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A physician prepares a measles vaccine. Photo: Daniel Mihailescu/AFP via Getty Images

A changing picture has emerged of the U.S.' susceptibility to epidemics of infectious diseases over the next decade — driven by organized anti-vaccine activity and the lack of incentives to develop new or more effective vaccines, along with inadequate mosquito control measures.

The big picture: Reducing the risk of new epidemics will require expanding the use of existing vaccines, especially for measles and seasonal influenza, as well as introducing new vaccines for any vector-borne or zoonotic diseases that emerge.

The main infectious disease epidemics to look out for:

  1. Measles: More than 40,000 measles cases occurred in Europe in the first half of 2018. With regular travel between North America and Europe, it's possible that on any given week measles cases are being imported into the U.S. Several western states with strong anti-vaccine movements —including Washington, Oregon, Idaho and Texas — are highly vulnerable to outbreaks because of low vaccine coverage, in some cases well below the 90%–95% immunization rates needed to achieve adequate herd immunity for measles.
  2. Seasonal influenza: Influenza is one of the most fatal infectious diseases in the U.S., especially among the very old and very young. Most of the 180 American children who perished in the 2018 flu epidemic were not vaccinated, despite strong recommendations from public health officials. (An anti-vaccine lobby may have promoted misleading information about both flu and the flu vaccine.) Flu is now being reported in the Southern Hemisphere this summer and will return to North America this winter. Given that influenza kills up to 50,000 Americans every winter, flu vaccinations, especially for children, are paramount.
  3. Vector-borne diseases: Diseases from infected ticks (e.g., Lyme disease), mosquitoes (e.g., West Nile, dengue and Zika), and fleas (e.g., typhus) have tripled over the past 13 years. Nine new disease pathogens spread by mosquitoes or ticks have also been either newly discovered or introduced into the U.S. over this period. A yellow fever epidemic in Brazil could emerge in U.S. Gulf Coast states where the Aedes aegypti mosquito — the most efficient mosquito vector — is found. There is probably a need for vaccines to prevent Lyme Disease, West Nile virus and Chagas disease — among others — but they are not being developed because of perceived market inadequacy. Also, as the recent HPV vaccine has shown, it’s increasingly difficult to introduce new vaccines in the U.S.

Peter Hotez is a professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine, where he is also Dean of the National School of Tropical Medicine.

Go deeper

37 mins ago - Health

CDC director says COVID-19 messaging should have been clearer

Rochelle Walensky. Photo: Stefani Reynolds-Pool/Getty Images

Rochelle Walensky, director of the Centers for Disease Control and Prevention, said in an interview with the Wall Street Journal that the messaging around the COVID-19 pandemic and changing guidance should have been clearer.

State of play: Walensky is being coached by media experts and is planning to have more press briefings by herself in order to ensure that CDC is seen as an independent, scientific entity, rather than as a political one, the Journal reports.

55 mins ago - World

UAE asks U.S. to reinstate Houthi terrorist designation after attack

Secretary of State Tony Blinken (left) listens to United Arab Emirates Foreign Minister Sheikh Abdullah bin Zayed al-Nahyan during a joint news conference at the State Department iin October. Photo: Andrew Harnik/Pool/AFP via Getty Images

Emirati Foreign Minister Abdullah Bin Zayed asked Secretary of State Tony Blinken in a phone call Monday to re-designate the Houthi rebels in Yemen as a terrorist organization, a senior Emirati official told Axios.

Why it matters: Less than a month after he assumed office, President Biden rolled back the Trump administration’s decision to make the designation. He said it hampered humanitarian assistance to the Yemeni people. Since then, the Houthis have escalated their attacks against Saudi Arabia and other countries in the region — including an attack Monday in Abu Dhabi.

Updated 1 hour ago - Economy & Business

World Bank: Gap between rich and poor countries is widening

Illustration: Sarah Grillo/Axios

For the last two decades, incomes in poorer countries were catching up to rich countries. The pandemic economy of the 2020s may reverse the trend, the World Bank warns in a new report.

Why it matters: Falling inequality between countries has been one of the most positive trends of the 21st century. If it reverses, it implies more human suffering and geopolitical instability.