CONTROL OF EXTENSIVELY DRUG-RESISTANT TUBERCULOSIS
The threat of global infectious agents has the potential to cripple national and global economies, as the outbreaks of SARS, Avian Flu, H1N1, and Extensively Drug-Resistant Tuberculosis (XDR-TB) have demonstrated. XDR-TB can be transmitted by air to others in close proximity and is highly fatal. In May 2007, the United States government isolated an individual under Centers for Disease Control and Prevention (CDC) auspices for the first time since 1963 (when it quarantined a patient with smallpox). The 2007 patient was Andrew Speaker, from Atlanta, Georgia, who was thought to have extensively drug-resistant tuberculosis (XDR-TB). The case (hereafter called the “Speaker case”) was complicated by Speaker's extensive travels, including two trans-Atlantic flights, some five flights within Europe, and at least one cross-national car ride – an itinerary that originated in the United States and included France, Greece, Italy, the Czech Republic, and Canada before ending back in the U.S. The Speaker case raises questions about the appropriate roles for international, federal, state, and local governments, along with health care personnel and individuals themselves, in addressing global infectious agents. We analyzed the Speaker case by employing Root Cause Analysis (RCA) methodology, which has been used in a variety of situations, ranging from accident and failure analysis to operations and systems analysis. We concluded that future investments in minimizing the risks of global threats should be focused more locally, closer to the source to obviate delayed responses to diseases that facilitate their spread. The current focus on the global public health system of laws and governance is important and necessary, but it is not sufficient for the control of emerging global health threats.
