for the prevention, diagnosis,
and treatment of vector-borne diseases … and tickborne diseases in particular.
The Act authorized increased support for CDC’s Epidemiology and Laboratory
Capacity cooperative agreement … or ELC … of which many of you are recipients.
In 2021, ELC awarded approximately 16 million dollars
to 63 recipients to continue work on vector-borne diseases
in health departments around the United States.
The Act provided ongoing support for the university-based
vector-borne disease Centers of Excellence program
originally established in 2017 with Zika supplemental funding.
Since 2017, those of you in the Centers of Excellence have:
· Trained over 5,300 vector control professionals and students
· Developed undergraduate and graduate degree programs
or certificates in public health entomology at all five centers
· Spearheaded creation of regional vector surveillance systems for centralized data tracking
· Evaluated effectiveness of innovative mosquito and tick control methods
· Provided resources and technical assistance
to local organizations ·And contributed more than 230
vector-borne disease-related publications to the literature.
The Act also directed HHS to continue development of a national strategy
for vector-borne disease prevention and control in humans,
an extension of the National Framework for the Prevention and Control
of Vector-Borne Diseases in Humans. Development of the original framework
was led by CDC in collaboration with the departments of Defense
and of the Interior, USDA, and the Environmental Protection Agency.
Through the Act, work to develop a full national strategy was authorized
to be completed in 2023 and federal participation has expanded
to involve six federal departments and 17 agencies. I look forward to reviewing
and supporting the implementation of this important cross-departmental plan.
I am excited to be learning about vector-borne disease advances
on the horizon. Until just last year, no vaccines were available to prevent
vector-borne diseases in the United States. On June 24, 2021,
ACIP voted unanimously to recommend
the first FDA-approved dengue vaccine
… Dengvaxia… for children nine to 16 years old
who have laboratory-confirmed previous dengue virus infection
and are living in dengue-endemic areas … the United States
territories of American Samoa, Puerto Rico, and the U.S.
Virgin Islands,
and freely associated states, including the Federated States of Micronesia,
the Republic of Marshall Islands, and the Republic of Palau.
Dengvaxia works against all four types of dengue
virus and protects people from hospitalization and severe dengue.
Our Division of Vector-Borne Diseases is currently working
hand-in-hand with the Puerto Rico Department of Health
to develop and implement a dengue vaccine program projected to prevent
thousands of dengue-related pediatric hospitalizations.
A second dengue vaccine candidate, originally developed by staff
in the Division of Vector-Borne Diseases, is in phase three clinical trials.
And in the coming years, several additional arboviral disease
vaccine candidates in various stages of development may offer us
a greater opportunity to decrease morbidity and mortality from diseases
including Lyme, dengue, West Nile, chikungunya, and Zika.
An estimated 476,000 people are diagnosed
with and treated for Lyme disease in the United States each year.
A new vaccine against Lyme disease is being evaluated for those ages
five and up and is now undergoing phase two clinical trials in Europe
and the United States, with availability projected for 2025.
To prepare for this new vaccine, CDC is conducting research on disease burden,
vaccine acceptability, and public health and economic impact.
This Lyme disease vaccine is especially important as we see
Lyme disease diagnoses in new geographic areas. Just as new vaccines offer us hope
for controlling vector-borne diseases, so do advances in mosquito control.
More than 75 years ago, CDC was established
as the agency for Malaria Control in War Areas … created
to keep the Southeastern states malaria-free during World War II.
Mosquitoes are still a scourge across the nation,
but new non-insecticide sterile insect techniques … such as mosquitoes
with Wolbachia,
genetically modified mosquitoes, and irradiated mosquitoes … use promising
new technologies for our mosquito-borne disease prevention and control toolbox.
Since January 2021, we have worked
closely with partners in Puerto Rico to develop strong community
support to release mosquitoes with Wolbachia in four neighborhoods.
As a result, the mosquito population there has been reduced by 50 percent.
CDC is monitoring the impact this technology will have on dengue
transmission. We are also working with other states, other countries,
and international partners on the feasibility
of implementing and assessing the impact of these non-insecticide
sterile insect techniques on local arboviral disease transmission.
As I said, this is an exciting time to be working in this field …
envisioning a future where vector-borne diseases no longer threaten
public health. Despite the challenges of balancing public
health priorities during the pandemic, significant progress positions us
well to advance our public health protection goals in the coming years.
I look forward to hearing all you will accomplish.