Protect the "soft underbelly" of the U.S.

Our Expert Voices conversation on pandemics.

It's no coincidence that America's last two pandemic threats — Ebola in 2014 and Zika in 2016 — struck Texas and Florida. I've previously called the Gulf Coast region (Texas, Louisiana, Mississippi, Alabama and Florida) America's "soft underbelly" when it comes to emerging infectious and tropical diseases. Here's why:

• Gulf Coast urban centers are major gateways for people.
• Insects such as the Aedes aegypti mosquito (that transmit Zika, dengue, yellow fever among other viruses), kissing bugs (Chagas disease), and others are widespread across the southern U.S.
• The region is especially susceptible to the effects of climate change.
• The Gulf Coast has the highest concentration of poverty in the U.S. Presumably due to poor housing and waste disposal, poverty is a leading social determinant of infectious and tropical diseases.

Bottom line: There is an urgent need to strengthen the health systems of the U.S. Gulf Coast states, particularly in active surveillance and disease detection activities, while doing a better job reaching region's poorest inhabitants to promote access to health services, and essential diagnostics, medicines, and vaccines.

Other voices in the conversation:

• Anne Rimoin, epidemiologist, UCLA: We need to study outbreaks in real-time
• Jason Cone, USA executive director, Doctors Without Borders/Médecins Sans Frontières': Governments play the greatest role in protecting people
• Ali Khan, public health expert and dean, College of Public Health, University of Nebraska Medical Center: Pandemics are as dangerous as war