Infectious diseases in 2020: 5 areas of concern

This transcript has been edited for clarity.

Hi. I’m Paul Auwaerter with Medscape Infectious Diseases. 2019 has closed and we moved to 2020. There have been many important and exciting areas of progress [in infectious diseases] but also areas of concern. As a doctor who treats patients, I think about these concerns quite frequently. I also wear a public health hat, as many people with infectious diseases usually do, and there are also concerns in those areas.

High cost of HIV treatment

A year ago, the President of the United States launched an initiative to try to eliminate HIV, which is exciting. Now that the therapy has improved, many of our patients only need a single pill. However, this initiative, as for hepatitis C, whose treatment has become relatively easy and straightforward, has problems, such as cost. Other issues include government support and funding initiatives, and the search for patients who transmit diseases and are not in therapy.

Mathematical models suggest that everything is very possible. From a cost-benefit base, it would probably benefit our country. However, with real taxes and costs always at the forefront, health infrastructure for public health and people generally goes to the background, unfortunately. I hope that such efforts continue.

Antimicrobial resistance

Antimicrobial resistance concerns many of us, as well as our patients. We are finding more and more resistant pathogens, and the World Health Organization has described this as one of the main threats to health. With the support of the government, BARDA (Advanced Biomedical Research and Development Authority) and other agencies have helped a number of smaller companies with basic research and development to bring new drugs to market, including cefiderocol, plazomycin, imipenem-relebactam and many others.

The concept of bringing multiple medications to the market seemed quite bleak 5-10 years ago, but now it is a reality. The problem has been that nobody in the pharmaceutical industry considers these drugs to be profitable. We tend to restrict drugs appropriately as part of the administration, but we have not found an appropriate model.

The European Union and other countries are concerned about these initiatives. How to help solve this has remained a very difficult issue, since politicians are not willing to see that helping pharmaceutical companies is acceptable. Trying to discover how to move forward and have effective medications that we can really buy and use, that are approved and maintained by the FDA in the market, is still very difficult and worrisome.

Vaccinating vaccinations

Vaccination hesitation is a growing concern. American Samoa, where there has been a large measles outbreak in 2019, is an area outside the United States where not having sufficient immunization coverage is a major concern. I don’t think this is going to disappear.

As our society becomes more technologically skilled with increasing amounts of facts and difficulties, I believe that many people try to carry out control by saying no. This is almost like a chronic health model in which patients with chronic diseases discover that they can get some sense of control by saying no and underestimating health risks instead of dealing with fears or unknowns. This will require continued efforts, and it is important that vaccine initiatives are not abandoned due to this growing concern.

A real positive last year has been the success of the Ebola vaccine in Congo, which was recently approved by the FDA, along with Ebola medications that have also proven effective. These are tremendous improvements. I believe that vaccines remain an effective and low-cost way on many fronts, hoping that improved influenza vaccines are at the forefront.

Immunization practices

The following area involves some interesting changes in immunization practices. For the first time, a vaccine, the pneumococcal conjugate vaccine for adults at average risk of 65 years or more, has been withdrawn. It is now a shared decision model about whether it is administered after the pneumococcal vaccine. That is not something we have faced before.

There is controversy about this, mainly due to the success of the reduction of pneumococcal disease in children, which were probably a major component of transmission of strains to older adults.

I think that if people will continue to administer the vaccine on a routine basis it has not yet been fully developed. The cost-benefit analysis seems to be deficient in most cases. Personally, I have stopped recommending it to most patients after the pneumococcal vaccine.


There have been some interesting developments in influenza with adjuvant vaccines and higher doses for populations 65 years of age or older. Working at new angles to improve immunization should be well funded, since this is a disease that affects more people per year than any other, and the strategies could have such a high reward.

A new anti-influenza drug, baloxavir, is a cap-dependent endonuclease inhibitor that works early in the viral life cycle. It is likely that most patients benefit from very early administration, but be vigilant. Over the next year, we can learn more from the combined studies where that medication or similar medications are combined with neuraminidase inhibitors to see if they are more effective in our treatment of patients who are very sick with influenza.

Thank you very much for listening. I wish you all the best for 2020. I am eager for new and exciting developments, which are the reasons why I find this field so important and very attractive. I hope our younger students continue to find this interesting. Thank you.

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