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November, 2003 Vol. 28 No. 3
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Duane J. Gubler of the CDC's Division of Vector-Borne Infectious Diseases.

Duane J. Gubler of the CDC's Division of Vector-Borne Infectious Diseases.

The Asia-Pacific Health Threat

UH is becoming a major research and training center in tropical medicine and emerging infectious diseases

by Kristen Cabral

TB. HIV/AIDS. SARS. CDC. WHO. UH. There's a connection within this alphabet soup. Tuberculosis, human immunodeficiency virus/acquired immune deficiency syndrome and severe acute respiratory syndrome represent some of the most serious of the historical and emerging infectious diseases that, combined, constitute what public health officials call today's most important worldwide health problem. And the Centers for Disease Control and Prevention, World Health Organization and University of Hawai'i are the old and new resources for addressing this global crisis.

Over the past two decades, the world has seen the emergence or return of more than 30 infectious diseases, including AIDS, Ebola and measles. A cholera outbreak struck Liberia, and malaria is a more serious threat than warfare to U.S. troops in that country. Monkeypox and West Nile virus have made their way from Africa to the United States. SARS spread from Asia to Canada. And in Hawai'i, dengue fever has appeared on Maui, Kaua'i and O'ahu.

Why here?

When it comes to infectious diseases, developing countries are the most ravaged, and many recent outbreaks are traced to Asia. Hawai'i's proximity makes it ideally situated to become the central command station for the Asia-Pacific region in the fight against these once-forgotten and frightening new diseases.

The University of Hawai'i is already a player through its alumni, including Jong Wook Lee, director-general of the World Health Organization. Another alumnus, international authority on vector-borne infectious diseases Duane J. Gubler (MS '65 Manoa), has been recruited to head the proposed Asia-Pacific Institute of Tropical Medicine and Infectious Disease. Gubler is director of the Colorado-based Division of Vector-Borne Infectious Diseases, part of the CDC's National Center for Infectious Diseases.

The UH institute will be part of the John A. Burns School of Medicine. "It will be made up of a consortium of new and existing programs, both within and outside the university, operating under the umbrella of the medical school," says Gubler. He envisions an institute headquartered at UH Manoa's Kaka'ako biomedical campus with Asia and Pacific field sites where UH faculty, students and partners from other institutions can conduct basic laboratory, field epidemiology, clinical and biobehavioral research.

"A strong graduate program in tropical infectious diseases is a major goal," Gubler says. "It is critical to train the next generation of tropical infectious disease experts in new medical technologies to facilitate development of surveillance, prevention and control programs in tropical developing countries where many of the recent disease epidemics have begun."

Development of laboratory and field research programs and graduate programs will require time and strategic recruiting, but Gubler expects the core institute to become a reality early next year. It will be a collaborative effort drawing on strengths and multidisciplinary expertise already available within UH's medical school, Pacific Biomedical Research Center and Cancer Research Center, as well as the Hawai'i State Department of Health.

The effort has been awarded a five-year $1.5-million-per-year grant from the National Institutes of Health to establish a Pacific Center for Emerging Infectious Diseases Research. The center, one of three within the institute, will focus on the molecular epidemiology and the origin and development of infectious diseases that are of local and regional importance and that disproportionately affect under-served ethnic minorities and disadvantaged communities in Hawai'i and the Asia Pacific region. Richard Yanagihara, medicine professor and researcher with years of experience in infectious disease field research in the Asia Pacific region, will lead the center. Yanagihara has already compiled a team of faculty, researchers and junior investigators who are pursuing innovative studies here.

The other two centers are the Pacific Center for Biodefense Research and the Pacific Rim Vaccine and Gene Therapy Research Center. Faculty efforts already underway include AIDS investigations and vaccine development for the prevention of malaria and dengue fever, as well as collaborations with the state Department of Health on bioterrorism preparedness.

"This institute will galvanize UH Manoa's position as a center of excellence for research and training in infectious diseases and as a regional reference center for the diagnosis and control of new, emerging and re-emerging microbial threats," Yanagihara says.

Why now?

Public health officials aren't sure why there has been such a dramatic global resurgence of infectious diseases over the past two decades.

"It is clear that many demographic and societal changes that occurred in the last half of the 20th century have played a major role," says Gubler, ticking off a list: "Unprecedented human population growth since World War II; human migrations, primarily to the urban centers of developing countries; the promiscuous use of antibiotics, which has led to widespread antibiotic resistance. . ."

What is clear is that there are many complex and contributing factors to the current outbreak of infectious diseases. "A new paradigm is required by international health agencies if we hope to reverse this trend in the next decade, he continues. UH, he says, can be a crucial component of this new paradigm.

Kristen Cabral is a public information officer in External Affairs and University Relations' Public Relations Office.