What does it take to control an epidemic? Learning from Thailand's experience

Earlier this summer, the HIV/AIDS effort achieved a notable accomplishment that the rest of the public health community may have overlooked, missing an important learning opportunity. In June, the World Health Organization certified that Thailand achieved what was inconceivable just 20 years ago: elimination of mother-to-child transmission of HIV.Thailand is the first country with a generalized HIV epidemic to achieve this milestone, one that is crucial to epidemic control.

Two decades ago, the HIV epidemic was expanding in Thailand. Use of antiretroviral drugs to prevent mother-to-child HIV transmission was an expensive, newly discovered intervention that had barely been implemented in areas of the world where resources were limited and the disease burden was greatest.

Despite these challenges, only 85 children were born with HIV infection in Thailand in 2015, compared to 1,000 children in 2000. This remarkable achievement resulted from a combination of essential factors:
  • Strong national leadership
  • A solid, functional health care system
  • A commitment to extending health care services to all people in the country, including undocumented individuals

What can Thailand's success teach us?

The foundation of Thailand's HIV success story is a decades-long commitment to disease control, a model that other countries can assess and adapt to other global infectious disease threats. Key elements of this successful model include:
  • Development of a health care system with broad national reach to include people at all socioeconomic levels
  • Investments in laboratories and surveillance systems
  • Training of public health officials in epidemiology
  • Support for collaborative research
  • A commitment to affordable universal health coverage for all, including documented and undocumented migrant workers

These elements have helped Thailand effectively control other recent emerging health threats, such as SARS (severe acute respiratory syndrome), avian and H1N1 influenza, multidrug-resistant tuberculosis, border health and noncommunicable diseases. And now, Thailand is redirecting its HIV control efforts to focus on marginalized key populations , including men who have sex with men, transgender individuals, sex workers and people who inject drugs.

A proactive response to epidemics is possible

The global response to emerging infectious disease threats, including Ebola virus and Zika virus, is largely reactive and usually depends on external, international organizations and funding. West Africa was unprepared to respond to the outbreak of Ebola virus, because even the most fundamental elements of a health care system were inadequate in that region. The steps that the international community took to respond to this outbreak were extraordinary.

We can and must do more to respond proactively

The Global Health Security Agenda is a partnership of more than 50 nations, international organizations and nongovernmental stakeholders whose goal is to build countries' capacity to create a world safe from infectious disease threats. Countries and global health leaders are adapting the agenda at a record pace to strengthen the health systems in many resource-constrained countries to prevent and control emerging pandemic threats. World leaders must sustain this effort, because it will require decades (not just years) of commitment and investment, as we saw in Thailand.

And while global cooperation and coordination are essential, the importance of public health leadership at the national and local levels cannot be overstated. National and local governments should be encouraged to turn the sense of urgency that comes with public health crises into solid action: They must build health systems that reflect the lessons learned from Thailand's example of what it takes to control epidemics.